Compassion fatigue occurs when people have ongoing, direct contact with others who are in crisis or require significant support. People vulnerable to compassion fatigue include those in helping professions and those caring for people with significant chronic illness. These helpers internalize their empathy for an extended time period which can result in feelings of hopelessness, irritability, and emotional exhaustion.
Therapy and daily self care practices can help those who experience compassion fatigue to manage their emotions in healthier ways.
What Is Compassion Fatigue?
Compassion fatigue, sometimes called empathy 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.
Watching family members suffer 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.
Compassion Fatigue Vs. Burnout
Researchers define compassion fatigue as being a combination of burnout and secondary traumatic stress. These negative feelings usually have a gradual onset.1 Compassion fatigue has another distinguishing feature in that it can evolve after a single case of trauma, or from years of accumulated “emotional residue.”2 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, but there are fundamental differences. 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.
Research has shown that the key difference is the permanency of change to the person. Those who have experienced vicarious trauma have their brains permanently altered, while those with compassion fatigue typically recover more quickly.3 In addition, professionals with vicarious trauma questioned the value of their work and the importance of its impact on those they encountered.
Who Is at Risk for Developing Compassion Fatigue?
Helping professionals and chronic caregivers are the population that are most at risk for compassion fatigue. The nature of their jobs/caregiving roles means they devote themselves to caring, healing, and protecting the people they come in contact with.
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 found that those particularly susceptible to compassion fatigue include healthcare, emergency, and community service workers.4
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
Symptoms of 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).5 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, and outlines the common symptoms experienced during compassion fatigue.
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
Compassion Fatigue Examples
Some symptoms of compassion fatigue, such as feeling detached from others or less passionate about work, might overlap in various professions. Although compassion fatigue can look different for each individual, there are certain examples of compassion fatigue which may show up in multiple professions.
Compassion Fatigue in Nursing
If you experience compassion fatigue in the nursing profession, you may become irritable with patients. You may find yourself spending less time asking questions about their symptoms, or performing examinations or administering medications in a robotic manner. Also specific to the nursing profession, you may find that you are not able to feel as much empathy for patients or their families.
Additionally, you may find yourself less interested in consulting on cases with colleagues. You may find yourself falling behind on charting or administrative work. You may also find excuses to arrive to shifts late, and may feel less satisfied with your direct care with patients.
Compassion Fatigue in Hospice Care
If you experience compassion fatigue in hospice care, you may find yourself feeling exhausted or angry before meeting with patients or their families. You may also experience anxiety or panic before work shifts, which may result in more absences or asking colleagues to cover for your patients.
Since hospice care works directly with dying patients, you may find yourself dreading coming to work. You may avoid spending too much time with patients or their families, or find a reduced ability to feel empathy for their final moments. You may feel numb or restless performing tasks related to their final moments.
Compassion Fatigue for a Caregiver
If you experience compassion fatigue as a caregiver, you may become extremely irritable or impatient with your patient or loved one. Compassion fatigue may even manifest as neglect of their mental or physical care, such as avoiding feeding or bathing them. You may begin to feel hopeless about your loved one or patient’s condition, or even feel indifferent towards their symptoms or pain.
Compassion fatigue may also manifest as emotional abuse, such as yelling or name-calling, or physical abuse, such as hitting the patient or loved one. It is important to seek your own professional help before symptoms manifest to this intensity.
Is Empathy Fatigue Preventable?
Empathy fatigue happens as a result of empathizing for prolonged periods of time with patients or loved ones’ grief, pain, or other strong emotions. Empathy fatigue, simply put, is a person’s inability to care for others as they previously did. While avoiding strong emotions may not be possible in healthcare fields, you can have some control over reducing the negative effects of direct patient care.
Having a work-life balance can help reduce the effects of empathy fatigue. Having an awareness of your own mental and emotional well-being, perhaps through having your own therapist or counselor, will help you understand your own limits for experiencing other people’s emotions. Having some form of spiritual connection, whether to a higher power or just simply to others outside of your occupation, can also provide some relief.
How to Deal With 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.
Here are additional actions you should consider to help reduce the severity of compassion fatigue symptoms:
Utilize Healthy Self-Care Strategies
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 Your Work/Caregiving
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.
Make Your Surrounding Environment 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.
Focus on Gratitude
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.
Find Ways to Help Your Colleagues
Pay attention to the emotional well-being of your colleagues. If each of you are attuned to one another’s needs, you may be able to notice symptoms of compassion fatigue before they exacerbate. Learning to have frequent and open conversations about emotional well-being can help provide much-needed support in your work environment.
Focus on Compassion Satisfaction
Compassion satisfaction is a sense of fulfillment derived from caring for someone. Some studies indicate high levels of management support as indicative of higher levels of compassion satisfaction.7 Other factors of compassion satisfaction may include a perception of team cohesiveness and positive mood, or sociableness with colleagues.8, 9
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. Another major warning sign to watch for is “workaholism,” as many helpers become so dedicated to their caregiving work that they lose any balance between work and home.10
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.
Compassion Fatigue Treatment
There are many available options for support if you find that you are unable to address compassion fatigue on your own. 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. There may be people you know who can make recommendations, or your physician may be able to give you a referral. You can also use an online therapist directory, where you can sort by specialty and insurance coverage. The number of therapy sessions will be determined by the treatment goals you develop with your therapist.
The cost of therapy 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 they offer a sliding scale rate, especially if they aren’t covered by your insurance.
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.
Compassion Fatigue Infographics
