Compassion fatigue, also known as secondary traumatic stress (STS), is a condition characterized by a gradual lessening of compassion over time. It is common among individuals that work directly with trauma victims such as, therapists (paid and unpaid), nurses, psychologists, police officers, first responders, animal welfare workers, health unit coordinators and anyone who helps out others, especially family members, relatives, and other informal caregivers of patients suffering from a chronic illness. It was first diagnosed in nurses in the 1950s.
Sufferers can exhibit several symptoms including hopelessness, a decrease in experiences of pleasure, constant stress and anxiety, sleeplessness or nightmares, and a pervasive negative attitude. This can have detrimental effects on individuals, both professionally and personally, including a decrease in productivity, the inability to focus, and the development of new feelings of incompetency and self-doubt.
Journalism analysts argue that the media has caused widespread compassion fatigue in society by saturating newspapers and news shows with often decontextualized images and stories of tragedy and suffering. This has caused the public to become cynical, or become resistant to helping people who are suffering.
An early use of the term was in a 1981 US document on immigration policy. In the early 1990s the news media in the United States used the term to describe the public's lack of patience, or perhaps simply the editors' lack of patience, with "the homeless problem," which had previously been presented as an anomaly or even a "crisis" which had only existed for a short time and could presumably be solved somehow. The term was also used in 1992 when Joinson used the term in a nursing magazine to describe nurses who deal with hospital emergencies. Compassion Fatigue has been studied by the field of traumatology, where it has been called the "cost of caring" for people facing emotional pain.
Compassion fatigue has also been called "secondary victimization" (Figley, 1982), "secondary traumatic stress" (Figley, 1983, 1985, 1989; Stamm, 1995; 1997), "vicarious traumatization" (McCann and Pearlman, 1989; Pearlman & Saakvitne, 1995), and "secondary survivor" (Remer and Elliott, 1988a; 1988b). Other related conditions are "rape-related family crisis" (Erickson, 1989; White & Rollins, 1981), and "proximity" effects on female partners of war veterans (Verbosky and Ryan, 1988). Compassion fatigue has been called a form of burnout in some literature. However, unlike compassion fatigue, “burnout” is related to chronic tedium in careers and the workplace, rather than exposure to specific kinds of client problems such as trauma.
In academic literature, the more technical term secondary traumatic stress disorder may be used. The term "compassion fatigue" is considered somewhat euphemistic. Compassion fatigue also carries sociological connotations, especially when used to analyse the behavior of mass donations in response to the media response to disasters. One measure of compassion fatigue is in the ProQOL, or Professional Quality of Life Scale. Another is the Secondary Traumatic Stress Scale.
Several personal attributes place a person at risk for developing compassion fatigue. Persons who are overly conscientious, perfectionists, and self-giving are more likely to suffer from secondary traumatic stress. Those who have low levels of social support or high levels of stress in personal life are also more likely to develop STS. In addition, previous histories of trauma that led to negative coping skills, such as bottling up or avoiding emotions, having small support systems, increase the risk for developing STS.
Many organizational attributes in the fields where STS is most common, such as the healthcare field, contribute to compassion fatigue among the workers. For example, a “culture of silence” where stressful events such as deaths in an intensive-care unit are not discussed after the event is linked to compassion fatigue. Lack of awareness of symptoms and poor training in the risks associated with high-stress jobs can also contribute to high rates of STS.
In health care professions
Between 16% and 85% of health care workers in various fields develop compassion fatigue. In one study, approximately 85% of emergency room nurses met the criteria for compassion fatigue. In another study, more than 25% of ambulance paramedics were identified as having severe ranges of post-traumatic symptoms. In addition, 34% of hospice nurses in another study met the criteria for secondary traumatic stress/compassion fatigue.
Caregivers for dependent people can also experience compassion fatigue; this can become a cause of abusive behavior in caring professions. It results from the taxing nature of showing compassion for someone whose suffering is continuous and unresolvable. One may still care for the person as required by policy, however, the natural human desire to help them is significantly diminished. This phenomenon also occurs for professionals involved with long term health care. It can also occur for loved ones who have institutionalized family members. These people may develop symptoms of depression, stress, and trauma. Those who are primary care providers for patients with terminal illnesses are at a higher risk of developing these symptoms. In the medical profession, this is often described as "burnout": the more specific terms secondary traumatic stress and vicarious trauma are also used. Some professionals may be predisposed to compassion fatigue due to personal trauma.
Mental health professionals are another group that often suffer from compassion fatigue, particularly when they treat those who have suffered extensive trauma. A study on mental health professionals that were providing clinical services to Katrina victims found that rates of negative psychological symptoms increased in the group. Of those interviewed, 72% reported experiencing anxiety, 62% experienced increased suspiciousness about the world around them, and 42% reported feeling increasingly vulnerable after treating the Katrina victims.
Charles R. Figley, co-author of Compassion Fatigue: Coping With Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized, states that, “there is a cost to caring. Professionals who listen to clients’ stories of fear, pain, and suffering may feel similar fear, pain, and suffering because they care. Sometimes we feel we are losing our sense of self to the clients we serve. Therapists who work with rape victims, for example, often develop a general disgust for rapists that extends to all males. Those who have worked with victims of other types of crime often ‘feel paranoid’ about their own safety and seek greater security. Ironically, the most effective therapists are most vulnerable to this mirroring or contagion effect. Those who have enormous capacity for feeling and expressing empathy tend to be more at risk of compassion stress”.
In a study done on child welfare workers, Mary Van Hook and Michael Rothenberg stated that, “compassion fatigue/vicarious trauma refers to work related, secondary exposure to extremely stressful events. Symptoms are usually rapid in onset. They can include trauma symptoms such as being scared, difficulty sleeping, images of the event popping into your mind, and avoiding things that remind you of the event. Compassion fatigue/vicarious trauma/secondary traumatic stress have been increasingly identified as risks for professionals working with individuals who have experienced trauma. As described previously, the lives of clients in the child welfare system are frequently marked by violence and other forms of trauma. Repeated exposure to the violence experienced by clients can create a shift in the counselors’ perceptions of the world and themselves and increases their sense of their own vulnerability. It can disrupt the counselor’s sense of safety, trust, sense of self-esteem, sense of control, and relationships with significant others”
Betan, Heim, Conklin, and Westen in 2005 surveyed Compassion fatigue and resultant emotional responses, they found eight patterns:
This study shows that it is normal for health care professions to have strong feelings toward clients, even negative or sexual feelings and the challenge is to understand why these feelings happen and to use them therapeutically if appropriate. Compassion fatigue must be attended to carefully, because unexamined emotional responses from the professional's part can lead the therapeutic relation astray.
Recent research shows that a growing number of attorneys who work with victims of trauma are exhibiting a high rate of compassion fatigue symptoms. In fact, lawyers are four times more likely to suffer from depression than the general public. They also have a higher rate of suicide and substance abuse. Most attorneys, when asked, stated that their formal education lacked adequate training in dealing with trauma. Besides working directly with trauma victims, one of the main reasons attorneys can develop compassion fatigue is because of the demanding case loads, and long hours that are typical to this profession.
In charitable giving
Some people become frustrated by constantly being solicited for donations or they become skeptical that most of the money will ever reach the needy. For example, in the aftermath of the September 11 attacks, many givers were frustrated with the Red Cross's handling of donations; they believed that their donations would go to the families of the victims, when the Liberty Fund only paid out approximately 1/3 of its receipts to families and dedicated the rest to long-term planning.
There are no known clinical treatment options for compassion trauma, but there are a number of recommended preventative measures.
Stress reduction and Anxiety management practices have been shown to be effective in preventing and treating STS. Taking a break from work, participating in breathing exercises, exercising, and other recreational activities all help reduce the stress associated with STS. Conceptualizing one's own ability with self-integration from a theoretical and practice perspective helps to combat criticized or devalued phase of STS. In addition, establishing clear professional boundaries and accepting the fact that successful outcomes are not always achievable can limit the effects of STS.
Social support and emotional support can help practitioners maintain a balance in their worldview. Maintaining a diverse network of social support, from colleagues to pets, promotes a positive psychological state and can protect against STS.
- Vicarious traumatization
- Donor fatigue
- Bystander effect
- Emotional exhaustion
- Diffusion of responsibility
- Post-traumatic stress disorder
- Burnout (psychology)
- Day, Jennifer R.; Anderson, Ruth A. (2011-09-08). "Compassion Fatigue: An Application of the Concept to Informal Caregivers of Family Members with Dementia". Nursing Research and Practice 2011: 1–10. doi:10.1155/2011/408024. PMC 3170786. PMID 22229086.
- "Compassion Fatigue - Because You Care" (PDF). St. Petersburg Bar Association Magazine. Archived from the original (PDF) on November 20, 2008. Retrieved February 2007.
- "Traumatic Stress & The News Audience". Dart Center for Journalism and Trauma. Retrieved June 2008.
- Link, BG; Schwartz, S; Moore, R; et al. (August 1995). "Public knowledge, attitudes, and beliefs about homeless people: evidence for compassion fatigue". Am J Community Psychol 23: 533–55. doi:10.1007/bf02506967. PMID 8546109.
- Beck, C (2011). "Secondary Traumatic Stress in Nurses: A Systematic Review". Archives of Psychiatric Nursing 25 (1): 1–10. doi:10.1016/j.apnu.2010.05.005.
- D’Souza, Egan, & Rees, 2011
- Meadors; et al. (2008). "Compassion Fatigue and Secondary Traumatization: Provider Self Care on the Intensive Care Units for Children". Journal of Pediatric Health 22 (1).
- Hooper; et al. (2010). "Compassion Satisfaction, Burnout, and Compassion Fatigue Among Emergency Nurses Compared With Nurses in Other Selected Inpatient Specialties". Journal of Emergency Nursing 36 (5): 420–427. doi:10.1016/j.jen.2009.11.027.
- Culver, L., McKinney, B., Paradise, L. (2011). Mental Health Professionals' Experiences of Vicarious Traumatization in Post-Hurricane Katrina New Orleans, 16(1), 33-42.
- Figley, C. R. (1995). Compassion fatigue as secondary stress disorder: An overview. Compassion fatigue: coping with secondary traumatic stress disorder in those who treat the traumatized (1-20). New York: Brunner/Mazel.
- Van Hook, M. P.; Rothenberg, M. (2009). "Quality of life and compassion satisfaction/fatigue and burnout in child welfare workers: A study of the child welfare workers in community based care organizations in Central Florida". Social Work & Christianity 36 (1): 36–54.
- "Red Cross defends handling of Sept. 11 donations". CNN. November 6, 2001. Retrieved April 30, 2010.
- Huggard, P. (2003). Secondary Traumatic Stress: Doctors at risk. New Ethicals Journal. http://home.cogeco.ca/~cmc/Huggard_NewEthJ_2003.pdf
- Adams, R.; Boscarino, J.; Figley, J. (2006). "Compassion Fatigue and Psychological distress among social workers: a validation study". American Journal of Orthopsychiatry 76: 103–108. doi:10.1037/0002-9418.104.22.168.
- Barnes, M. F (1997). "Understanding the secondary traumatic stress of parents". In C. R. Figley (Ed). Burnout in Families: The Systemic Costs of Caring, pp., 75-90. Boca Raton: CRC Press.
- Beaton, R. D. and Murphy, S. A. (1995). "Working with people in crisis: Research implications". In C. R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized, 51-81. NY: Brunner/Mazel.
- Figley, C. R. (Ed.) (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. NY: Brunner/Mazel.
- Hall, J.; Rankin, J. (2008). "Secondary Traumatic Stress and Child Welfare". International Journal of Child and Family Welfare 11 (4): 172–184.
- Kinnick, K; Krugman, D.; Cameron, G. (1996). "Compassion fatigue: Communication and burnout toward social problems". Journalism & Mass Communication Quarterly 73 (3): 687–707. doi:10.1177/107769909607300314.
- Kottler, J. A. (1992). Compassionate Therapy: Working with Difficult Clients. San Francisco: Jossey-Bass.
- Joinson, C (1992). "Coping with compassion fatigue". Nursing 22 (4): 116–122.
- Phillips, B. (2009). Social Psychological Recovery, Disaster Recovery. (p. 302). Boca Raton, FL: CRC Press - Taylor & Francis Group.
- Putman, J.; Lederman, F. (2008). "How to Maintain Emotional Health. When Working with Trauma". Juvenile and Family Court Journal 59 (4): 91–102.
- Compassion Fatigue Awareness Project
- ProQOL.org, Professional Quality of Life Organization
- Mirrored emotion by Jean Decety from the University of Chicago.
- Compassion Fatigue: Being an Ethical Social Worker by Tracy C. Wharton, from The New Social Worker, Winter 2008.
- The Signs Symptoms and Treatment of Compassion Fatigue