Compassion fatigue is a condition that impacts many professions and caregivers in trauma-informed organizations. Medical or healing professions, first responders, law enforcement, therapists, nurses, and other service providers are the most commonly affected by compassion fatigue and empathic distress. Often confused with burnout, compassion fatigue includes emotional, cognitive, physical, behavioral, religious and spiritual reactions due to helping clients, patients or victims, typically through stressful or traumatic events. Those who deal with other people’s trauma, grief or life crisis every day may experience compassion fatigue.

Professionals who deal with people suffering from stress or trauma on a regular basis can experience fatigue as they empathize with those they are helping. It’s a hazard of the job and can manifest as extreme tiredness, exhaustion, and the loss of empathy for patients. Two aspects of compassion fatigue are burnout and secondary traumatic stress. Burnout occurs from having too much work, too many responsibilities, and not enough resources. Secondary traumatic stress occurs from experiencing the same stress as the person who experienced the primary trauma.

Warning signs to watch for when working in trauma-informed care

Compassion fatigue is a gradual process that takes time to manifest. It slowly drains compassion, empathy, and emotional reserves until there is nothing left to give while working in trauma-informed care. Because it affects the ability to do their job, anyone in this type of work should be watchful for indications that compassion fatigue may be developing. Here are some signs to watch for:

• Providing counseling that exposes you to serious or extreme issues
• Being threatened physically or verbally while providing care
• Being confronted with a person in your care threatening suicide or ending their life
• Treating patients or clients in dangerous situations
• Providing support to someone who is depressed
• Providing ongoing care for patients who are terminally ill, grieving, or experiencing prolonged grief disorder
• Caring for a patient with a sick child or a child that died
• Providing assistance while under a lot of stress, with a lot of work responsibilities, or long work hours
• Feeling completely mentally and physically exhausted
• Feeling hopeless or powerless

Compassion fatigue develops when these triggers and events start to impact your thinking, emotions, and well-being when not at work. It’s natural for caregivers to be affected by their work, but when you begin to be overwhelmed, you may be suffering from compassion fatigue.

Even though the symptoms can be depressing and frightening, there are self-care actions you can take to get better. Knowing what signs to watch for, taking preventative precautions, and getting treatment will help.

15 Top Symptoms of Compassion Fatigue

Compassion fatigue can be physically, mentally, spiritually, and emotionally draining for those who suffer from it. It manifests itself in a variety of ways, including:

1. Poor job satisfaction
2. Emotional numbness
3. Feeling anxious
4. Depressed
5. Not being able to sleep
6. Lack of appetite or nausea
7. Getting angry or easily irritable
8. Feeling detached from everything
9. Headaches and body aches
10. Changes in mood, drastic mood swings
11. Thinking pessimistic or negative thoughts
12. Not being productive, unable to concentrate
13. Self-medicating, drinking, gambling, or working too much
14. Neglecting relationships and friendships, feeling emotionally disconnected
15. Moral injury, where you blame yourself while thinking you’re not doing enough to help those who are suffering

Strategies for Treating Compassion Fatigue

Ways to prevent and handle compassion fatigue

If left untreated, compassion fatigue symptoms can progress to mental health issues. You can’t help other people if you aren’t first helping yourself. Taking care of your own physical and mental health is important when your job is to provide care for others. Here are some ways to stay healthy while working in trauma-informed care.

• Make meaning of your work
• Experience moments of awe in nature such as standing near water or looking at the sky
• Find a balance between work and your personal life
• Take adequate time off to rest and replenish
• Choose to follow healthy routines – get enough sleep, eat healthy foods, exercise regularly
• Foster healthy relationships
• Be aware of how traumatic or stressful information affects you physically and mentally
• Practice being grateful every day
• Focus on living in the present

Realize that other people’s suffering and pain is a part of life and you don’t have any control over it. Instead, focus on the things you do have control over – your own physical and mental health. Consider going to a mental health professional for help.

The bottom line

If you try to help others without replenishing yourself, you can easily become overwhelmed and experience compassion fatigue. Be watchful for the signs and symptoms and take steps to eliminate it by making yourself the priority. Consider taking care of yourself as a partnership. If you take better care of yourself then you will be better able to take care of others. It’s a win-win!

Symptoms can mirror post-traumatic stress disorder, along with psychological distress, muscle tension, and cognitive shifts. Although some signs overlap, for the most part, signs of burnout are anger, frustration, cynicism, negativity, and withdrawal.

Differences between compassion fatigue and burnout

There are four major differences between compassion fatigue and burnout.

1. Compassion fatigue is caused by the exposure of traumatic material. Burnout is caused by work-related attributes such as the job, coworkers, one’s supervisor and poor work culture.
2. Compassion fatigue has a rapid onset and can be felt after the first experience of absorbing one’s traumatic material. Burnout emerges gradually over time as the work-related attributes such as too much paperwork, lack of resources, and long shifts, pile up.
3. Compassion fatigue is a term that describes the impact of helping others. Burnout is a term that describes the impact of a stressful workplace.
4. Compassion fatigue has a quicker recovery time than burnout, if managed early. Burnout has a longer recovery time.

Burnout Case Study

In order to assess and intervene with issues of burnout, the following case study can be incorporated into one’s learning.

Everly, a 34-year-old, was once enthusiastic about their career and was engaged in the workplace. They considered themselves a good fit for their job. Everly goes to the gym every morning and takes care of their health. They are goal driven and look forward to moving up the ladder in their company. Being single, Everly feels as though she has the time to work long hours and often takes work home. Everly hardly ever says no to coworkers or their supervisor. Everly does not drink alcohol or partake in drug use.

Everly is facing several challenges. Everly’s career is not moving forward, as there is no room for advancement. Everly does not feel as though her supervisor has clear expectations. Being micromanaged, they have limiting control over their own work. Everly has been asked to perform tasks that do not match their job description, which adds to their frustration. Everly explains that they do not delegate, even though they have a lot of work to do, nor do they take breaks. Their hopes for achieving their goals deteriorate. One of the problems being faced is stagnation. Although Everly has several friends, they bottle up their feelings. They recognize the need for a survival strategy to continue to do their work.

You know that Everly has become frustrated that they cannot make decisions about their schedule. They have lost control, feel bored, apathetic, and indifferent about their role. They have stopped feeling engaged and are no longer connected to their workplace. Everly’s work culture is not in sync with their values. Overall, Everly lacks the morale to do their job and is burned out.

Questions
1. In regard to what has been described, what are your feelings about Everly?
2. What do you know about Everly so far?
3. What are you worried about as you provide support to Everly?
4. What are the identified issues in this case study?
5. Considering the context of Everly’s life, what specific factors might place Everly at risk for burnout?
6. What questions might you ask Everly to fully assess the extent of her burnout?
7. What self-care strategies would you recommend to manage burnout?
8. What might be a reasonable goal?

Organizations need to understand both job burnout and compassion fatigue and be mindful of their employee wellbeing. Otherwise, job turnover will impact their bottom line.

I define compassion fatigue as a palette of grief® where there is a blending of physical, emotional, cognitive, behavioral, and spiritual reactions due to empathetic engagement with those who are grieving or traumatized while neglecting one’s own self-care. Compassion fatigue can occur after one exposure to traumatic material or many exposures to traumatic material. This can occur whether working with adults, children, or animals. When a person works in a field where they are exposed to another person’s suffering, they can experience a change in their mental and physical state.

Empathic distress and job satisfaction

When a person experiences compassion fatigue they may no longer be satisfied with their job. There is a link between job satisfaction and compassion satisfaction. The more job satisfaction one has, the less compassion fatigue that they will have. If people are not satisfied with their job, there is a higher chance of increased absenteeism or leaving the field that they once loved.

When a person cares about traumatized people or those who are suffering, they need to recognize the compassion fatigue definition, as it guides them as they offer an empathetic presence. First responders, those who work in the courts, health care professionals, clinicians, and victim advocates, are caring and compassionate individuals. From the very first day on the job, they need to be mindful of their personal wellbeing.

Occupations at higher risk for empathic distress

Occupations that have a higher risk of compassion fatigue include those who work in healthcare, mental healthcare, emergency, animal cruelty, the courts, and victim services. These occupations are often exposed to traumatic material. Victim service providers, helping professionals, emergency and community service workers, and health care providers with a high level of empathy can bring have compassion fatigue. They are at risk for exhaustion and a diminished decision-making ability. This is especially true when they are aware of what is needed, want to provide help, but feel helpless to solve the issues that the person is facing.

Certain triggers for compassion fatigue are previous exposure to trauma, extending emotional energy while being present for someone experiencing severe issues, being personally threatened while providing care, or working in a dangerous environment. Other triggers are listening to someone who is depressed or managing the illness of their child. Furthermore, triggers can occur while visiting an accident scene, a suicide, or deal with evidence or reports of trauma and abuse.

Common signs of compassion fatigue

What is compassion fatigue? To answer that question, we must recognize signs that a helper is experiencing it. One sign of compassion fatigue is no longer feeling sympathetic toward others. Helpers may work in situations where people are traumatically bereaved due to a sudden loss such as suicide, homicide, drug misuse death, or accident.

Those impacted by compassion fatigue may no longer feel sympathy for those touched by sorrow. Their level of empathy can be reduced. Common signs are feeling exhausted, angry, and irritable. If they are using negative coping behaviors like drinking, drug abuse, smoking, or gambling, their compassion fatigue is not being managed in a healthy way. It is imperative that they have ways to manage these signs and need positive coping mechanisms rather than negative ones.

If you work in a capacity that puts you at risk for compassion fatigue, Barbara Rubel has training to help you identify symptoms and create a plan for self care.

Practice self-care

Helpers impacted by compassion fatigue often see and hear things that most people would have a difficult time seeing or hearing. Helpers are often exposed to those who are grieving or traumatized, and that experience can take a toll. When they are dedicated and want to help those who experience pain or sorrow, they can become exhausted by that interaction and experience acute symptoms that challenge their physical and mental health. For that reason, helpers need to identify ways compassion fatigue affects their overall health.

When a helper is compassionate, they may choose to work extra shifts, or not take days off from work. It is imperative that they do self-care to manage compassion fatigue symptoms that can disrupt their life. Symptoms include disrupted sleep which might cause them to be tired while doing their job.