Summary
In September 2025, the American Psychiatric Association added “Moral Problems” as a Z code in the DSM-5-TR, recognizing moral concerns that may warrant clinical attention. Drawing on their scholarship and leadership in this field, Dr. Jennifer Wortham and Dr. Harold G. Koenig will introduce Z codes and their significance in clinical care and present empirically informed theories of moral trauma, moral distress, and moral injury. Particular attention will be given to compound moral trauma: the cumulative and recursive effects of adverse childhood experiences and exposure to potentially morally traumatic events across the life course. These frameworks explain how morally traumatic experiences can disrupt beliefs, relationships, meaning, trust, and spiritual well-being; contribute to depression, anxiety, and suicidal ideation; and how developmental adversity may heighten vulnerability to subsequent exposures and their effects. In closing, the workshop introduces practical approaches to assessment and intervention emphasizing trauma-informed, spiritually sensitive care, interdisciplinary collaboration, and appropriate referral.
Learning Objectives
- Define morally traumatic experiences, moral distress, and moral injury within the moral trauma spectrum.
- Identify experiences that may disrupt a person’s understanding of right and wrong or sense of the goodness of oneself, others, institutions, or higher powers.
- Recognize psychological, emotional, relational, existential, and spiritual manifestations of moral trauma, including guilt, shame, betrayal, anger, moral disorientation, spiritual struggle, and loss of trust or meaning.