Moral Injury in the DSM-5-TR: Syndrome Spectrum vs. Categorical Disorder

Area of Science:

• Psychiatry
• Mental Health
• Clinical Psychology

Background:

• Moral injury (MI) has gained significant recognition in recent years.
• MI is now included in the DSM-5-TR under a Z code for 'Religious, Spiritual and Moral Problem'.

Purpose of the Study:

• To summarize changes in the DSM related to moral injury.
• To discuss the potential inclusion of MI in other diagnostic systems like the WHO-ICD.
• To review criteria for classifying MI as a distinct disorder and explore conceptualization challenges.

Main Methods:

• Review of DSM-5-TR updates concerning moral injury.
• Analysis of scales assessing MI symptom severity and functional impairment.
• Discussion of conceptual issues in diagnosing mental health conditions.

Main Results:

• Moral injury is recognized in DSM-5-TR, but its classification as a distinct disorder faces challenges.
• A dimensional or spectrum approach is proposed, ranging from moral dilemma to moral injury disorder.
• Concerns from clergy and chaplains regarding diagnostic inclusion are noted.

Conclusions:

• Moral injury is best understood as a dimensional construct within a broader spectrum of moral trauma.
• Categorical diagnosis should be reserved for severe and persistent cases of moral injury.
• Further research is needed to define MI's boundaries, identify optimal treatments, and determine appropriate care providers.