Moral injury refers to the repercussions of breaking our moral boundaries or experiencing others doing so. This often happens when we are put in a situation where we cannot uphold our ethical code. Moral injury can result in a loss of faith in ourselves or others and a lasting negative impact on our mental health.1

Example: Don ran away from the scene of a crime out of fear, instead of helping a victim weaker than himself. He later experienced immense guilt, shame and self-hatred. “I thought I was better than that, but I guess I’m not,” he says. The guilt intensifies and leads to suicidal ideation, self-injury and debilitating anxiety from intrusive thoughts. Don also ritually replays the scene in his head, feeling like he does not deserve to forget about it and move on. He feels he does not deserve help for his problems because he considers himself “just as bad as the perpetrator.” He spends most of his days isolated in his apartment and finds it difficult to sleep or focus on anything, including work.

Commonly Affected Populations: 2,3

  • First responders and police
  • Soldiers
  • Health care professionals
  • Other high-stakes occupations
  • People struggling with addiction or poverty

Causes of Moral Injury: 1,4

  • Acts of commission (directly or indirectly causing harm)
  • Acts of omission (allowing harm through inaction or failing to carry out moral action)
  • Acts of betrayal (betrayal by a trusted person or person in power)

Moral injury can emerge if we are the victim, perpetrator or witness to an immoral act, but often, people may overestimate their role or culpability in such events. It is also possible that people assume more than one role, or even all three, if the situation is complex enough. Moral injury prevents victims from seeking help when their survival instincts have driven them to do morally questionable things. A child may struggle to like herself because she was too afraid to protect her sibling from violence or because she broke her promise not to “snitch” on her parents. Prisoners of war may struggle to come to terms with the harm they were forced to inflict on their cellmates. A mother grapples with the consequences of having gambled away her children’s inheritance. Dire circumstances may lead us to go against our morals to avoid pain or protect ourselves.

Symptoms: 1,5

  • Intense guilt, shame or worthlessness
  • Marked distress and intrusive thoughts about the event
  • Inability to love or accept yourself
  • Questioning your spiritual beliefs
  • Rejecting help, opportunities, or love
  • Feeling that you deserve the bad things that happen to you
  • Fear you will be found out or punished
  • Self-punishment as a way to do penance
  • Self-injuring or abusing your body with excessive work, exercise, substances, or food
  • Distancing yourself from others physically or mentally
  • Considering or attempting suicide.

Healing from Moral Injury

Albeit distinct, moral injury is often a large and unique contributor to psychological trauma, propelling self-destructive symptoms and hampering progress.6,7 Because of the associated shame, it can be challenging to bring up what you did in therapy.8 You may fear that the therapist will react poorly or lose respect for you. It might even be difficult to admit to yourself what happened. However, when it is brought out in the open and addressed, clients often experience considerable relief, and their progress in therapy leaps forward.

In cases of moral injury, our skilled team works on helping you move out of shame and into growth by balancing contextualization, forgiveness, reconciliation, and behavioural change.6 Having an accepting and non-judgmental therapist throughout this process allows you to accept your past and find a version of yourself that you can love moving forward.

Sources:

  1. VanderWeele, T. J., Wortham, J. S., Carey, L. B., Case, B. W., Cowden, R. G., Duffee, C., Jackson-Meyer, K., Lu, F., Mattson, S. A., Padgett, R. N., Peteet, J. R., Rutledge, J., Symons, X., & Koenig, H. G. (2025). Moral trauma, moral distress, moral injury, and moral injury disorder: Definitions and assessments. Frontiers in Psychology, 16. https://doi.org/10.3389/fpsyg.2025.1422441
  2. Norman, S. B., & Maguen, S. (2020, April 20). Va.gov: Veterans Affairs. Moral Injury. https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp
  3. Van Denend, J., Harris, J. I., Fuehrlein, B., & Edens, E. L. (2022). Moral injury in the context of Substance Use Disorders: A narrative review. Current Treatment Options in Psychiatry, 9(4), 321–330. https://doi.org/10.1007/s40501-022-00280-4
  4. Government of Canada. (2025, February 19). Understanding Moral Injury. Canada.ca. https://www.canada.ca/en/department-national-defence/corporate/reports-publications/health/understanding-moral-injury.html
  5. Kamkar, K. (2017, September 14). Behind the uniform: When struck by Moral Injury. CAMH. https://www.camh.ca/en/camh-news-and-stories/moral-injury
  6. Griffin, B.J., Purcell, N., Burkman, K., Litz, B.T., Bryan, C.J., Schmitz, M., Villierme, C., Walsh, J. and Maguen, S. (2019), Moral injury: An integrative review. Journal of Traumatic Stress, 32: 350-362.https://doi.org/10.1002/jts.22362
  7. Fani, N., Currier, J. M., Turner, M. D., Guelfo, A., Kloess, M., Jain, J., Mekawi, Y., Kuzyk, E., Hinrichs, R., Bradley, B., Powers, A., Stevens, J. S., Michopoulos, V., & Turner, J. A. (2021). Moral injury in civilians: associations with trauma exposure, PTSD, and suicide behaviour. European journal of psychotraumatology, 12(1), 1965464. https://doi.org/10.1080/20008198.2021.1965464
  8. Onnink, B., Correll, M. C., Correll, A., & Correll, T. (2024). Psychotherapy’s role in evaluating the invisible wounds of moral injury. Innovations in Clinical Neuroscience, 21(1-3), 36–42.