Date

6-17-2026

Department

School of Behavioral Sciences

Degree

Doctor of Philosophy in Psychology (PhD)

Chair

Kristen Kellen

Keywords

PTSD, moral injury, Veterans, diagnosis, treatment, combat

Disciplines

Psychiatry and Psychology | Psychology

Abstract

The attacks on the United States on September 11, 2001, and the ensuing wars in Afghanistan and Iraq, heralded in a new concept affecting our combat and support military personnel. This concept is known today as moral injury. Military personnel were already familiar with post-traumatic stress disorder (PTSD), whether from personal experience or from reading and training on the subject, but no training addresses the prevalence or effects of moral injury. The term moral injury (MI) was first coined by psychiatrist Jonathan Shay and his colleagues based on feedback from military and veteran patients in 1998; however, it remains that practitioners fail to differentiate moral injury from PTSD. The question being answered is to what extent Veterans with PTSD also have instances of MI. To this end, this study examined a group of 100 combat and non-combat U.S. military Veterans who were diagnosed with PTSD to determine the difference in prevalence of MI among demographic groups. To accomplish this, a demographic questionnaire and two standardized assessment instruments were administered: (1) the Moral Injury Outcome Scale (MIOS); and (2) the PTSD Checklist for DSM-V (PCL-5). To assess the difference in prevalence of moral injury among Veterans, paired subjects t-tests and analysis of variance (ANOVA) were used. In the analyses, it was observed that MI was present in nearly every Veteran—regardless of demographic—who was diagnosed with PTSD, indicating the need for both military and civilian mental health professionals to conduct further studies and develop programs that include mental health and ministry professionals, as well as support from the community.

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