Moral injury, a state of inner conflict and turmoil that often precipitates feelings of shame, guilt, grief, anxiety, anger, and remorse, can often be confused with:
A) Grief
B) PTSD
C) Anxiety
D) Insomnia

Question

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According to Litz et al. (2009), moral injury is a consequence of "perpetrating, failing to prevent, bearing witness to acts that transgress deeply held moral beliefs and expectations" (p. 695). Acts that may precipitate moral injury include incidents causing harm to civilians during war, friendly fire deaths, military sexual assaults, and betrayals by leadership. Moral injury is a "broad clinical concept that exists in the intersection of multiple emotional, cognitive and social pathways" (Farnsworth, Drescher, Nieuwsma, Walser, & Currier, 2014, p. 258). It is a state of inner conflict and turmoil that often precipitates feelings of shame, guilt, grief, anxiety, anger, and remorse. Other reactions include purposelessness and alienation from self and others. Behavioral manifestations of moral injury may include self-harm, social withdrawal, substance abuse, and social instability. Although moral injury and PTSD have some common characteristics, "each has unique components that make them separable consequences of war" (Maguen & Litz, 2012, para. 6). PTSD is emotionally characterized by fear, while moral injury is emotionally characterized by shame. Moral injury can co-occur with depression and substance use disorder, as well as in the absence of active PTSD symptoms (Farnsworth et al., 2014).

Moral Injury, a State of Inner Conflict and Turmoil That