What Is Moral Injury?

Since 2014, Leanne Paynter has provided case management services as an independent living coach for Volunteers of America in St. Petersburg, Florida. Leanne Paynter also conducts psychoeducational groups that explore issues such as post-traumatic stress disorder and moral injury.

Moral injury occurs when individuals participate in or fail to prevent something that contradicts their deeply held values or moral beliefs. Common in combat veterans, moral injury can cause psychological stress that interferes with normal life long after the event. Because the individual feels personally responsible for the transgression, self-forgiveness may be difficult. The lingering guilt may contribute to self-sabotaging behaviors in professional and personal relationships.

While moral injury has some symptoms in common with post-traumatic stress disorder (PTSD), it typically does not involve the hyperarousal that marks PTSD. Patients may benefit from treatment options such as Prolonged Exposure (PE), which allows individuals to process emotional trauma through imagined exposure, and Cognitive Processing Therapy (CPT), which helps individuals reframe negative beliefs that form the foundation of their guilt and shame.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) first entered the Diagnostic and Statistical Manual of Mental Disorders in 1980. Psychiatrists and psychologists initially believed the disorder was rare and closely linked with highly distressing experiences, such as warfare or a natural disaster.

However, later research found that PTSD can develop due to more common types of traumatic events, such as car accidents, or after prolonged exposure to trauma, like childhood or domestic abuse. Nearly 8 million Americans have some form of PTSD.

Traumatic events alter areas of the brain. For example, many people with PTSD have an overactive limbic system, which regulates the fight or flight response. On the other hand, brain regions associated with processing memories and calculating risks become underactive.

PTSD causes several debilitating effects. People with PTSD may experience vivid memories of a traumatic incident, known as a flashback. Attempting to avoid flashback triggers can cause individuals to withdraw. People with PTSD may also develop extreme vigilance, irritability, depression, and anxiety.

Only a mental health professional can diagnose PTSD. The psychiatrist or psychotherapist will review the client’s history, behaviors, and other factors to make a determination. Often, a PTSD diagnosis is further broken down into five categories. This ensures that clients receive the right type of treatment for their situation.

PTSD often begins as a normal stress response. After undergoing a traumatic experience, even those that are necessary, such as surgery or childbirth, many people will experience somatic and psychological symptoms. While the normal stress response subsides after a period, people experiencing this level of stress can benefit from therapy and social support.

Adjustment disorder is a type of stress response that is more intense and long-lasting than would be expected. For example, the end of a short-term relationship may lead to months of intense sadness. Common treatments for this disorder include cognitive behavioral therapy and medication.

Acute stress disorder (ASD) is a short-term form of PTSD. This disorder usually develops shortly after a life-threatening or highly traumatic situation. Some common effects include depersonalization, intrusive recollections of the event, and unstable mood.

People with ASD benefit from therapy and healthy lifestyle habits, such as exercise and a structured schedule. If these ASD symptoms last more than a month, the individual is re-diagnosed with PTSD.

PTSD itself has two different forms. Uncomplicated PTSD is caused by a single traumatic event. In some cases, uncomplicated PTSD is responsive to exposure therapy, a method that builds an individual’s tolerance for triggers by confronting them, either directly or mentally. Talking about the traumatic experience in a safe environment can also mitigate the symptoms.

Complex PTSD is caused by repeated exposure to trauma. Both types of PTSD require therapeutic support, but CPTSD treatment is more likely to last longer than six months. Some people with CPTSD need mental health support for several years to recover.

PTSD often develops as a symptom of other disorders and illnesses. Comorbid PTSD typically occurs when people have serious chronic conditions such as cancer or advanced heart disease. People with severe substance use disorder or anxiety also have a higher risk of developing PTSD.

Volunteers of America Turns 125 Year

 

A Sebring, Florida resident, Leanne Paynter has been in social welfare work for more than 25 years. Leanne Paynter is an independent living coach with Volunteers of America (VOA), an organization that serves those who are vulnerable and in need.

This past January VOA announced that it had turned 125. Established in 1896, VOA was created after one of the founders, Ballington Booth, left the Salvation Army to form the organization along with Frances Hesselbein.

Since this time, the organization has expanded to offer a number of services to the populations it serves. In the beginning, the organization operated an employment office, medical dispensaries, and stores. During the Great Depression, the charity ran soup kitchens to feed many who were hungry and homeless.

By the 1960s, VOA’s mission included fundraising and thrift store operation, with an additional focus on affordable housing. In the 1970s, the organization added professional long-term nursing care to its services.

Today, all of these objectives have been expanded. The organization is one of the country’s largest providers of affordable housing, owning 500 properties that provide shelter for an estimated 25,000 residents. In addition to providing housing, VOA also buys, renovates, builds, and develops homes for the country’s homeless, veterans, seniors, and families. It also owns and operates assisted and independent living residences and nursing facilities.

Since its inception in 1896, the organization has come to be one of the country’s largest and most comprehensive charitable organizations. Today, it has 30 affiliates in 46 states including the District of Columbia and Puerto Rico.