Compassion Fatigue

Compassion Fatigue

Verified by World Mental Healthcare Association

Compassion fatigue is a condition characterized by the diminished ability to empathize or feel compassion toward others due to emotional and physical exhaustion. This condition is often described as “the negative cost of caring”.

What Is Compassion Fatigue?

Compassion fatigue, also referred to as secondary traumatic stress, is a condition that occurs due to emotional and physical exhaustion. According to the American Psychological Association, it can be defined as “the burnout and stress-related symptoms experienced by caregivers and other helping professionals in reaction to working with traumatized people over an extended period of time.” Although this condition is sometimes referred to as burnout, it is a different concept altogether. Burnout and secondary traumatic stress, according to the Professional Quality of Life Scale, are two intertwined components of compassion fatigue. Burnout is the stress and mental exhaustion that one experiences by the inability to cope with the environment and continuous physical and mental demands.

This term was first coined by Carla Joinson in 1992 to describe the negative impact that hospital nurses were experiencing as a result of their repeated and daily exposures to patient emergencies. So in order to ensure that there are no negative consequences from this condition, the individual must take time to take care and pay attention to their feelings and emotions. Some studies 1 even confirm that healthcare professionals with this condition may even develop substance abuse and suicidal thoughts.

Understanding Compassion Fatigue

People who experience this condition experience a variety of symptoms that includes low concentration, numbness, feelings of helplessness, irritability, withdrawal, aches, and pains or work absenteeism. Sometimes, healthcare professionals or other people with this condition find it difficult to continue their jobs. They also experience symptoms of depression, stress, and trauma. The onset of this condition can be sudden. However, compassion fatigue is highly treatable, and preventive measures can be adopted in the daily routine to avoid developing this condition.

Practicing mindfulness and self-monitoring in order to recognize changes in work, behavior, and life is the first step towards prevention. Instead of focusing on self-doubt, it is important to self-reflect in order to develop coping strategies.

Stress reduction and anxiety management have proven effective in preventing and treating this condition. Social and emotional support are also important for anyone who is suffering from this condition. Psychologist Heidi Allespach, Ph.D., University of Miami’s Miller School of Medicine explains “caregivers can become so over-empathic that they find themselves growing numb to their patients suffering.” This is why she advises her students to develop a “semi-permeable membrane” around their hearts. She explained, “without enough shield, everything just comes in, and being overwhelmed with the feelings of others can feel like drowning”.

For therapists with this condition, it can have ethical and legal complications, especially if there are patients under their care that are not benefiting from the services. There are several factors why psychiatrists are at great risk of developing this condition. They are:

  • Specializing in therapy that exposes them to extremely stressful issues
  • Being threatened physically by a person under their care
  • A patient under their care dying by suicide
  • Providing therapy to someone who is dangerous
  • Working with people who experience depression and/or child abuse
  • Specializing in treating grief, death, and bereavement
  • Providing therapy who has experienced the death of a child or a child who is dying

Hence, it is important to seek medical assistance in case the individual is experiencing any symptoms. With treatment and support, it is possible to recover from this condition. This will enable them to give the best care possible to their patients.

Burnout vs. Compassion Fatigue

Burnout is caused by the stress that healthcare professionals experience when interacting with their surroundings. Compassion fatigue occurs when a healthcare professional is repeatedly exposed to traumatic situations, leading to a feeling of hopelessness or numbness.

The main signs and symptoms 2 of burnout are emotional exhaustion, a sense of ineffectiveness, or dissatisfaction with work. All these symptoms result in cynicism and detachment from work. Other symptoms can include poor sleep, difficulty in concentrating, a social withdrawal which can lead to interpersonal conflicts, poor judgment, and addictive behavior. Physicians with burnout are more likely to make errors that lead to low quality patient care. Young physicians who have people dependent on them (wife or children) may experience difficulty in maintaining a work-life balance but are not dissatisfied with work.

Compassion fatigue comprises people or health care workers who are unable to care for their patients due to symptoms that are similar to post traumatic stress disorder (PTSD). Signs and symptoms may include chronic physical and emotional exhaustion, impaired behavior and judgment, or loss of self-worth. They may avoid situations where patient suffering is involved and intrusive thoughts or dreams of distressing situations. Physiologic distress may occur when they are working with dying patients.

Read More About Post-Traumatic Stress Disorder (PTSD) Here

Professions Are At Risk Of Developing Compassion Fatigue

Professions Are At Risk Of Developing Compassion Fatigue
Compassion Fatigue

A 2011 study 3 suggested that people working with victims of disasters, trauma, illness, especially in the healthcare industry are more likely to develop this condition. Other professions that may be at risk of developing this condition include:

  • Child protection workers
  • Veterinarians
  • Teachers
  • Social workers
  • Palliative care workers
  • Journalists
  • Police officers
  • Firefighters
  • Animal welfare workers
  • Public librarians
  • Health unit coordinators
  • Paramedics
  • Students affair professionals
  • Nurses
  • Oncologists
  • Psychiatrists
  • People who are overly conscientious or perfectionist
  • Those who have low levels of social support
  • People who work in a helping or healing capacity
  • Lawyers who practice in areas that involve investigating accident scenes or deal with reports of trauma
  • People who have high levels of stress in personal life

Prevalence Of Compassion Fatigue

A study 4 found that more than 25 percent of ambulance paramedics were identified to have severe ranges of post traumatic symptoms and compassion fatigue. 34 percent of hospice nurses in another study met the criteria for secondary traumatic stress or compassion fatigue. Two studies 5 reported that the prevalence rate of this condition was 7.3 percent and 40 percent respectively.

Signs Of Compassion Fatigue

Signs Of Compassion Fatigue
Compassion Fatigue

This condition can take a huge toll on the emotional, spiritual, physical, and mental toll on someone. The common symptoms of this condition include:

1. Physical And Emotional Symptoms

  • Chronic physical and emotional exhaustion
  • Depersonalization
  • Feelings of inequity towards any caregiver relationship
  • Irritability
  • Feelings of self-contempt
  • Difficulty sleeping
  • Weight loss
  • Headaches
  • Poor job satisfaction
  • Nervous system arousal
  • Emotional intensity increases
  • Cognitive ability decreases
  • Impaired behavior and judgment
  • Isolation and loss of morale
  • Depression and post-traumatic stress disorder (PTSD)
  • Loss of self-worth and emotional modulation
  • Identity, worldview, and spirituality impacted
  • Loss of hope and meaning
  • Anger towards perpetrators or casual events
  • Aches and pains
  • Numbness
  • Low concentration

Read More About Major Depressive Disorder (Depression) Here

2. Organizational Symptoms

  • Work absenteeism
  • Constant changes in the relationship between co-workers
  • Being unable to work in teams
  • Breaking company rules
  • An outbreak of aggressive behavior among staff
  • Being unable to complete tasks and assignments
  • Inability to meet deadlines
  • Lack of flexibility among employees
  • Strong reluctance to change
  • The inability of staff to trust that improvement is possible
  • Lack of vision for the future

Causes Of Compassion Fatigue

Causes Of Compassion Fatigue
Compassion Fatigue

There can be several causes for developing this condition, especially for people working in the healthcare industry. One study 6 suggested that 86 percent of emergency room nurses met the criteria for compassion fatigue. Some of the causes include:

1. Critical Care Work

People who work in the healthcare industry, especially nurses and doctors experience trauma every day and repeated exposure can be a cause of this disorder. The emotional and physical distress caused by treating patients that need critical care can desensitize health care professionals. This can cause a lack of empathy for future patients

2. High Mortality Rates

Some healthcare workers who work with cancer patients or terminal cases can develop this condition due to the high mortality rates of patients. The constant loss of patients can take an emotional and physical toll on these healthcare workers. They tend to think that their efforts are futile due to the constant loss of patients under their care.

3. Lack Of Support

Healthcare workers who lack peer support are more likely to experience compassion fatigue. The spouse or other peers can be an escape from the daily trauma that they experience. Sometimes the partners or fellow peers cant process the grief and confusion that is being shared by them. This can become a cause of developing this condition.

4. Stress At Home

Working for these professionals is emotionally and physically draining. Hence, home can be the only place to recharge their mental health. Sometimes stressful situations at home can leave them feeling hopeless and drained. Thus, this can be a cause of developing this condition.

Read More About Stress Here

Diagnosis Of Compassion Fatigue

The first step towards recovery is to seek professional assistance in case you are experiencing any symptoms. The psychiatrist will evaluate you and ask you questions about your work and its effects on your behavior. This will help him to devise an effective treatment plan. They may also refer to the following scales used for assessment of this condition:

  • Professional Quality of Life Measure
  • Compassion Fatigue and Satisfaction Self Test for Helpers
  • Maslach Burnout Inventory

Treatment For Compassion Fatigue

There are several measures that can help to treat patients with this condition. They can include:

  • Talking about feelings to a trusted friend or a mental health professional
  • Regularly exercising
  • Developing a healthy diet
  • Getting restful sleep
  • Developing hobbies that are not relevant to work
  • Developing coping strategies
  • Joining support groups and networks

Prevention For Compassion Fatigue

Prevention For Compassion Fatigue
Compassion Fatigue

Even though the individual can’t avoid what happens at work, there are definitely some preventive measures you can take to feel empathy towards those who need it. They are as follows:

  • Reducing stressful workloads
  • Monitoring sleep patterns
  • Taking regular vacations
  • Meditation
  • Journaling
  • Seeking personal therapy for work problems
  • Regular exercise
  • Stress and anxiety management practices
  • Taking a break from work
  • Practicing self-compassion and self-care
  • Cultivate healthy friendships outside of work
  • Build your resiliency
  • Routine check-ins
  • Onsite counseling

Read More About Meditation Here

Recovery From Compassion Fatigue

It is not uncommon for a healthcare worker or someone from the healing industry to experience the symptoms of this condition. If left untreated, it can significantly impact emotional and physical health. However, it is important to keep in mind that the first step towards healing is to seek help. With some positive changes in the daily routine and therapy, it is possible to recover from this condition.

Compassion Fatigue At A Glance

  1. Compassion is typically characterized as a reduced ability to empathize or feel compassion for others as a response to emotional and physical exhaustion.
  2. Impaired focus, numbness, feelings of helplessness, impatience, withdrawal, body aches, or job absenteeism are all symptoms of this condition.
  3. Compassion fatigue is more likely to take place among healthcare professionals who lack peer support. They are unable to process grief and frustration, which can be a  contributing factor to the development of this condition.
  4. Burnout occurs as a result of stressful encounters, whereas compassion fatigue develops when a person is repeatedly exposed to traumatic situations, leaving them feeling hopeless or numb.
  5. The first step toward preventing compassion fatigue is to practice mindful meditation and self-monitoring in order to identify changes in work, behavior, and life.
👇 References:
  1. Moss, M., Good, V. S., Gozal, D., Kleinpell, R., & Sessler, C. N. (2016). An official critical care societies collaborative statement: Burnout syndrome in critical care health care professionals: A call for action. American Journal of Critical Care, 25(4), 368-376. https://doi.org/10.4037/ajcc2016133 []
  2. Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual review of psychology, 52, 397–422. https://doi.org/10.1146/annurev.psych.52.1.397 []
  3. Day, J. R., & Anderson, R. A. (2011). Compassion fatigue: an application of the concept to informal caregivers of family members with dementia. Nursing research and practice, 2011, 408024. https://doi.org/10.1155/2011/408024 []
  4. Beck C. T. (2011). Secondary traumatic stress in nurses: a systematic review. Archives of psychiatric nursing, 25(1), 1–10. https://doi.org/10.1016/j.apnu.2010.05.005 []
  5. van Mol, M. M., Kompanje, E. J., Benoit, D. D., Bakker, J., & Nijkamp, M. D. (2015). The Prevalence of Compassion Fatigue and Burnout among Healthcare Professionals in Intensive Care Units: A Systematic Review. PloS one, 10(8), e0136955. https://doi.org/10.1371/journal.pone.0136955 []
  6. Hooper, C., Craig, J., Janvrin, D. R., Wetsel, M. A., & Reimels, E. (2010). Compassion satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialties. Journal of emergency nursing, 36(5), 420–427. https://doi.org/10.1016/j.jen.2009.11.027 []
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