The type of trauma you haven't heard of: Moral Injury

When we talk about trauma, most people think of the obvious culprits: abuse, assault, accidents, natural disasters, or combat. But there’s another kind of trauma that’s quieter, more insidious, and often overlooked — yet its impact can be just as deep. It’s called moral injury, and chances are, you or someone you love has experienced it.

What is Moral Injury?

Moral injury isn’t a diagnosis you’ll find in the DSM. It’s not a specific event — it’s a rupture in the soul. It occurs when someone perpetrates, witnesses, or fails to prevent something that violates their deeply held moral beliefs. This could be a soldier ordered to fire on civilians. A healthcare worker forced to make life-or-death decisions due to a lack of resources. A child who has to lie to protect a parent. A therapist who feels powerless after a client dies by suicide.

In these moments, people are left not just with fear or sadness, but with shame, guilt, and an overwhelming sense that something inside them has been broken — not because of what happened to them, but because of what they did or couldn’t stop.

How Moral Injury Differs From PTSD

Post-traumatic stress disorder (PTSD) is often fear-based — rooted in terror, helplessness, or horror. Moral injury, on the other hand, is rooted in moral emotions like guilt, shame, disgust, and betrayal. You might not have nightmares or flashbacks — instead, you’re haunted by questions like: How could I have let that happen? Why didn’t I speak up? What kind of person am I?

The person with PTSD might feel the world is unsafe. The person with moral injury might feel they are unsafe — or unworthy — because of what they’ve done or failed to do.

Many people experience both, and they often overlap, especially in high-stakes professions like military service, medicine, emergency response, or social work. But moral injury doesn’t just affect professionals. It can arise in families, in systems, and in moments when survival required violating one’s own values.

Where Moral Injury Shows Up

• Veterans and military personnel: The term originated in the military to describe the inner conflict of soldiers who participated in or witnessed acts that went against their sense of right and wrong — whether through direct combat or the structure of war itself.
• Healthcare workers: The COVID-19 pandemic made moral injury a household term in hospitals, as providers made impossible decisions about who received care and who didn’t. Many were praised as heroes, but quietly carried enormous guilt for what they couldn't fix.
• First responders: Paramedics, firefighters, and police officers often face scenes where they must act quickly, sometimes with irreversible outcomes. When those actions conflict with their training or instincts, moral injury can take root.
• Therapists and helping professionals: When someone you're working hard to help dies, relapses, or suffers harm — especially in a broken system — the weight of responsibility can become overwhelming, even if logically you know it's not your fault.
• Survivors of abuse: Moral injury can also appear in people who’ve experienced abuse, particularly if they were forced into decisions they didn’t agree with or if they blame themselves for not fighting harder, speaking out sooner, or protecting others.

Signs of Moral Injury

• Persistent guilt or shame
• Difficulty forgiving oneself
• Loss of faith — in humanity, institutions, or spirituality
• Social withdrawal or isolation
• Anger or bitterness, especially toward systems or authority
• Feeling "stained" or like a bad person
• Depression, hopelessness, or thoughts of suicide

Unlike PTSD, which may cause someone to fear others, moral injury makes people fear — and mistrust — themselves.

Healing from Moral Injury

Healing from moral injury is not about erasing the memory or pretending it didn’t happen. It’s about integration — holding the truth of what occurred, acknowledging the harm, and finding a path back to meaning, connection, and self-compassion.

Here are a few ways healing can happen:

• Naming it: Just putting words to the experience — “this is moral injury” — can be deeply validating.
• Therapy: Approaches like trauma-informed care, Internal Family Systems (IFS), EMDR, and narrative therapy can be effective. The goal is not to “undo” the event but to process it in a way that restores dignity and agency.
• Ritual and community: Storytelling circles, moral repair groups, and community acknowledgment can provide space for reflection, accountability, and reconnection — especially when traditional systems fall short.
• Compassion practices: Practices like self-forgiveness, loving-kindness meditation, or even writing a letter to your younger self can begin to soften the harsh inner critic.

You Are Not Broken

If you’ve experienced moral injury, it doesn’t mean you are bad, weak, or irredeemable. In fact, it’s often a sign that your values are deeply held — that you care. Moral injury can feel like it isolates you, but in truth, it’s part of the human experience of grappling with complexity, especially in systems that don’t always allow for ethical clarity.

You are not alone. You are not beyond healing. And your pain deserves compassion, not judgment.

At Caladrius Therapy, we specialize in trauma-informed care that honors the complexity of your story — including the parts you might be afraid to tell. If moral injury is something you or someone you love is navigating, we’re here to help.