Compassion Fatigue: Causes, Signs, & Ways to Cope

What Is Compassion Fatigue?

Compassion fatigue emerges when people care too much and internalize the pain they experience, resulting in less overall empathy. First responders, doctors, nurses, and other people who experience ongoing life-threatening, crisis-oriented situations can create internal trauma for themselves. Family members caring for people with chronic illnesses such as dementia can experience similar symptoms. This trauma creates an emotional and physical toll, and can become an occupational hazard.

Observations of family members suffering can lead to feelings of helplessness, hopelessness, and social isolation and result in a growing inability to be empathic. Compassion fatigue can occasionally occur with a one time traumatic event that severely traumatizes the helping professional. Psychology Today defines the dynamics from this work: “the more such individuals open themselves up to other’s pain, the more likely they will come to share those victims feelings of heartbreak and devastation.”¹

What’s the Difference Between Compassion Fatigue & Burnout?

Researchers define compassion fatigue as  “having two components—burnout and secondary traumatic stress,”² and burnout as “feelings of hopelessness and difficulties dealing with work or in carrying out one’s job effectively.” These negative feelings usually have a gradual onset.³ Compassion fatigue has another distinguishing feature in that it can evolve exposure to a single case of trauma, or from years of accumulated “emotional residue.”⁴ Burnout differs in that it occurs over time.

The experience of burnout is not the result of feeling another individual’s pain and suffering. When someone experiences therapist or caregiver burnout, there can be overlap between the symptoms of compassion fatigue and burnout, including feelings of exhaustion, helplessness, and stress. However, caregiver burnout has no relationship to exposure to repeated trauma or crisis.

What’s the Difference Between Compassion Fatigue & Vicarious Trauma?

Many use the terms compassion fatigue and vicarious trauma interchangeably. However there are fundamental differences. Research has shown “a clear distinction between compassion fatigue and vicarious traumatization lies in the permanency of change to the individual. Individuals experiencing vicarious traumatization have their cognitive schema permanently altered.”⁵ In other words, their patterns of thought and the way they organized information was changed.

In addition, these professionals questioned the value of their work and the importance of its impact on those they encountered. Another distinguishing characteristic of vicarious trauma is those that are impacted by it tend to question and ultimately change their core beliefs about the world. They both result from ongoing interactions with people who experience trauma. In both compassion fatigue and vicarious trauma, the professional affected may have difficulty continuing their work.

Who Is at Risk for Compassion Fatigue?

Helping professionals and chronic caregivers are the population that are most at risk for compassion fatigue. The nature of their jobs/care means they devote themselves to caring, healing, and protecting the people they come in contact with.

Here are more specifically defined professions that are at a higher risk for experiencing compassion fatigue:

• Nurses/Nurses Aides
• Doctors
• Military personnel
• Mental Health Professionals
• Emergency Medical Technicians/paramedics
• Fireman
• Law Enforcement
• Clergy
• Hospice Workers
• Emergency care staff
• Lawyers
• People who care for animals like veterinarians and animal rescue programs
• Chronic caregivers

It can be an occupational hazard where the “cost of caring” becomes too high for the caregiver. This was a term created by Charles R. Figley, PhD who has done extensive research on compassion fatigue. Compassion fatigue is more common in women because they tend to choose professions in the caring field. Researchers highlighted professionals that are most vulnerable. They discovered that those particularly susceptible to compassion fatigue include healthcare, emergency, and community service workers.⁶

Signs That You May Be Experiencing Compassion Fatigue

The risk professions highlighted above are very demanding and all consuming. Beth Hundall Stamm, PhD, a leading expert on compassion fatigue developed the Professional Quality of Life Questionnaire  (PROQOL).⁸ This questionnaire is an effective tool to determine levels of compassion satisfaction, burnout, traumatic stress, and other levels of trauma a person may be experiencing.

The most common signs of compassion fatigue include:

• Ongoing physical, spiritual, and emotional exhaustion
• Irritability
• Difficulty concentrating and focusing
• Feelings of hopelessness and helplessness
• Difficulty sleeping
• Feeling overwhelmed by the pain and suffering of others
• Self isolation
• Feelings of anger, sadness
• Reduced empathy
• Inability to tolerate stress
• Feeling detached or distant from your environment and emotions
• Feeling overly sensitive or insensitive to the emotional experiences of others

One of the dangers of compassion fatigue is those that suffer from it refuse to acknowledge it. Sherrie Bourg Carter, Psy.D. explains the danger of denial “because it prevents those who are experiencing compassion fatigue from accurately assessing how fatigued and stressed they actually are, which prevents them from seeking help.”⁷

When to Get Professional Help for Compassion Fatigue

If you begin to experience any combination of the symptoms above it is important to be honest with yourself about the possibility that you may be experiencing compassion fatigue. Dr. Robert Muller, PhD, says that a major warning sign to watch for is “workaholism.” “Many helping professionals are so dedicated to their jobs that they don’t have a balance between their work and home lives.”⁹

When you feel you have nothing left to give in terms of life outside of work and you don’t have the energy to change this dynamic you need outside help. This is a common mistake made by people suffering from compassion fatigue. They throw themselves even more fully into their work in hopes of reconnecting and fixing the problem. By doing this they self isolate more and eliminate self care activities like exercise, socialization, meditation, and relaxation. These types of activities can energize you and give a healthier perspective on work related issues.

Not being able to make this work/life adjustment is another warning sign that additional help may be needed for you to move forward. It may be a painful process but honest self reflection is a mandatory exercise that must be done to understand the implications of compassion fatigue. If you are able to successfully accomplish this and make the necessary life changes you may be able to successfully manage overcoming compassion fatigue without outside support.

Who Should I Consult for Help in Overcoming Compassion Fatigue?

There are many available options for support if you find that you are unable to address compassion fatigue on your own. Compassion fatigue can take a huge toll on the person who experiences it and it can spill into all areas of life. Time becomes an issue because the longer you wait the more overwhelming it can feel. Reach out and find a therapist or counselor who has expertise in trauma and compassion fatigue. It is therapeutic to have a trained listener who can guide you through the process of healing.

If compassion fatigue has impacted family relationships you may want to seek family counseling to help rebuild those relationships. Your counselor can offer insights on how to create more balance in your life. That counselor can also assist you with recognizing symptoms of compassion fatigue and offer ways to cope and manage the disabling symptoms that can arise.

Those suffering from compassion fatigue may also benefit from attending support groups with a trauma/compassion fatigue focus. Talking to other people who have had similar experiences with trauma and compassion fatigue can help normalize your feelings and help you to understand your reactions. Having people familiar with your type of work who are prepared to listen to you can have a healing component. Knowing you are not alone can be an additional source of comfort.

How to Find a Therapist

There are many ways to find and choose a therapist.¹⁰ There may be people you know who can make recommendations. Your physician may be able to give you a referral. The number of therapy sessions will be determined by the treatment goals you develop with your therapist.

Costs do vary. Costs can depend on the type of therapist you see and the place you live. It is also determined by the licensing and credentials of the person you see. Your insurance coverage will help determine the amount you pay. The average cost of a 45-60 minute therapy session is between $60-$120 an hour. Be sure and ask your therapist if sliding scale fees are accepted.

How to Cope With & Prevent Compassion Fatigue

Compassion fatigue is a treatable condition. People who experience compassion fatigue have many actions they can take to help alleviate the symptoms it creates. You can learn to identify the symptoms and find ways to cope with its ramifications. You can reduce the negative feelings it produces and find constructive ways to strengthen relationships that may have been damaged by compassion fatigue. The primary goal is to learn what you need to do to take care of yourself and to help you create a healthy balance between your work and your life outside of work.

The American Psychological Association offers these recommended self care interventions:

• “Examine beliefs about self care
• Practice self compassion
• Create community-connect with like minded others
• Help colleagues
• Focus on compassion satisfaction-celebrate the positives of helping others”¹¹

Here are additional actions you should consider to help reduce the severity of symptoms:

• Recognize that empathy is both a feeling and a skill. Use this skill to manage your emotions when empathizing with others. Your expertise can help others. This process creates distance for you.
• Consider individual, group, or family therapy.
• Engage in activities that recharge you and bring you self joy.
• Eat healthy, get adequate sleep, and exercise.
• Recognize that you have limited control over people’s pain and suffering that you cannot alter.
• Set realistic goals for yourself regarding your work and caregiving efforts. Making small, achievable goals can bring great satisfaction, but know that you are just one person and cannot always meet everyone’s needs. Make priorities and write your goals down in a place where you will see them often.
• Take action to make the environment around you more positive: Play your favorite songs, treat yourself to flowers, and place your favorite photos in prominent places. Do things that will make you feel better and lift your mood and spirit.
• Articulate gratitude for the positive things about your life. Many people keep a daily gratitude journal. Identify something each day that is satisfying or makes you feel good. It can be as small as someone giving you a compliment or you completing a task or achieving a personal goal, allowing you a moment to celebrate yourself.

How to Support a Loved One Who Is Experiencing Compassion Fatigue

Recognize that a loved one who is in a high risk group can be vulnerable to compassion fatigue. Watch for the warning signs and changes in behavior and personality. It is easy to overlook symptoms if you are not paying close attention. Do not allow silence and denial to continue for too long. These dynamics can cause the person who has compassion fatigue and family members to become increasingly isolated, frustrated, and angry. Remember one of the challenges of this diagnosis is people who have it may be in denial.

Gently inquire if you have concerns about a loved one and you see worrisome behavioral changes that are impacting them and their relationships. If a loved one is constantly talking about work in negative terms or seems to dread going into work encourage them to discuss this with you. You may need to take this first step to help them to explore the struggles they are having more honestly and productively. If your loved one is assuming a caregiver role in their personal life identify ways you can help ease the burden of caregiving that is occurring outside of work.