Moral Injury

Understanding Moral Injury and Moral Trauma

According to a 2025 study, nearly 6% of more than 3,000 veterans surveyed screened positive for moral injury. Comparatively, the overall lifetime prevalence of post-traumatic stress disorder (PTSD) among veterans is 7%, with the rate for post-9/11 veterans reaching nearly 30%, according to the Department of Veterans Affairs. But much less is understood about moral injury, and when left unaddressed, the results can be devastating. In the sections that follow, we define moral injury, review treatment options and offer resources.

What is moral injury?

Inspired by Homer’s “Iliad,” a psychiatrist first coined the term “moral injury”—sometimes referred to as “moral trauma”—in 1994 as a way to describe what Vietnam veterans experienced during combat. It’s now generally understood as the result of witnessing, experiencing or perpetrating something that violates a person’s sense of right and wrong. When that violation negatively affects how a person views themself or the world and impairs how they function, it can be considered a moral injury.

In September 2025, the American Psychiatric Association updated its Diagnostic and Statistical Manual of Mental Disorders to include moral problems, including moral injury. The manual update defined moral problems as experiences that disrupt one’s understanding of right and wrong or sense of goodness of oneself, others or institutions. This inclusion could lead to better understanding and help guide clinicians, but it doesn’t create a clinical diagnosis code for moral injury. Instead, it’s included under “other conditions that may be a focus on clinical attention.”

PTSD and moral injury

It’s essential to distinguish moral injury from PTSD. PTSD often stems from life-threatening danger, while moral injury stems from exposure to acts that violate one’s moral code and is more commonly associated with experiences of guilt or shame, according to the VA. Experts agree there’s overlap between moral injury and PTSD, but PTSD diagnosis and treatment don’t necessarily account for an injury to someone’s values and identity.

Examples of moral injury

Many potentially morally injurious events (PMIEs) can result in moral injury. In military settings, it can result from participating in acts of violence, witnessing the suffering of innocent civilians or being compelled to make morally difficult decisions. Other examples include experiencing a sense of betrayal by leadership or having to stay silent in the face of injustice.

In nonmilitary contexts, moral injury can occur in professions such as health care, law enforcement or journalism, where individuals may encounter situations that challenge their moral integrity.

Signs and symptoms of moral injury

Moral injury can manifest in various ways, affecting a person’s behavior, psychological well-being and even physical health. It can result in feelings of shame, guilt, apathy and unworthiness and can cause a person to isolate. The Moral Injury and Distress Scale is a self-report measure that assesses exposure to potentially morally injurious events and the possible impacts of moral injury.

Moral injury and suicide

Limited research shows that moral injury is an independent risk factor for suicide, with one study reporting that of the surveyed veterans, health care workers and first responders who screened positive for moral injury, over 60% reported suicidal ideation and over 40% said they had attempted suicide in their lifetime.

Treatment for moral injury

According to the VA, “interventions to address moral injury are in their infancy,” but experts agree that a multidisciplinary and personalized approach is necessary. Limited evidence indicates that some PTSD treatments, including cognitive processing therapy, can be effective for guilt and shame, which can be components of moral injury. However, it’s unclear how much these treatment address the other core features of moral injury.

Interventions that focus specifically on moral injury include trauma-informed guilt reduction therapy, acceptance and commitment therapy, adaptive disclosure, and impact of killing, according to the VA. The VA also leads interventions that include clinicians and chaplains.

One approach to healing involves examining negative beliefs resulting from the moral injury and rewriting those beliefs. For example, for someone who has harmed others and is grappling with guilt or shame, healing can include reestablishing their value in their community, like by serving others. For someone who has been victimized by or witnessed harm, making room for others to show their goodness can help change their negative beliefs about humanity.