“We have not been directly exposed to the trauma scene, but we hear the story told with such intensity, or we hear similar stories so often, or we have the gift and curse of extreme empathy and we suffer. We feel the feelings of our clients. We experience their fears. We dream their dreams. Eventually, we lose a certain spark of optimism, humor and hope. We tire. We aren’t sick, but we aren’t ourselves.”
– C. Figley, 1995



Compassion Fatigue
Also called “vicarious traumatization” or secondary traumatization (Figley, 1995). The emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events. It differs from burn-out, but can co-exist. Compassion Fatigue can occur due to exposure on one case or can be due to a “cumulative” level of trauma.

Cumulative process marked by emotional exhaustion and withdrawal associated with increased workload and institutional stress, NOT trauma-related.

Primary Traumatic Stress
Primary stressors are those inherent in the extreme event, such as what was immediately experienced or witnessed, especially those things most contributing to a traumatic response.


Mother Teresa Understood Compassion Fatigue

She wrote in her plan to her superiors that it was MANDATORY for her nuns to take an entire year off from their duties every 4-5 years to allow them to heal from the effects of their care-giving work.

Is it Burnout or Compassion Fatigue?

The Stages of Burnout have been identified as:

  • enthusiasm
  • stagnation
  • frustration
  • apathy

Not only are care givers vulnerable, but members of the team/family are as well. Caregivers/team members should not intentionally expose themselves to trauma, unless required to perform a mission.
Commonalitities of Burnout and Compassion Fatigue:

  • Emotional exhaustion
  • Reduced sense of personal accomplishment or meaning in work
  • Mental exhaustion
  • Decreased interactions with others (isolation)
  • Depersonalization (symptoms disconnected from real causes)
  • Physical exhaustion


Clear difference: Compassion fatigue has a more rapid onset while burnout emerges over time. Compassion Fatigue has a faster recovery (less severe, if recognized and managed early).

Symptoms of Compassion Fatigue
– Affects many dimensions of your well-being
– Nervous system arousal (Sleep disturbance)
– Emotional intensity increases
– Cognitive ability decreases
– Behavior and judgment impaired
– Isolation and loss of morale
– Depression and PTSD (potentiate)
– Loss of self-worth and emotional modulation
– Identity, worldview, and spirituality impacted
– Beliefs and psychological needs-safety, trust, esteem, intimacy, and control
– Loss of hope and meaning=existential despair
– Anger toward perpetrators or causal events

“First, you should understand that it’s a process. It’s not a matter of one day, you’re living your life with a great deal of energy and enjoyment, and the next, you wake up exhausted and devoid of any energy – both physical and emotional. Compassion fatigue develops over time – taking weeks, sometimes years to surface. Basically, it’s a low level, chronic clouding of caring and concern for others in your life – whether you work in or outside the home. Over time, your ability to feel and care for others becomes eroded through overuse of your skills of compassion. You also might experience an emotional blunting – whereby you react to situations differently than one would normally expect.”

When Helping Hurts by F. Oshberg, MD



Chart: Compassion Fatigue Process



Tips for Managing Compassion Fatigue


Find someone to talk to.
Understand that the pain you feel is normal.
Exercise and eat properly.
Get enough sleep.
Take some time off.
Develop interests outside of medicine.
Identify what’s important to you.


Blame others.
Look for a new job, buy a new car, get a divorce or have an affair.
Fall into the habit of complaining with your colleagues.
Hire a lawyer.
Work harder and longer.
Neglect your own needs and interests.

— Source: Landstuhl Regional Medical Center



The ABC’s of Prevention

What types of cases contribute to your stress level increasing your vulnerability to compassion fatigue?

Think of events or situation that causes one to experience an unusually strong reaction and often overpowers one’s usual coping mechanisms.
Are you aware of any of these issues or contributing factors in your workday? If so, you could be at risk of compassion fatigue.
  • Ability to function is interfered with or altered.
  • Situation or incident does not seem “typical or ordinary”, it feels traumatic.
  • “Compassion stress” impinges upon or breaks through normal boundaries
  • Regularly waking up tired in the morning and struggling to get to work?
  • Feeling as if you are working harder but accomplishing less?
  • Becoming frustrated/irritated easily?
  • Losing compassion for some people while becoming over involved in others?
  • Routinely feeling bored or disgusted?
  • Experiencing illness, aches and pains?
Keep Balance in Your Life
  • Practice excellent self-care
  • Nurture yourself by putting activities in your schedule that are sources of pleasure, joy and diversion
  • Allow yourself to take mini-escapes- these relieve the intensity of your work
  • Transform the negative impact of your work (find meaning, challenge negativity, find gratitude)
  • Get medical treatment if needed to relieve symptoms that interfere with daily functioning- don’t use alcohol or drugs to self-medicate
  • Get professional help when needed to get back on track- we all need coaches and consultants at times
Balancing Excersise
  • List one mini-escape or diversion that worked well to restore and renew you
  • List one thing that brings you joy
  • Name 3 things you feel grateful for today
  • Think of something that has brought you a sense of joy (Make your top ten list)
  • Who do you love that you can reach out to today? (Call them!)
  • What made you laugh today? (Share it!)

Find Your Passion


  • We all have hidden sources of energy and healing power.
  • When you identify the things that fuel you, the things that you have true passion for, your fatigue will disappear.
  • Balancing your life involves putting the things that we value and have passion for in our schedule.
Balance For Your Soul
  • Have quiet alone time in a calm, beautiful place- a safe retreat where you feel renewed
  • Have an awareness of what restores and replenishes you.
  • Find ways to acknowledge loss and grief
  • Stay clear with commitment to career goals or your personal mission
  • Know how to focus on what you can control
  • Look at situations as entertaining challenges and opportunities, not problems or stresses

Talk out your stress- process your thoughts and reactions with someone else (coworker, therapist, clergy, friend, family, supervisor)

Build a positive support system that supports you, not fuels your stress

Pets accept whatever affection you are able to give them without asking for more—Pets are basically invulnerable to “provider burnout”–Blood pressure and heart rate decrease when interacting with animals