Shame and moral injury in an operation iraqi freedom combat veteran

Abstract

Combat veterans may present secondary to moral injury in conjunction with classic posttraumatic stress disorder (PTSD). Moral injury represents a syndrome that stems from a conflict of deeply held personal values that might result from action in operational environments. Key manifestations of moral injury include guilt and shame. We refer to published studies and literature that indicate a crucial role for killing behaviors and shame in the development and perpetuation of mental health problems in veterans. We discuss a case from presentation through trials of evidence-based treatment, reviewing clinical pearls and pitfalls that relate to the psychotherapeutic and psychopharmacologic management of these complex problems.