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This is the second in a series of posts in May to commemorate Mental Health Awareness Month. Mental Health America’s website at http://www.mentalhealthamerica.net/may   has scores of ideas to help make  people more aware about the importance of good mental health.

With American troops at war for over a decade, clinicians suspect that some veterans are suffering from “moral injuries.” These are wounds caused from having “done something,” or having “failed to stop something” that violates the individual’s moral code.

According to the National Center for PTSD .. http://www.ptsd.va.gov    MHM2014 Mind Your Health HORIZONTAL BANNER for may page-01-01in the context of war, moral injuries may stem from direct participation in acts of combat, such as killing or harming others, or indirect acts, such as witnessing death or dying, failing to prevent immoral acts of others, or giving or receiving orders that are perceived as gross moral violations.

In terms of the aftermath of moral injuries, transgressive acts may result in haunting states of inner conflict and turmoil. Emotional responses may include:

* Shame (e.g. “I am an evil terrible person; I am unforgiveable”);

* Guilt;

* Anxiety about possible consequences; and

* Anger about betrayal-based moral injuries.

Behavioral manifestations of moral injuries may include:

* Alienation (e.g. purposelessness and/or social instability caused by a breakdown in standards and values);

* Withdrawal and self-condemnation;

* Self-harm (e.g. suicidal thoughts or attempts); and

* Alcohol or other drug use.

Although the constructs of post-traumatic stress disorder (PTSD) and moral injury overlap, each has unique components that make them separable consequences of war and other traumatic contexts:

* PTSD is a mental disorder that requires a diagnosis. Moral injury, conversely, is a dimensional problem – there is no threshold for the presence of moral injury. Rather, at a given point in time, a veteran may have none, or mild to extreme manifestations.

* Transgression is not necessary for a PTSD diagnosis nor does the PTSD syndrome sufficiently capture moral injury (shame, guilt, etc).


Consequently, it is important to assess mental health symptoms and moral injury as separate manifestations of war trauma to form a comprehensive clinical picture, and provide the most relevant treatment.

 Additional sources: Shira Maguen, Ph.D. and Brett Litz, Ph.D., U.S. Department of Veterans Affairs. This article should not be construed as a substitute for medical advice, diagnosis or treatment.