Bringing Philosophy to Bear on Moral Injury and Posttraumatic Stress Disorder Construct Validation: Commentary on...

Farnsworth (2019) proposed that posttraumatic stress disorder (PTSD) and moral injury (MI) can be differentiated using DSM-5 PTSD's Criteria D. It was suggested that PTSD cognitions are descriptions about what the world is like whose accuracy can be targeted by cognitive therapies, whereas MI cognitions are prescriptions about what the world should be like, which cannot be assessed for truth or falsehood and so are unsuitable for cognitive therapies. We believe that this appeal to the is/ought distinction distorts the therapeutic challenge, and misconceptualizes moral thinking as manifested only in thin terms such as "ought/should." In practical usage, it is unlikely that when people express cognitions they are only describing the world and not evaluating it as well. In this commentary, we will critique the prescriptivist view of trauma, suggest the importance of "thick terms," and reconsider the purported differences between MI and PTSD. MI might be meaningfully different from PTSD, but it is premature to differentiate these constructs based on DSM-5's Criteria D. A trauma theory that accounts for the interwoven descriptive and evaluative, cognitive as well as affective, elements of traumatic experiences will clarify both the PTSD diagnosis and MI model and improve treatment development and clinical care.