Compassion Fatigue

One of the main reasons people become public health workers or disaster and emergency responders is to help people. However, such professionals often make an emotional investment in their jobs, and sometimes shoulder too much of the burden of or assume that they are immune to the effects of disasters.

This can produce a variety of misconceptions that are summarized below.

  1. I will fix the problem and save the world
  2. I am invincible
  3. I am responsible for outcomes
  4. If I care enough, everything will be okay
  5. People will appreciate everything I do
  6. I will have enough resources to fix things
  7. I know what I'm getting into
  8. Significant people in my life will support and approve my absence from our relationship while I invest in this compassionate mission

Having discussed the basics of stress, let us now focus on stress that is specific to disaster responders.

Signs and symptoms of stress can occur not only in survivors of a traumatic event, but also in those who are responding to the event and assisting survivors. This is particularly true in situations where the perceived danger is great, or where the event is unexpected (i.e., terrorist attack, pandemic, or natural disaster). Caregivers can experience stress in severe, ongoing, or repeated traumatic events.

This phenomenon is referred to as compassion fatigue - a state of stress produced by preoccupation with the trauma of a single victim or the cumulative traumas of clients.

Compassion fatigue can manifest itself in a number of ways. These manifestations can include re-experiencing traumatic events, avoiding or numbing oneself to reminders of the event, or the development of a persistent state of arousal. 

Types

Types of compassion fatigue include burnout, secondary trauma, and post-traumatic stress disorder (PTSD).

Burnout

Burnout refers to feelings of emptiness, lack of motivation, and difficulty in caring that result from enduring or being surrounded by too many effects of stress.

Often burnout leads to a pessimistic view of things and an inability to see any hope of positive change. If left untreated, burnout can lead to depression.

People who have depression are usually unable to imagine that any problem or situation can be solved in a positive way.

Secondary Trauma

Secondary trauma is the stress resulting from helping or wanting to help a traumatized or suffering person.

Like burnout, if secondary trauma is untreated, it can lead to depression and vicarious trauma.

Vicarious trauma is the emotional impact of listening to traumatic stories day after day, or responding to traumatic situations. A transformation occurs both internally and in your perception of the world around you.

PTSD

PTSD is an anxiety disorder that can occur after suffering a traumatic event.

The four major symptoms are:

  1. Reliving the event
  2. Avoiding situations that remind the person of the event     
  3. Feeling numb
  4. Hyperarousal (constant alertness)
 

Risk Factors

Mental and emotional health is influenced both by your past experiences and current circumstances.

Before moving on, see if you can list some risk factors for compassion fatigue. Compare your list to ours.


  • Fears for your safety or for the victims
  • Separation from your personal supports
  • Guilt over access to food, shelter, etc.
  • Physically difficult or exhausting tasks
  • Heavy workload
  • Lack of sleep
  • Moral and ethical dilemmas
  • Substance use (both alcohol and drugs)
  • Exposure to anger or lack of gratitude
  • Early childhood experiences (i.e., poor connection to primary caretaker which can cause feelings of helplessness or isolation)
  • Disturbing images from stories people share
  • Being unprepared for your reactions
  • Over-identification with the survivors
  • Incidents trigger personal recollections
  • Feeling that you have not done enough
  • Feeling helpless to ameliorate pain or loss
  • Repeated exposure to grim situations
  • Empathy
  • Type A personality
  • Co-dependence
  • Your own prior traumatic experiences

 

Identifying Compassion Fatigue

The sections below summarize many of the symptoms and other indicators of compassion fatigue. Another useful tool in identifying and assessing the severity of compassion fatigue is the Compassion Satisfaction/Fatigue Self-Test for Helpers (PDF).

Before moving on, see if you can list some symptoms of compassion fatigue. Compare your list to ours.


  • Bottling up of emotions
  • A feeling of isolation from others
  • Receiving unusual amount of complaints from others
  • Excessive complaining about administrative functions
  • Substance use
  • Compulsive behaviors (i.e., overspending, overeating, gambling, sexual addictions)
  • Poor self-care (i.e., hygiene, appearance)
  • Developing legal problems, indebtedness
  • Recurring nightmares and flashbacks to traumatic events
  • Chronic physical ailments (i.e., gastrointestinal problems)
  • Apathy, sadness, and loss of interest in pleasurable activities
  • Difficulty concentrating
  • Mental and physical fatigue
  • Sense of dread working with certain clients  
  • Excessive blaming of others

 

 

Compassion fatigue can manifest in a variety of other ways including:

  • Silencing response: When we are already emotionally overwhelmed, we find ways of silencing others' painful stories so that their pain doesn't add to our own trauma load. The silencing response is a reaction which guides a caregiver to redirect, shut down, minimize, or neglect the disturbing information brought by an individual to the caregiver.
  • Arousal symptoms: Often related to PTSD, caregivers may feel constantly alert after a traumatic event. This is known as increased emotional arousal, and it can cause difficulty sleeping, outbursts of anger or irritability, and difficulty concentrating. They may find that they are constantly on guard and on the lookout for signs of danger.
  • Physical symptoms: Compassion fatigue can also manifest in physical ailments, such as head, back, and/or muscle aches; insomnia and sleep disruptions; and loss of energy or fatigue.

 

 

Debilitating Effects

Compassion fatigue can take a toll on many aspects of your life, from your ability to do your job effectively to influencing your personal life.

Common Effects of Compassion Fatigue

 

  • Difficulty attending to clients with empathy, hope, and compassion
  • Reduced willingness to provide care
  • Inhibited ability to cope
  • Caregivers changing roles from caregiver to victim
  • Diminished sense of purpose
  • Loss of occupational joy
  • Lower morale or motivation

In your personal life, you may experience:

  • Decrease in sense of safety
  • Inability to separate work life from personal life
  • Diminished functioning
  • Emotional shutdown
  • Isolation from social engagements and activities
  • Disruptions in self-care habits
  • Diminished capacity for joy and loss of sense of humor
  • Relationship dysfunction

 

 

Coping

A simple way to deal with compassion fatigue can be summarized by the acronym HALT.

  • Hungry
  • Angry
  • Lonely
  • Tired

If you feel overwhelmed, take a moment to have a snack, decompress, check in with your support network, or take a nap.

Other tips for coping can be found in the RN.com article Compassion Fatigue: Tips for Coping. The article contains techniques for yourself, your professional environment, and your organization.