Compassion Fatigue: Signs, Causes & Recovery
Compassion fatigue happens to the best of us. It describes what happens when caring for people in pain steadily takes more out of you than you can put back. It accumulates slowly over many years, and the first sign is usually irritation rather than sadness.
Many people can’t name it and simply think they are getting rusty at their job.
In this article, we’ll cover:
- An overview of compassion fatigue.
- The difference between fatigue, vicarious trauma, and burnout.
- Symptoms to watch out for.
- People who are most at risk.
- Therapies that help.
- Where to find professional support.
Compassion Fatigue: An Overview
In 1995, psychologist Charles Figley observed clinicians who attended to trauma patients. He noticed that the empathy with which these experts used to care for patients wore down over time. He called this “compassion fatigue.”[1]
Researchers later developed the Professional Quality of Life Scale to measure this observation. The scale measures three dimensions of professional quality of life:[2]
- Burnout.
- Secondary traumatic stress.
- Compassion satisfaction.
Compassion fatigue combines the first two, while compassion satisfaction is the positive counterpart: the sense of fulfillment that caring for others can bring.
These two components show that clinicians are often dealing with two problems at once. As a clinician, you will almost certainly experience some level of work-related stress, and this is a real and common experience.
But you can also end up carrying a patient’s post-traumatic stress, and that’s a different problem entirely. Both can exist at the same time, and if you address only one, the other doesn’t just vanish.
Compassion fatigue is linked to emotional depletion and empathy fatigue, and is sometimes called caregiver fatigue. The labels might vary, but the underlying patterns are the same.
Understanding Compassion Fatigue, Vicarious Trauma, and Burnout
Compassion fatigue, vicarious trauma, and burnout are terms that describe different things.
Burnout happens in the workplace. The World Health Organization treats it as an occupational syndrome with three features:[3]
- Reduced effectiveness.
- Exhaustion.
- Mental distance or cynicism.
Vicarious trauma describes a slow shift in how you see the world after many years of encountering the bad in it. The way you view safety, trust, and people is never quite the same.[4]
For clinicians, secondary traumatic stress can build when you take in other people’s trauma until you start having post-traumatic stress disorder (PTSD)-like symptoms of your own.
Evidence has shown that compassion fatigue, vicarious trauma, and burnout can coexist. A meta-study of 41 studies covering a pool of 8,256 workers found that secondary traumatic stress and burnout tend to rise and fall together. They track each other closely enough that a worker who has one is very likely to have the other.[5]
Symptoms of Compassion Fatigue
Compassion fatigue symptoms build up slowly and are often hard to see from the outside.
The emotional symptoms include:
- Losing interest in your patients and in things you used to enjoy.
- Irritability at the smallest thing.
- Guilt.
- Cynicism.
- Emotional exhaustion.
Physical symptoms include:
- Fatigue that does not resolve with rest.
- Headaches.
- Stomach upset.
- Repeated bouts of illness.
There are behavioral signs too, like:
- Avoiding patients.
- Responding late to calls.
- Focusing on charts to avoid eye contact with patients and their families.
Intrusive symptoms include:
- A patient’s story coming back to you during a walk.
- Finding it hard to sleep after a case.
- Checking on your own children more than necessary.
The two clearest warnings are feeling relieved when someone cancels and losing your sense of purpose at work.[2] You may see only one or two of these signs at first, but they tend to add up the longer the situation stays the same.
Who Is Most at Risk of Compassion Fatigue?
People whose jobs demand absorbing other people’s stress are usually the most at risk. These jobs include:
- Nurses.
- Physicians.
- Paramedics.
- Social care workers.
- High school teachers.
- Veterinarians.
- Hospice staff.
- 911 dispatchers.
- Interpreters working on asylum cases.
The prevalence among nurses is well studied. A pool of 79 studies involving over 28,000 nurses across 11 countries reported moderate levels of compassion satisfaction alongside moderate levels of compassion fatigue.[6]
Compassion fatigue rose steadily across the studies from 2010 to 2019. ICU nurses recorded the highest levels of all.[6] It was also significant among oncology nurses, with 22% at high risk for burnout and 22% in the secondary traumatic stress risk band.[7]
Higher risk goes with:
- A demanding caseload.
- Inadequate support.
- A personal history of trauma.
- Repeated trauma exposure.
Being the person who gets all the difficult cases also increases this risk.
Compassion Fatigue in Family Caregivers
Most of the studies on compassion fatigue leave out family caregivers, but the same issues affect people looking after loved ones too.
Compassion fatigue and burnout in family caregivers look very similar to the experiences of caregivers in a hospital setting, and the triggers are almost the same. Take a daughter who is caring for an older father with dementia. In many cases, she will work the entire day or close to it, with no supervision or relief.
The symptoms overlap in many cases and can be hard to tell apart. They include:
- Numbness.
- Guilt.
- Irritability.
- Dread.
- Physical discomfort.
In some cases, the issues appear to be worse for family caregivers than for professional ones. There is no difference between the person and the role, no working hours, days off, or clearly defined responsibilities.
The stress can accumulate and slowly change the relationship between the caregiver and their loved one. Clinicians, on the other hand, get to go home at the end of the day.
If you are a family caregiver, the information here still applies to you, even if the context looks a bit different. If you’re finding it hard, ask your local services about respite care, and split the caring duties with relatives where you can.
Causes of Compassion Fatigue
It may seem obvious that compassion fatigue comes from caring too much, but that is not entirely true.
The main drivers are sustained trauma, listening to patients’ traumatic experiences with no time to process them, and an overwhelming caseload.
A study by Maslach and Leiter found six areas where a mismatch between a person and their job can predict burnout. These are:[8]
- Control.
- Community.
- Reward.
- Fairness.
- Values.
- Workload.
There are also structural components to healthcare burnout and compassion fatigue. Recognized structural triggers include:
- Understaffing.
- Lengthy paperwork and administrative tasks.
- Moral distress.
Moral distress means knowing what a patient needs and being unable to provide it, and it can drain clinicians more than the hours themselves.
If you work in healthcare, burnout can feel like proof that you’re not strong enough for the job, but it isn’t. Burnout is an indicator of the reality of the conditions you work in.
Mission Connection is here to help you or your loved one take the next steps towards an improved mental well-being.
Why Self-Care Often Fails
Many healthcare professionals have tried self-care strategies. Sometimes, yoga, more sleep, exercise, and things like a gratitude journal can really help. However, for serious issues like compassion fatigue, burnout, depression, and anxiety, they are often not enough.
A mindfulness app cannot help with a workload that is just too heavy. Breathing exercises are unlikely to help if what’s affecting you is the trauma of children under your care.
When advice focuses only on your personal habits, it is easy to conclude that you are the problem. In reality, the research supports a plan that combines personal strategies with changes at work.
The personal strategies still have a role, because they keep you steady enough to push for the bigger changes. But recovery is faster once something changes at work too.
Recovery From Compassion Fatigue
Recovery from compassion fatigue and burnout can take a long time, and it starts only when something about your situation changes.
Professional Support
A therapy plan for caregiver stress or therapist burnout is a practical step, but some clinicians may not feel like they need one or may question whether therapy can help.
Effective therapy addresses the underlying driver. That might be:
- Guilt that won’t fade.
- The beliefs that keep resurfacing.
- The stories you have absorbed.
Cognitive behavioral therapy (CBT) works for the unhelpful thought patterns that build up under a chronic workload, such as self-blame and the belief that you should be able to cope with anything.
If the symptoms are linked to post-traumatic stress disorder (PTSD), Eye Movement Desensitization and Reprocessing (EMDR) and other trauma-focused approaches can help process and make the symptoms easier to manage. In that case, your treatment plan should reflect the trauma, not just the stress.
Changing Something Structural
Lasting recovery usually depends on changing the working conditions themselves. That can mean:
- A smaller caseload.
- Regular clinical supervision.
- Better training and support.
These are changes to be negotiated at work, and they often do more than any individual effort can.
Take real breaks, leave the building, and spend time in nature. Limit after-hours contact and set clear boundaries that protect your life outside work, such as not checking messages once your shift ends. One structural change can move recovery along faster than any number of personal resolutions.
Rebuilding What Refills You
Compassion satisfaction can be rebuilt. Spend time with people you care about, take on work that produces visible results, and keep at least one part of your week that has nothing to do with the job.
Separating your work from the rest of your life is important because it can allow you to rest and recharge at home. This should give you more energy and patience for demanding work days.
What Recovery Looks Like
Compassion fatigue recovery often follows a specific order:
- Your sleep cycle settles first.
- The physical symptoms resolve.
- The emotional reset happens much later.
The emotional recovery feels so ordinary that it’s easy to miss. One day you notice that you find a patient’s story interesting again or that you are looking forward to a shift.
Recovery might not be smooth, and it is possible to feel worse before you feel better. That is partly because slowing down lets you feel everything the busy pace has been covering up.
Some people return to the same role with different boundaries, while others change roles or care for a different population. Any of these can work, and they depend on your individual needs.
When to Get Professional Help
Rest and a lighter workload might be enough in many cases, especially if you catch the pattern early. Other times, you might need more than that.
If your symptoms have gone on for months, your mood stays low, or you feel nothing about outcomes that would ordinarily excite you, it is time to involve a professional.
You don’t need the right word for what is wrong. Describing an ordinary working week is usually enough for an experienced clinician to see the pattern.
Mental health professionals are among the least likely to get help for compassion fatigue and similar difficulties. Part of it is cost and time, and part of it is the fear that needing treatment means they are not fit to practice.
Getting treatment does not mean you have been exposed as unfit. Think of it as the same process you would recommend to a patient who came to you with your symptoms.
Benefit From Compassion Fatigue Support at Mission Connection
If you or someone you care about is experiencing compassion fatigue, support is available.
At Mission Connection, we work with adults carrying trauma, anxiety, and the depression that often sits underneath long-term emotional depletion. We personalize outpatient treatment to your unique needs. Our expert clinical team provides medication management in conjunction with a range of other evidence-based mental health treatment approaches.
We offer outpatient care at our locations in California, Virginia, and Washington, including more intensive levels of care, such as a partial hospitalization program (PHP) or an intensive outpatient program (IOP). We treat a variety of mental health conditions and are in-network with most major insurance providers.
To find out more about our in-person, virtual telehealth, or hybrid program that combines in-person and virtual care, call us at 866-833-1822. You can also get started online.
