VanderWeele, T. J., Wortham, et al. (2025).
Frontiers in psychology, 16, 1422441.
Abstract
We propose new definitions for moral injury and moral distress, encompassing many prior definitions, but broadening moral injury to more general classes of victims, in addition to perpetrators and witnesses, and broadening moral distress to include settings not involving institutional constraints. We relate these notions of moral distress and moral injury to each other, and locate them on a “moral trauma spectrum” that includes considerations of both persistence and severity. Instances in which moral distress is particularly severe and persistent, and extends beyond cultural and religious norms, might be considered to constitute “moral injury disorder.” We propose a general assessment to evaluate various aspects of this proposed moral trauma spectrum, and one that can be used both within and outside of military contexts, and for perpetrators, witnesses, victims, or more generally.
Here are some thoughts:
This article proposes updated, broader definitions of moral injury and moral distress, expanding moral injury to include victims (not just perpetrators or witnesses) and moral distress to include non-institutional contexts. The authors introduce a unified concept called the “moral trauma spectrum,” which ranges from temporary moral distress to persistent moral injury—and in severe, functionally impairing cases, possibly a “moral injury disorder.” They distinguish moral trauma from PTSD, noting different causes (moral transgressions or worldview disruptions vs. fear-based trauma) and treatment needs. The paper also presents a new assessment tool with definitional and symptom items applicable across military, healthcare, and civilian settings. Finally, it notes the recent inclusion of “Moral Problems” in the DSM-5-TR as a significant step toward clinical recognition.
