People sometimes confuse moral injury and moral distress. It may be helpful to think about moral injury and moral distress as occurring along a spectrum. Following potentially morally injurious events, some individuals do not experience adverse reactions, whilst others experience short-term distress (lasting days or weeks) marked by shame, guilt, anger, worthlessness, and disgust, which may be termed ‘moral distress’.
Moral distress is often a normal response to challenging ethical dilemmas and it can be a driver for right action (e.g. standing up for a bullied colleague in the future). As such, moral distress is typically less severe and can get better if the situation changes or the person can fix the problem.
However, moral distress can develop into moral injury, which is often more severe and persistent. A morally injured person may view themselves in a negative way (e.g., “I am a terrible person”, “I am a monster”), believe the world or others are untrustworthy (e.g., “my team does not care about me”, “the world is an awful place”) or lose faith in humanity. Individuals with moral injury might use harmful coping strategies, such as drinking alcohol excessively, gambling, or using drugs, to cope with their difficult feelings.
