Post-traumatic stress disorder
A recognised psychiatric disorder that can follow exposure to death, serious injury, or sexual violence, marked by intrusive memories, avoidance, dark shifts in mood and thinking, and heightened arousal. The frame is built around fear and threat to life. That focus is also its limit: it captures terror-based trauma well but sits awkwardly with the guilt, shame, and meaning-loss reported by people who feel morally compromised by what they did.
The DSM-listed psychiatric disorder defined by intrusion symptoms, avoidance, negative alterations in cognition and mood, and alterations in arousal following exposure to actual or threatened death, serious injury, or sexual violence. PTSD entered the DSM in 1980 (DSM-III) largely on the basis of post-Vietnam clinical experience and was reorganised significantly in DSM-5 (2013) into a separate category from anxiety disorders.
Etymology§
The term was introduced as a formal diagnosis in DSM-III (1980) after extensive advocacy from Vietnam-era clinicians and veteran organisations; it consolidated and replaced earlier categories including combat fatigue, shell shock, and gross stress reaction. The post-traumatic emphasises the temporal structure (the disorder follows the trauma); stress disorder locates it in the family of stress-related psychiatric conditions rather than the family of moral or character injuries.
For the moral-injury literature PTSD is the foil concept — the diagnostic category against which the construct of moral injury is articulated. Almost every foundational moral-injury text, from Shay (1994) through Litz (2009) through Sherman (2015), opens with some version of the same argument: PTSD captures fear-based, life-threat-based trauma adequately but is the wrong frame for the guilt, shame, betrayal, meaning-loss, and spiritual damage that morally compromised participants in war report.
The relationship is complicated. Moral injury and PTSD are not mutually exclusive — most patients identified as morally injured also meet PTSD criteria — but the field's argument is that the moral content is doing distinct work and is not captured by the existing diagnostic frame. The potentially morally injurious event is Litz's clinical-research operationalisation of the distinction; the Shay definition rests on a different distinction (betrayal versus fear).
The healthcare extension of moral injury repeats the same foil-concept structure but with burnout in PTSD's role — Dean and Talbot argue that what is called burnout in clinicians is moral injury misnamed, and that the rename matters because it re-locates the cause from the individual's resilience to the institutional arrangement.