Compassion Fatigue: The Toll of Caring Too Much

Compassion fatigue involves emotional and physical exhaustion that can affect people who have been exposed to other people's traumas or stressors. It is characterized by a decreased ability to empathize, feelings of helplessness, and burnout due to the demands of supporting those who are suffering. It is also sometimes referred to as secondary or vicarious trauma.

The ability to feel compassion and empathy for others is essential for prosocial behaviors and supportive interpersonal relationships.

“Authentic compassion, as opposed to being polite or nice, is a complex neuropsychological process that is related to frontal lobe executive functioning, the most recently developed and most complex of cognitive processes. To engage in compassion, you have to be cognitively present, understand one’s social surroundings, and be aware of one’s impact on others,” says Dr. Eric Zillmer, Professor of Neuropsychology at Drexel University.

For people who support those who are suffering, such as those who work in the helping professions, continual exposure to other people’s trauma can take a toll, making people feel that their well of compassion has been drained dry. Even when people want to empathize, they may find that they simply don’t have the emotional and physical resources to do so.

People who work in healthcare settings are often more susceptible, including nurses, doctors, first responders, home health aides, therapists, social workers, and other helping professionals. It can also affect caregivers who are responsible for the day-to-day care of a loved one with a medical or mental health condition.

What Are the Signs of Compassion Fatigue?

"While it is common for individuals working in professions that involve healing others to experience compassion fatigue, it can happen to anyone, especially if you are that family member, friend, or coworker everyone turns to for guidance and support," says Dr. Shakira Espada-Campos, MDLIVE Associate Chief of Behavioral Health.

"Even behavioral health professionals who are trained to take on the trauma and suffering of others experience it," she explains.

Compassion fatigue can affect people differently, but a few common signs can include:

• Feelings of emotional, physical, and psychological exhaustion
• Feeling detached, cynical, or apathetic
• Excessive ruminating and worrying about other people's suffering
• Blaming yourself or others for not doing enough to help or prevent a trauma
• Irritability or anger
• Emotional numbness
• Feelings of sadness
• Feelings of helplessness
• Difficulty sleeping, changes in appetite, stomach upset, nausea, dizziness
• Changes in your worldview or spiritual beliefs
• Struggling to empathize with people who are suffering

People with compassion fatigue often find themselves feeling increasingly pessimistic. They may question their beliefs and question whether there is any good in the world. In the workplace, they may feel unappreciated, lose confidence and interest, and struggle to feel compassion toward people in their care.

What Are the Stages of Compassion Fatigue?

Compassion fatigue tends to happen gradually over time. It is important to remember that this is a progressive and cumulative process and that compassion fatigue is the end stage.

Researcher Charles Figley has suggested a causal model that described different factors that predict the onset of compassion fatigue. It occurs in four primary stages:

1. Empathetic ability: This involves the ability of the individual to notice other people's pain. Figley suggests that this ability is a keystone of the helping professions, which then exposes people to the emotional costs of caring. As part of this aspect of compassion fatigue, people must also experience empathetic concern, which involves a desire to relieve other people's pain and suffering.
2. Empathetic response: As a result of exposure to a person experiencing pain, people then have an empathetic response. In this stage, they engage in actions to understand the other person and explore ways to help them.
3. Compassion stress: At this point, people may begin to experience residual compassion stress, particularly if they are helping someone who has ongoing trauma.
4. Compassion fatigue: Unless a person is able to sufficiently manage their compassion stress, their risk of developing compassion fatigue increases. The risk of reaching this stage is greater if a person is exposed to the secondary trauma for a prolonged period of time or if they begin to have traumatic recollections of past traumas. People may also experience significant life disruptions, including increased illness, changes in lifestyle, problems managing personal or professional responsibilities, and feelings of anxiety or depression. All of these things make it more likely that the individual will develop compassion fatigue.
   

Causes of Compassion Fatigue

Compassion fatigue is caused by prolonged exposure to secondary trauma. People may be more likely to experience it if they also feel like they lack control of the situation or have a sense of helplessness.

One of the key elements behind compassion fatigue is the constant demand for empathy. While empathy is essential in helping professions, it can become emotionally exhausting when the demand for empathy is persistent and excessive.

“Compassion is a meta-cognitive process—thinking about one’s own thinking. It is one of the highest forms of cognition in my opinion and, therefore, one only visits compassion. You can’t live there. It would be cognitively exhausting,” Dr. Zillmer explains. 

When people engage in too much authentic compassion, fatigue sets in.

There are also factors that can increase a person's risk of developing compassion fatigue in such situations. These can include:

• High stress levels
• Poor coping skills
• Lack of social support
• Insufficient self-care
• A history of trauma

Working in a setting that involves constant exposure to trauma, such as emergency services or social work, increases a person's risk of experiencing compassion fatigue. Research has found that among helping professionals, the prevalence of compassion fatigue ranges from 7.3% to 40%.

Burnout vs. Compassion Fatigue

While compassion fatigue and burnout share some similarities, there are important distinctions between the two. Burnout refers to a state of exhaustion that causes poor motivation and a lack of interest in work. Compassion fatigue, on the other hand, is a specific type of burnout that refers to the negative emotions and loss of empathy people experience after being exposed to other people's trauma, pain, and suffering.

“Compassion fatigue occurs predominately in people who work in helping professions and pops up the most for those in direct patient care," says Kristen Tomlinson, Director of Grief Support Services for Taylor’s Gift Foundation, a national nonprofit organization that provides grief support for families of organ, eye, and tissue donors. "Having patients who rely on them can be a heavy weight to carry at times, especially when they don’t (or can’t) prioritize their own well-being, too."

Unfortunately, such feelings can then spill over into an individual life outside of work and lead to other problems. People who experience compassion fatigue experience burnout that contributes to feelings of helplessness and hopelessness. They may become cynical about their work and feel that nothing that they do will have a positive impact on relieving other people's pain.

What distinguishes compassion fatigue from burnout is the source of these feelings. Compassion fatigue stems from exposure to vicarious trauma, while burnout is caused by excessive work-related stress and occupational exhaustion.

“Burnout can happen to anyone in any profession and is usually confined to work duties only. People experiencing burnout can feel a sense of dread at work, procrastination, negative interactions with coworkers or clients, and other symptoms. However, these symptoms usually subside when not at work,” Tomlinson says.

Overcoming Compassion Fatigue

If you recognize the signs of compassion fatigue, it is important to take steps to address it before it begins to take a further toll on your emotional well-being.

Overcoming compassion fatigue can take time and requires people to focus on reducing their stress levels. Some strategies that can help people recover include:

Reduce Your Exposure to Stress

In the short term, relieving feelings of compassion fatigue may involve taking a break from the source of stress that is causing the problem. Taking time away from work is one approach that may help, but for many, it might involve temporarily reducing their workload, seeing fewer patients/clients, or working in a different area of patient care.

The ability to reduce exposure can vary depending on a person's job, however. A therapist might be able to reduce their client load while a nurse might opt to switch to working in a different area for a time. An emergency room doctor or EMT, on the other hand, typically has less control over the patients and situations they will deal with in the workplace. In such cases, it is important to find other ways to cope with compassion stress.

Creating Emotional Boundaries

“The first step is to set boundaries. Recognize and accept what you can’t control and focus on what you can control,” Dr. Espada-Campos says.

For many people who are in helping professions or who are caregivers, saying "no" to someone in need can be a challenge. For example, a therapist might agree to arrange sessions during off-hours that interfere with their personal life. Creating specific rules for sessions, services, and hours can help.

Practice Self-Care

If you feel yourself starting to experience symptoms of burnout or compassion fatigue, it is OK to step back and do what you need to do to support your own mental and physical needs. Espada-Campos recommends taking steps such as:

• Maintaining a healthy work-life balance
• Engaging in hobbies that bring you joy
• Eating a healthy diet
• Getting enough exercise
• Sticking to a daily routine

“Preventing or overcoming compassion fatigue comes down to self-care. Your physical, emotional, and psychological well-being must be in check before you can help others,” suggests Dr. Espada-Campos.

Compassion fatigue can be a risk for people who work in helping professions, particularly if they are exposed to high levels of secondary trauma. If you recognize the signs of compassion fatigue, it is important to take steps to care for yourself.

Self-help strategies can be effective, but it is also important to reach out for help if you need additional support. “Seek professional help if you are finding it difficult to pull yourself out of the situation, especially if you are showing signs of depression, anxiety, or overwhelming stress,” Espada-Campos suggests.