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.
Abstract: The unique demands of military life can adversely impact romantic relationships; however, research has mainly focused on these adverse outcomes at one-time point, overlooking changes over time or potential positive outcomes. Using a subsample of 3,845 male and female military personnel and veterans from a large UK dataset, this study examined positive and negative changes in relationship satisfaction between two-time points (2007–2009; 2014–2016). Most participants reported no change in their relationship satisfaction, suggesting stability − 8% reported a positive change and 10% a negative change. Positive change was associated with being in a long-term relationship, alcohol misuse remission, and persistent alcohol misuse. Negative change was associated with the onset of mental health problems (probable PTSD, CMD, or alcohol misuse) and having children under 18. Some factors, like increasing age, childhood family relationship adversity, and mental health problems, were associated with both positive and negative changes in relationship satisfaction. This study highlights the complexity of factors associated with relationship satisfaction among military personnel and veterans, with some experiencing positive changes, as well as negative changes over time.