Secondary Trauma: Definition, Causes, & How to Cope

What Is Secondary Trauma?

Secondary trauma or second-hand trauma can occur if you are repeatedly exposed to particularly distressing details of the trauma experienced by others.³ Secondary traumatic stress (STS) disorder refers to experiencing a trauma response even though you didn’t experience the trauma directly yourself.¹ STS can occur after only one exposure to the details of another’s trauma or after repeated exposures.

Those who experience STS will have at least some of the symptoms that are commonly associated with post-traumatic stress disorder (PTSD). A small proportion of these individuals will experience full-blown PTSD as a result of secondary trauma exposure.³

Vicarious Trauma vs Secondary Trauma

Vicarious trauma refers to permanent changes in the way you view and make sense of the world as a result of the cumulative effects of working with trauma survivors over time.⁵ These changes can occur in five areas:

• Sense of safety
• Ability to trust others
• Self-esteem
• Intimacy
• Sense of control

Secondary Trauma vs Compassion Fatigue

Compassion fatigue is described as a consequence of STS. It is characterized by physical and mental exhaustion, and a loss of empathy or compassion for others, as a result of the ongoing “demands of being empathic and helpful to those who are suffering.”²

Burnout vs Secondary Trauma

Burnout is described as a response to prolonged interpersonal work-related distress (i.e., not specifically exposure to secondary trauma). It’s characterized by three components:^6,7

• Exhaustion: being emotionally and physically depleted or worn out
• Cynicism: becoming irritable, and developing negative or inappropriate attitudes toward your clients/patients
• Inefficiency: as a result of feeling overwhelmed and unable to cope, your work performance suffers

Secondary Trauma Symptoms

STS is the result of exposure to the details of someone else’s trauma, causing a traumatic stress reaction even though the trauma never happened to you directly. STS symptoms are identical to symptoms of PTSD, but you might only experience one type of symptom. Alternatively, you might experience several debilitating symptoms to the point of receiving a diagnosis of PTSD.

Potential symptoms include:³

• Intrusive symptoms: You might experience unwanted and painful trauma-related memories, dreams, and/or flashbacks. You might also experience distressing psychological or physical reactions to reminders of the trauma.
• Avoidance symptoms: You might find yourself actively avoiding anything that reminds you of the trauma (e.g., memories, thoughts, emotions, people/places/things, discussions, situations)
• Arousal symptoms: You might find that you are more irritable and prone to angry outbursts, possibly engaging in self-destructive or reckless behaviors. It could be difficult to relax, too. You might experience concentration difficulties, sleep problems, and an exaggerated startle response (e.g., when someone comes up behind you unexpectedly or walks in the room).

Causes of Secondary Traumatic Stress

STS reactions can result from exposure to the distressing details of the traumatic experience of others, such as sexual assault, physical assault, or a terrorist attack.

Potential causes of secondary traumatic stress are:

• Sexual assault
• Physical assault
• Child abuse or neglect
• Motor vehicle accident
• Act of nature (e.g., flood, hurricane, tornado)
• Terrorist attack
• Torture
• War atrocities
• A violent or gruesome death

Who Experiences Secondary Trauma?

Secondary trauma has been referred to as “the cost to caring” and was initially identified as an occupational hazard for mental health professionals due to repeated exposure to details of their clients’ traumas.^1,2 Over time, it was recognized as a risk for anyone who, in the course of their work or personal life, is exposed to the graphic details of trauma experienced by others.²

First Responders

Paramedics, police officers, and firefighters are often first on the scene to traumatic events. In the course of their work, they are repeatedly exposed to distressing details, images, and sounds of the trauma. In some cases, if the traumatic event was particularly disturbing, it might only take that one event to result in an STS and/or PTSD response. The general prevalence rate of STS among first responders has been found to be between 4-13%.⁸

Nurses & Physicians

Nurses and physicians who work in areas where they treat the injuries of trauma survivors are at risk for experiencing STS symptoms. In some cases, STS can contribute to burnout in these areas (such as nurse burnout, physician burnout, and therapist burnout).

Specific studies have indicated that:

• As many as 85% of nurses experience symptoms of STS^9,10
• 65% of surgeons experience at least one symptom of STS and 22% meet the criteria for PTSD¹¹
• Among emergency medicine staff (i.e., nurse practitioners, physicians and residents), 37% report mild to moderate symptoms of STS, while 8% reported severe symptoms¹²
• Mental Health Professionals

Social workers, psychologists, psychotherapists, professional counselors, and other mental health professionals who work with survivors of various types of trauma are at risk for developing STS reactions as a result of their exposure to the graphic details of their clients’ traumas, and empathy with their clients’ suffering. Up to 70% have experienced at least one symptom of STS and 15% met the criteria for a diagnosis of PTSD.¹³

Child Protection Workers

Witnessing the cruelty of caregivers towards vulnerable children can have a significant impact on the well-being of those whose job it is to try to protect them. Approximately 63% of child protection workers show some symptoms of STS and among these, 37% show moderate symptoms.¹⁴

Children of Traumatized Parents

If a child hears about the graphic details of their parent’s own trauma experiences (e.g., childhood abuse, a violent physical attack, living through a terrorist attack or war atrocity) they can experience STS and might even be diagnosed with PTSD if their symptoms are severe.³

STS can overlap with intergenerational trauma, which refers to trauma that occurs to one generation and continues to impact the generations that follow. This has been observed among the families of survivors of the Holocaust and Indigenous peoples who have experienced trauma. Unlike STS, it can occur regardless of whether details of the trauma are ever mentioned or referred to. Intergenerational trauma is believed to be transmitted through culture and/or the ways the parent interacts with the child.¹⁵

Family Members or Intimate Partners of Traumatized Individuals

Hearing the details and/or witnessing the suffering of a loved one who has been through a traumatic ordeal can result in STS. Although you weren’t exposed directly, you might also be traumatized and exhibit some symptoms of STS or meet the criteria for a PTSD diagnosis. For example, the family members of sexual assault survivors and the romantic partners of soldiers have shown STS symptoms.²

Other Occupations

Journalists, jurors, lawyers, researchers, and insurance claim workers who are in frequent contact with survivors of trauma and the details of their trauma are also at risk for developing STS reactions.²