Chronic Pain, PTSD and Moral Injury in Military Veterans: Suffering and the Compromised Self

Abstract: Veterans with chronic pain may face complex additional challenges, notably the potentially high rate of comorbid post-traumatic stress disorder. Linked to this is the developing concept of moral injury, essentially feelings of guilt and shame associated with transgressing one’s moral beliefs. Work has begun to explore moral injury in the context of psychological trauma, however it has not to date been considered in relation to chronic pain. As the moral injury concept is still developing, this paper explores what is known about the roles of guilt and shame in psychological trauma and chronic pain, and aims to set this in a military context, to begin to understand clinical implications and to make recommendations for further research. A search of the literature reveals that guilt and shame in psychological trauma and chronic pain are not well understood, and research has predominantly focused on these as consequences, rather than as potential contributory elements. Literature is currently separated, focusing either on PTSD or on chronic pain, and we suggest a more integrated approach is required.

Read the full article
Report a problem with this article

Related articles

  • More for Researchers

    Examination of the mental health symptoms and stigmatizing attitudes of student servicemembers and Veterans in postsecondary education

    Abstract:Student servicemembers and veterans (SSM/V) face challenges when transitioning from military service into higher education, including mental health concerns and difficulties with academic and social adjustment. This study examined mental health symptoms, adjustment to college, stigma, and help-seeking attitudes among 79 SSM/V enrolled in postsecondary education. Participants completed measures related to depression (PHQ-8), anxiety (GAD-7), posttraumatic stress (PCL-5), adjustment to college (VAC), self-stigma (SSOSH), public stigma (SSRPH), and attitudes toward seeking professional psychological help (ATSPPH-SF). Results indicated that average scores reflected mild levels of depression, anxiety, and posttraumatic stress. Veterans reported significantly higher levels of depressive and PTSD symptoms compared to active-duty servicemembers. Number of deployments was negatively correlated with adjustment scores. Race and ethnicity were found to be significant predictors of help-seeking attitudes. Although college adjustment was negatively correlated with depression, anxiety, and PTSD symptoms, the findings did not reach statistical significance, perhaps due to the limited variability in the sample. Most participants reported generally positive attitudes toward mental health services, though both self-stigma and perceived public stigma were present. Service utilization was high overall, with 76% of participants reporting prior mental health service use and 44% who were currently engaged in treatment at time of survey completion. Findings underscore the importance of addressing cultural factors, deployment experiences, and stigma to improve adjustment, retention, and well-being among SSM/V in postsecondary education.