Compassion Fatigue and Vicarious Trauma

“We have not been directly exposed to the trauma scene, but we hear the story told with such intensity, or we hear similar stories so often, or we have the gift and curse of extreme empathy and we suffer. We feel the feelings of our clients. We experience their fears. We dream their dreams. Eventually, we lose a certain spark of optimism, humor and hope. We tire. We aren’t sick, but we aren’t ourselves.”
– C. Figley, 1995

Definitions

Compassion Fatigue
Also called “vicarious traumatization” or secondary traumatization (Figley, 1995). The emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events. It differs from burn-out, but can co-exist. Compassion Fatigue can occur due to exposure on one case or can be due to a “cumulative” level of trauma.

Burnout
Cumulative process marked by emotional exhaustion and withdrawal associated with increased workload and institutional stress, NOT trauma-related.

Primary Traumatic Stress
Primary stressors are those inherent in the extreme event, such as what was immediately experienced or witnessed, especially those things most contributing to a traumatic response.

Mother Teresa Understood Compassion Fatigue

She wrote in her plan to her superiors that it was MANDATORY for her nuns to take an entire year off from their duties every 4-5 years to allow them to heal from the effects of their care-giving work. Is it Burnout or Compassion Fatigue?

The Stages of Burnout have been identified as:

  • enthusiasm
  • stagnation
  • frustration
  • apathy

Not only are care givers vulnerable, but members of the team/family are as well. Caregivers/team members should not intentionally expose themselves to trauma, unless required to perform a mission.
Commonalitities of Burnout and Compassion Fatigue:

  • Emotional exhaustion
  • Reduced sense of personal accomplishment or meaning in work
  • Mental exhaustion
  • Decreased interactions with others (isolation)
  • Depersonalization (symptoms disconnected from real causes)
  • Physical exhaustion

Clear difference: Compassion fatigue has a more rapid onset while burnout emerges over time. Compassion Fatigue has a faster recovery (less severe, if recognized and managed early).

Symptoms of Compassion Fatigue
– Affects many dimensions of your well-being
– Nervous system arousal (Sleep disturbance)
– Emotional intensity increases
– Cognitive ability decreases
– Behavior and judgment impaired
– Isolation and loss of morale
– Depression and PTSD (potentiate)
– Loss of self-worth and emotional modulation
– Identity, worldview, and spirituality impacted
– Beliefs and psychological needs-safety, trust, esteem, intimacy, and control
– Loss of hope and meaning=existential despair
– Anger toward perpetrators or causal events

“First, you should understand that it’s a process. It’s not a matter of one day, you’re living your life with a great deal of energy and enjoyment, and the next, you wake up exhausted and devoid of any energy – both physical and emotional. Compassion fatigue develops over time – taking weeks, sometimes years to surface. Basically, it’s a low level, chronic clouding of caring and concern for others in your life – whether you work in or outside the home. Over time, your ability to feel and care for others becomes eroded through overuse of your skills of compassion. You also might experience an emotional blunting – whereby you react to situations differently than one would normally expect.”

Tips for Managing Compassion Fatigue

Do:

Find someone to talk to.
Understand that the pain you feel is normal.
Exercise and eat properly.
Get enough sleep.
Take some time off.
Develop interests outside of medicine.
Identify what’s important to you.Don’t:

Blame others.
Look for a new job, buy a new car, get a divorce or have an affair.
Fall into the habit of complaining with your colleagues.
Hire a lawyer.
Work harder and longer.
Self-medicate.
Neglect your own needs and interests.

— Source: Landstuhl Regional Medical Center

The ABC’s of Prevention

Awareness

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Balance

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Connections

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