Recognizing Moral Injury in Women Veterans

Moral injury remains one of the most misunderstood challenges facing women veterans today. When actions during military service violate one's deeply held moral beliefs, the resulting invisible wounds can devastate lives long after uniforms are hung up. Unlike PTSD, moral injury hides beneath the surface—characterized by shame, guilt, and internal conflict rather than outward distress.

Dr. Daniel Roberts, president of Moral Injury Support Network for Servicewomen Inc., takes listeners through an illuminating exploration of how to recognize these hidden wounds. Drawing from his upcoming book "Moral Injury: A Guidebook for Women Veterans," he outlines the subtle yet profound indicators that something isn't right: social withdrawal that happens gradually, decreased work performance when once-driven servicewomen can no longer concentrate, sleep disturbances that range from insomnia to vivid nightmares, and spiritual distress that shatters previously held beliefs about justice and meaning.

What makes this episode particularly valuable is its comprehensive approach to identification. Beyond examining behavioral changes like substance abuse and anger issues, Dr. Roberts delves into the emotional landscape of moral injury—where women veterans might experience overwhelming guilt, profound loss of meaning, or betrayal that fundamentally alters how they view themselves and the world. The physical manifestations, from chronic pain to appetite disturbances, illuminate how deeply moral injury affects the entire person. For women veterans struggling with unexplained feelings of unworthiness or those who work with them, this episode offers critical insights and a path forward through understanding. Listen, share, and reach out for your free copy of the guidebook to begin the journey toward healing these profound wounds.

Women veterans can receive a free copy of the book by emailing Dr. Roberts at droberts@misns.org. 

Chapters

• 0:00 Introduction to Moral Injury Guidebook
• 2:03 Recognizing Moral Injury in Women Veterans
• 5:28 Behavioral Changes and Substance Abuse
• 8:22 Anger, Sleep Issues and Emotional Indicators
• 13:46 Physical Manifestations of Moral Injury
• 19:10 Free Book Offer for Women Veterans

Transcript

Speaker 1: 0:34

Hi, this is Dr Danny Roberts, president and CEO of Moral Injury Support Network for Service Women Incorporated. Welcome to the Moral Injury Support Network podcast. Today I want to talk about a book that will be published 1 July 2025 called Moral Injury a Guidebook for Women Veterans. This book discusses a lot about moral injury. It talks about the foundations of moral injury. How do you define moral injury, what are the sources of moral injury and how does it devastate people? We also talk about how to recognize moral injury in yourself and other women veterans. The book continues to talk about healing and resilience strategies for recovery. We talk about intervention strategy, daily practices for healing and rebuilding and the role of forgiveness in recovering from moral injury, as well as other things. Today I want to do an excerpt from Chapter 4, called Recognizing Moral Injury. Moral injury stemming from acts that violate a service member's moral compass often go unrecognized, leading to delayed treatment and suffering. This chapter provides women veterans with the knowledge and tools to identify potential indicators of moral injury in themselves or other service members or veterans. Early indication is crucial for timely intervention and improved outcomes.

Speaker 1: 2:01

Moral injury manifests differently than PTSD or other mental health conditions. It is often characterized by internal conflict, shame and guilt rather than outward displays of distress. Military women may attempt to mask their struggles due to the stigma and cultural expectations fear of career impact, the desire to maintain a professional image, concerns about confidentiality, perceived lack of support or personal beliefs. Recognizing these subtle indicators requires careful observation and a deep understanding of the individual's personal context. Observing changes in behavior may include withdrawal and isolation.

Speaker 1: 2:51

Women veterans with moral injury may feel intense guilt, shame or self-blame about their actions or experiences during service. Shame or self-blame about their actions or experiences during service. These feelings can lead to a desire to withdraw from others to avoid judgment, questions or disappointment. They might believe their presence is burdensome or fear being misunderstood, which results in distancing themselves from social connections. Mi can cause feelings of alienation and mistrust, making it difficult for women veterans to participate in social gatherings or community events. They may perceive interactions as superficial or fear that sharing their experiences could lead to stigmatization. Additionally, emotional numbing or hyperarousal symptoms associated with moral injury can reduce motivation to participate in activities that once brought joy. Moral injury often leads to anhedonia the inability to feel pleasure in activities that were previously enjoyable. This withdrawal can be a coping mechanism to manage intense emotional pain or distress associated with their experiences.

Speaker 1: 4:05

The internal conflict and emotional numbness can diminish interest and engagement in hobbies, work or social relationships, further exacerbating feelings of loneliness and despair. Exacerbating feelings of loneliness and despair, changes in work performance MI can significantly impair motivation and confidence, leading servicewomen to perform their duties less effectively. The internal turmoil associated with feeling responsible for morally conflicting actions or witnessing unethical behavior can diminish their sense of competence and purpose. As a result, they may struggle to meet the standards they once upheld, leading to a decline in work quality and overall job performance, often accompanied by feelings of inadequacy or failure. Concentrating on tasks becomes particularly challenging when overwhelmed by guilt, shame or intrusive thoughts related to moral injury. The mental distraction and emotional preoccupations can lead to oversights or mistakes, especially during complex or demanding tasks. Increased errors may also emerge from cognitive fatigue, as persistent emotional distress drains mental resources necessary for careful decision-making and attention to detail.

Speaker 1: 5:21

Moral injury often results in intrusive memories, ruminations or flashbacks about morally distressing experiences. These cognitive-emotional intrusions disrupt concentration, making it difficult for military women to focus on immediate tasks or absorb new information. Military women to focus on immediate tasks or absorb new information. This symptom can be exacerbated by hypervigilance or emotional numbing, both common in trauma-related conditions, further impairing their ability to remain engaged and alert at work or in daily life. The emotional pain and psychological burden of MI can lead to feelings of exhaustion. The emotional pain and psychological burden of MI can lead to feelings of exhaustion, overwhelm or helplessness, prompting some women veterans to avoid work responsibilities altogether. They may also experience physical symptoms like fatigue, sleep disturbances or somatic complaints linked to their emotional state. Fear of stigma or disclosure concerns may contribute to reluctance to seek help, leading to increased absenteeism or withdrawal from their roles.

Speaker 1: 6:34

Substance abuse numb emotional pain, decrease anxiety or temporarily escape intrusive memories, flashbacks or feelings of worthlessness associated with moral injury. Substances can provide a fleeting sense of calm, reduce hyperarousal or silence distressing thoughts, creating an immediate but temporary relief. Substance abuse can alter mood states, leading to feelings of relaxation, euphoria or disassociation from emotional turmoil. This may be particularly appealing for those who feel misunderstood or stigmatized because of their moral injury, as it offers a way to disconnect from internal suffering and social discomfort. Repeated reliance on alcohol or drugs to cope can escalate into dependence or abuse. Military women may find it increasingly difficult to control their substance use, especially mental health issues such as depression, anxiety or post-traumatic stress disorder, which often co-occur with moral injury are also present. Over time this can lead to physical dependence, characterized by withdrawal symptoms if substance use is reduced or stopped.

Speaker 1: 7:48

Anger and irritability. Irritability Increased anger and irritability. Moral injury often involves feelings of betrayal, guilt, shame or moral conflict related to past actions or experiences. These intense emotions can foster a persistent sense of frustration and anger. Women veterans may feel rage directed toward themselves. Others are perceived injustices which can be difficult to contain. This anger often manifests as irritability, a low threshold for frustration, or persistent resentment. Women veterans may experience sudden, intense emotional outbursts that can feel uncontrollable. These episodes can involve yelling, crying or aggressive responses triggered by underlying internal distress.

Speaker 1: 8:34

The difficulty in regulating emotion stems from both the emotional pain of MI and potential co-occurring conditions like PTSD or depression, which impair impulse control and emotional resilience resilience the internal experience of moral injury often leads to feelings of emotional dysregulation, an inability to maintain stable emotion states, feelings of shame and guilt can be overwhelming, resulting in episodes of intense anger or sadness that are hard to diffuse. Such emotional volatility may be exacerbated by hyperarousal symptoms, hypervigilance or intrusive thoughts, common in MI and trauma-related disorders. These emotional challenges can strain relationships with loved ones, friends and colleagues, leading to social withdrawal or alienation. Persistent anger and difficulty in managing emotions can reinforce negative self-perceptions, fueling feelings of worthlessness or shame. In extreme cases, the inability to control anger may lead to aggressive behavior, legal issues or self-harm.

Speaker 1: 9:53

Changes in sleep pattern Insomnia Military women with MI might struggle with difficulty falling asleep, staying awake or waking too early. The persistent internal emotional turmoil, guilt, shame, betrayal or moral conflict can lead to heightened arousal levels, making relaxation and sleep elusive. Racing thoughts, intrusive memories or flashbacks related to morally distressing experiences may prevent restful sleep, resulting in chronic insomnia. Conversely, some servicewomen may experience an increased desire to sleep, either falling asleep frequently or sleeping for unusually long periods. This can serve as an avoidance strategy, helping them escape from painful memories or emotional distress associated with moral injury. Excessive sleep might also be a symptom of depression, which commonly co-occurs with moral injury, further exacerbating fatigue and social withdrawal.

Speaker 1: 10:54

Nightmares are a hallmark of trauma-related conditions and are particularly prevalent among women veterans with MI. These distressing dreams often replay morally conflicting or traumatic events, causing intense emotional reactions such as fear, guilt, shame or helplessness. The content of nightmares may be graphic or accusatory, reinforcing negative self-perceptions and feelings of moral failure. Night terrors, although less common, involve sudden awakening with intense fear, panic or agitation, often accompanied by confusion or physical symptoms like sweating and rapid heartbeat. Both nightmares and night terrors severely disrupt sleep quality and can create a cycle of sleep deprivation, increasing psychological distress, emotional and Cognitive Indicators.

Speaker 1: 11:46

Women veterans with moral injury often grapple with intense feelings of guilt or shame that are disproportionate to the actual circumstances. These feelings may stem from actions they took, failed to take or observed during military service that conflict with their moral or ethical beliefs. Guilt typically involves a sense of responsibility or remorse for specific actions or inactions that they perceive as morally wrong or harmful. Shame relates to a deep sense of worthlessness, humiliation or feeling fundamentally flawed because of perceived moral failings. Manifestations of Excessive Guilt and Shame, constantly replaying past events, questioning did I do enough or was I morally justified, is what we call persistent rumination. Self-blame is harsh self-criticism and feelings of being morally defective. Many women veterans engage in avoidance behavior, which is steering clear of reminders of the event, suppressing memories or avoiding social situations to escape feelings of shame. Suppressing emotions related to guilt-shame to appear stoic or resilient may lead to emotional numbness. Some may engage in behaviors like self-injury or risk activities as a way of punishing themselves or alleviating internal pain.

Speaker 1: 13:17

Mi often shatters core assumptions about morality, justice and personal identity formed before and during military service. Service women may struggle to reconcile their experiences with their values, leading to a pervasive sense that life lacks purpose or direction. They might question the point of their sacrifices, feel disconnected from their goals or believe their actions have rendered their lives morally compromised. Military women with moral injury often describe an overwhelming sense of inner void or numbness. This emotional pain may be a way to detach from painful emotions like guilt, shame or grief associated with their experiences. It can also signify profound disconnection from oneself, others and the world, evoking feelings of loneliness and alienation.

Speaker 1: 14:06

Betrayal shatters foundational trust. Leading women veterans have become highly suspicious or guarded. They might find it difficult to trust leadership, colleagues or even their own judgment. As a protective response, they might develop cynical attitudes towards authority figures, the military structure or societal institution, perceiving them as unjustly or morally compromised. Feelings of anger, hurt, disappointment and grief are common. These emotional responses can ferment into persistent resentment and despair.

Speaker 1: 14:42

Mi can shatter foundational spiritual or moral frameworks. Military women may find their previously held beliefs about divine justice, morality or meaning in life shaken to the core. An initial reaction may be a loss of trust in God, a higher power or a moral order they once believed in. Service, women may question the existence of a benevolent divine presence, the fairness of the universe or the moral goodness of humanity. The experience of moral injury can produce feelings that spiritual teachings no longer provide comfort or guidance.

Speaker 1: 15:16

Intrusive thoughts and memories. Intrusive thoughts are voluntary, distressing and persistent mental images or ideas related to morally disturbing experiences encountered during military service. These memories often pop into consciousness unexpectedly, often without warning. Memories can be highly detailed and sensory rich, involving sights, sounds, smells or physical sensations, and they might evoke strong emotional reactions such as shame, guilt, anger or despair. Women veterans with moral injury often report persistent difficulties in maintaining attention, focusing on tasks or completing activities. These concentration problems are not merely due to fatigue, but are often intertwined with emotional and psychological factors related to their trauma.

Speaker 1: 16:09

Physical indicators While less specific to moral injury, some physical indicators may be present. Chronic pain Military women with MI frequently report ongoing physical discomfort, such as headaches, stomach aches, muscle tension or generalized pain that cannot be attributed to identifiable medical conditions through conventional testing. This type of pain is often chronic, resistant to standard treatments and deeply tied to emotional and psychological states. Emotional trauma, especially moral injury, characterized by guilt, shame, betrayal and moral conflict can manifest physically through somatic symptoms. The body responds to psychological distress by producing physical sensations or pain. Chronic emotional distress activates the body's stress response system, releasing hormones like cortisol and adrenaline that can lead to muscle tension, inflammation and altered pain perception. Heightened arousal levels associated with moral injury often cause muscle tightness, headaches or gastrointestinal issues. Prolonged emotional distress can alter brain regions involved in pain processing, heightening sensitivity to pain signals and creating a phenomenon known as psychogenic pain Service. Women with moral injury often experience fluctuations in appetite as a physical manifestation of their emotional and psychological distress. These changes can lead to a tendency to eat more than usual, often as a form of emotional comfort or numbing. Other women experience a diminished desire to eat, driven by feelings of despair, worthlessness or emotional numbness.

Speaker 1: 17:53

In this chapter, we focused on recognizing moral injury by understanding its unique challenge, differentiating it from conditions like PTSD.

Speaker 1: 18:02

We highlighted key behavior, emotional, cognitive and physical indicators such as withdrawal, changes in work performance, substance abuse, increased irritability, sleep pattern changes, excessive guilt and shame, loss of meaning, betrayal, spiritual distress, intrusive thoughts and chronic pain. We emphasize that recognizing these signs requires a compassionate, multifaceted approach that combines observation, communication and empathy to facilitate timely intervention and support for healing and resistance. In future episodes we'll cover different healing and resilience strategies, but I want to let you know that if you're a woman veteran, we have free copies of this book available to you. Due to some great sponsors and grants, we can give a bunch of these books away for free to women veterans who want more information on moral injury and find out ways they can overcome and recover from moral injury. To get your free copy of this book Moral Injury a guidebook for women veterans just email Dr Daniel Roberts. That's me at droberts at misnsorg. Okay, I hope you have a great day and go to our podcast, the Moral Injury Support Network podcast, and find this and a great many other episodes.