The self-loathing and distrust of others that often follow moral injury can lead to depression and anxiety, occasionally aggression, and, at worst, suicidal thinking. Psychiatrist Jonathan Shay, who developed the concept of moral injury in working with Vietnam veterans for over 20 years, contends that violence and suicide among veterans stem more from a moral injury than from PTSD.
Post-traumatic stress disorder and moral injury often go hand in hand, but there are important differences: PTSD is the result of a life-threatening experience that leads to chronic hypervigilance and fear; it is difficult to ever feel safe. Moral injury involves loss of trust; it is not a disorder but a reasonable response to having one’s ethical compass thrown off track.
Moral injury is not currently included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Scientific consensus has yet to be reached on the parameters of moral injury.