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Survivor’s Guilt: Why It Happens & 7 Ways to Cope

Published: August 12, 2021 Updated: May 18, 2023
Published: 08/12/2021 Updated: 05/18/2023
Headshot of Iris Waichler MSW, LCSW
Written by:

Iris Waichler

MSW, LCSW
Headshot of Rajy Abulhosn, MD
Reviewed by:

Rajy Abulhosn

MD
  • What Is Survivor’s Guilt?Definition
  • Symptoms of Survivor’s GuiltSymptoms
  • Causes & Risk FactorsCauses
  • Ways to Cope With Survivor’s Guilt8 Tips
  • Professional Treatments for Survivor’s GuiltTreatment
  • Additional ResourcesResources
  • Survivor’s Guilt InfographicsInfographics
Headshot of Iris Waichler MSW, LCSW
Written by:

Iris Waichler

MSW, LCSW
Headshot of Rajy Abulhosn, MD
Reviewed by:

Rajy Abulhosn

MD

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.

Therapy can help you recover from trauma. BetterHelp has over 20,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp starts at $60 per week. Complete a brief questionnaire and get matched with the right therapist for you.

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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.

David J. Chesire, PhD, Director of the Center for Healthy Minds and Practice (CHaMP)“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.

Dr. Michael J. Poulin Associate Professor Department of Psychology College of Arts and Sciences at University at Buffalo“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

  1. Obsessive thoughts about the traumatic event
  2. Having flashbacks
  3. Feeling irritable
  4. Having difficulty sleeping
  5. Feeling immobilized, numb, and/or disconnected
  6. Feeling helpless
  7. Having suicidal thoughts
  8. Having an intense sense of fear
  9. Experiencing physical symptoms such as headaches, stomachaches, and palpitations

Help For Grief & Loss

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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:

  1. Previous history of childhood trauma
  2. Pre-existing mental health history of depression, anxiety, or suicidal ideation
  3. Current or past problems with alcohol or drug abuse
  4. Having a limited support system
  5. 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:

  1. 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.
  2. 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.
  3. Consider thinking about who was really responsible, if anyone
  4. Remind yourself that you were given the gift of survival and allow yourself to feel happy about that
  5. Try to be of service to someone or something by engaging in a purposeful action4
  6. 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
  7. 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. When helping a grieving friend, know that 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

Education is just the first step on our path to improved mental health and emotional wellness. To help our readers take the next step in their journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy may be compensated for marketing by the companies mentioned below.

Online Therapy 

BetterHelp Get support and guidance from a licensed therapist. BetterHelp has over 20,000 therapists who provide convenient and affordable online therapy.  Complete a brief questionnaire and get matched with the right therapist for you. Get Started

Virtual Psychiatry

Talkiatry Get help from a real doctor that takes your insurance. Talkiatry offers medication management and online visits with expert psychiatrists. Take the online assessment and have your first appointment in days. Free Assessment

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A free newsletter from Choosing Therapy for those impacted by the loss of a loved one. Get encouragement, helpful tips, and the latest information. Sign Up

Choosing Therapy partners with leading mental health companies and is compensated for marketing by BetterHelp and Talkiatry.

For Further Reading

  • Facebook Covid-19 Loss Support For Family & Friends
  • Trauma Survivors Network peer support group
  • Substance Abuse and Mental Health Services Administration (SAMHSA)

Survivor’s Guilt Infographics

Survivor’s Guilt: Why it Happens and Ways to Cope What is Survivor’s Guilt Who are Most at Risk of Developing Survivor’s Guilt

Survivor’s Guilt and PTSD Symptoms of Survivor’s Guilt Risk Factors of Survivor’s Guilt

Ways to Cope with Survivor’s Guilt Getting Help for Survivor’s Guilt

5 sources

Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.

  • Lindsey Phillips. Relieving the heavy burden of survivor guilt. Counseling Today, June 27, 2019. Retrieved from https://ct.counseling.org/2019/06/relieving-the-heavy-burden-of-survivor-guilt/

  • Hutson SP, Hall JM, Pack FL. Survivor guilt: Analyzing the concept and its contexts. ANS Adv Nurs Sci. 2015;38(1):20-33. doi:10.1097/ANS.0000000000000058

  • Sabrina J. Stoltz, Thomas Elbert, Veronika Muller, Maggie Schauer. The relationship between trauma, shame, and guilt: findings from a community- based study of refugee minors in Germany. European Journal of Psychotraumatology. June 22, 2105. Doi: 10.3402/ejpt.v6.25863. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4478074/

  • Darlington, Richard & Macker, Clifford. (1966). Displacement of guilt-produced altruistic behavior. Journal of personality and social psychology. 4. 442-3. 10.1037/h0023743.

  • Eye Movement and Processing Institute (EMDR Institute) What is EMDR? Retrieved from https://www.emdr.com/what-is-emdr/

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Headshot of Iris Waichler MSW, LCSW
Written by:

Iris Waichler

MSW, LCSW
Headshot of Rajy Abulhosn, MD
Reviewed by:

Rajy Abulhosn

MD
  • What Is Survivor’s Guilt?Definition
  • Symptoms of Survivor’s GuiltSymptoms
  • Causes & Risk FactorsCauses
  • Ways to Cope With Survivor’s Guilt8 Tips
  • Professional Treatments for Survivor’s GuiltTreatment
  • Additional ResourcesResources
  • Survivor’s Guilt InfographicsInfographics
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