Survivor’s guilt can occur when someone survives a life-threatening situation while others don’t. They may feel a sense of responsibility or find themselves grappling with questions of why and how. This is especially true if they think they could’ve prevented or changed the outcome.1 Counseling is a valuable tool to help survivors understand and overcome their guilt.
What Is Survivor’s Guilt?
Survivor’s guilt is a symptom of post-traumatic stress disorder (PTSD); however, people can have survivor’s guilt without a PTSD diagnosis. The pain and despair resulting from a traumatic event can become difficult to cope with especially when it involves loss of life. Guilt is frequently associated with serious trauma and tragic deaths, but there are groups of people who are at higher risk of experiencing survivor guilt.
“Any event that leads to someone’s death is a potential source for survivor’s guilt. When there is a sense of randomness as to why one person perished and another survived, the survivor often feels unworthy of being ‘chosen’ to live,” says David J. Chesire, PhD, Director of the Center for Healthy Minds and Practice (CHaMP). “This is especially true if the survivor feels in some way responsible for the event occurring in the first place, for example a drunk driver in a car accident, or a COVID survivor that passed on the virus to others.”
These groups of people are at risk of developing survivor’s guilt:
- Combat veterans
- Survivors of crashes
- Survivors of natural disasters like floods, tornadoes, or fires
- Survivors of serious medical illnesses like cancer
- People who witness or are a part of a traumatic event like a mass shooting
- Parents who outlive their children
- First responders
- Holocaust and other survivors of genocide
- Refugees
9 Symptoms of Survivor’s Guilt
Severity and duration of symptoms varies between people. Initially, they may feel gratitude for being alive, but as they start to relive the experience, they may experience regret, blame, shame, and guilt. Circumstances vary, but when a survivor believes they could’ve changed the outcome of someone’s else’s death or someone dies helping them, they tend to question the reason they survived.
“Survivor’s guilt is especially likely if someone has experienced what we call a ‘near miss’ event–that is, almost suffering some negative consequence, but narrowly avoiding it,” says Dr. Michael J. Poulin, Associate Professor in the Department of Psychology at College of Arts and Sciences at University at Buffalo. “This can lead people to question why they were spared while someone else was not, leading to repetitive distressing thoughts including a feeling of reliving the near-miss event.”
Nine common symptoms of survivor’s guilt are:2
- Obsessive thoughts about the traumatic event
- Having flashbacks
- Feeling irritable
- Having difficulty sleeping
- Feeling immobilized, numb, and/or disconnected
- Feeling helpless
- Having suicidal thoughts
- Having an intense sense of fear
- Experiencing physical symptoms such as headaches, stomachaches, and palpitations
Causes & Risk Factors
The majority of people who experience and survive a traumatic event associated with loss of life experience guilt, but some risk factors have a causal relationship. These include instances that involve a loss of control or situations that result in confusion, debilitating injury/pain, helplessness, or inability to combat the threat. Researchers have also discovered that cumulative stress (such as exposure to multiple traumatic events) poses a risk factor for mental health issues including greater suffering and functional impairment due to shame and guilt.3
Dr. Chesire adds, “Anyone with a history of trauma or exposure to trauma is particularly at risk for experiencing survivor’s guilt. Other’s at risk are people who are isolated or have poor social support are at risk, as are people with poor coping skills. Often people with inadequate social support or have insecure housing can fall into these groups. People who have an inflexible moral code, believing that something is right/wrong or good/evil may have difficulty finding the nuances necessary for uncovering existential meaning in chaotic events.”
Risk factors that may make an individual more susceptible to survivor’s guilt are:
- Previous history of childhood trauma
- Pre-existing mental health history of depression, anxiety, or suicidal ideation
- Current or past problems with alcohol or drug abuse
- Having a limited support system
- Low self-esteem
7 Ways to Cope With Survivor’s Guilt
Survivor’s guilt is a common, understandable human reaction to surviving life-threatening trauma, but people cope with it in different ways. There are several strategies used to help people cope with the impact and consequences of survivor’s guilt.
Here are seven strategies for coping with survivor guilt:
- Give yourself permission to grieve and experience whatever feelings you are having. Allow yourself to do this without self-judgement. Practice self-forgiveness. Don’t put time limits on your feelings of loss and grief. It takes time to process these painful emotions.
- Remind yourself that it’s normal to have these feelings. Don’t chastise yourself for being human and feeling self-doubt or self-recrimination. Acknowledging these feelings is the first step toward some type of healing.
- Consider thinking about who was really responsible, if anyone
- Remind yourself that you were given the gift of survival and allow yourself to feel happy about that
- Try to be of service to someone or something by engaging in a purposeful action4
- Consider how the people you love feel about your survival. Even if you suspect that you shouldn’t still be alive, remind yourself of who would be devastated if you weren’t
- Reach out to family and friends who you trust and feel comfortable sharing your feelings with
How to Help a Friend or Loved One
If you have a friend or loved one who is struggling with survivor’s guilt, it’s important that you not try to downplay what they are experiencing. Their feelings of guilt are serious and will take time to process.
Chesire recommends, “First and foremost, accept that what the other person is feeling is a valid response to a chaotic circumstance. We should not try to dismiss the other person’s sense of guilt and shame. Rather, offer support and try to help them find meaning in their survival. Perhaps encourage the survivor to work for a cause to help others. A drunk driver might focus on encouraging others to drive safely. A COVID-19 survivor might focus on helping others to get vaccinated. Such activities help form a sense of meaning as to why a person survived the event.”
Professional Treatments for Survivor’s Guilt
Treatment for PTSD usually involves some kind of therapy. Reach out to a mental health professional if the consequences of your survivor’s guilt remain or worsen. Consider using Choosing Therapy’s online directory to look for a therapist who specializes in trauma, PTSD, grief, and loss.
Two treatment options for survivor’s guilt are:
- Cognitive behavioral therapy (CBT): This type of therapy focuses on changing patterns of self-blame or negative thinking. It teaches patients to restructure the thoughts that cause these negative outcomes and focus on the present. It also incorporates mindfulness techniques to help heighten awareness of emotions and feelings.
- Eye movement desensitization and reprocessing therapy (EMDR): This therapeutic treatment was designed to help patients cope with symptoms stemming from a traumatic event. It facilitates the accessing and processing of traumatic memories and other adverse experiences. Affective distress is relieved, negative beliefs are reformulated, and physiological arousal is reduced.6
Additional Resources
- Facebook Covid-19 Loss Support For Family & Friends
- Trauma Survivors Network peer support group
- Substance Abuse and Mental Health Services Administration (SAMHSA)
- Online Therapist Directory: Sort therapists by specialty, cost, availability and more. Watch intro videos and see articles written by the therapists you’re considering working with. When you’ve found a good match, book an online therapy appointment with them directly.
Are you ready to connect with a therapist but feel a little overwhelmed by all your options? Speak with one of Choosing Therapy’s Client Navigators. Client Navigators are mental health professionals who will listen to what you’re looking for in a therapist and help pair you with the best possible fit. Getting started is free, easy, and confidential.
