Navigating Compassion Fatigue: Recognizing and Addressing Secondary Traumatic Stress

By Dr. Corey Milsap, PsyD, LPC, CSP, LSP, LMHC

Secondary traumatic stress, sometimes termed “compassion fatigue,” is a psychological phenomenon that occurs when individuals are indirectly exposed to traumatic experiences through their professional engagements with traumatized clients. This condition mirrors the characteristics of post-traumatic stress disorder (PTSD).

Professionals such as physicians, psychotherapists, emergency responders, human service providers, and lawyers often confront this type of stress. Their roles involve treating and assisting individuals who’ve endured traumatic incidents, which necessitates regularly hearing traumatic narratives and witnessing strong emotional reactions. This frequent exposure can be mentally and emotionally draining.

Signs and Symptoms of Compassion Fatigue Symptoms of this condition span cognitive, emotional, behavioral, and physical domains:

  • Cognitive: Diminished concentration, apathy, inflexible thinking, perfectionistic tendencies, and a constant preoccupation with trauma.
  • Emotional: Feelings of guilt, anger, numbness, despair, and a sense of powerlessness.
  • Behavioral: Isolation, disturbed sleep patterns, changes in appetite, heightened vigilance, and an exaggerated startle reflex.
  • Physical: Elevated heart rate, breathing difficulties, musculoskeletal pain, a weakened immune response, and amplification of existing health issues.

On a personal level, an affected individual might experience disturbing dream imagery, intrusive thoughts, physical discomforts, fatigue, feelings of guilt, and emotional detachment. Professionally, indicators include increased absenteeism, compromised decision-making, reduced work quality and productivity, increased staff attrition, interpersonal conflicts at work, task avoidance, defensiveness, and frequent arguments.

Detection and Diagnosis A range of tools and methods can help detect secondary traumatic stress:

  • Self-assessments: These involve questionnaires, scales, and checklists that gauge one’s trauma history, work dynamics, and associated symptoms.
  • Reflective Supervision: This focuses on the emotional aspect of one’s professional role, helping to highlight the effects of secondary trauma.
  • Formal Assessment: One such tool is the Professional Quality of Life Measure, which quantifies the signs of secondary stress.

Interventions and Strategies Addressing compassion fatigue is two-fold: prevention and treatment. Both the individual experiencing it and their organizational support system bear the responsibility for interventions.

Preventative measures incorporate:

  • Education: Awareness of secondary trauma’s risks prompts professionals to take preventive actions.
  • Organizational Support: Measures such as caseload adjustments, flexible schedules, and workplace self-care group participations.
  • Personal Efforts: These include relaxation practices, boundary-setting, priority arrangement, a balanced diet, regular exercise, and adequate rest.

For those already affected, therapeutic interventions like cognitive behavioral therapies, mindfulness techniques, self-care routines, journaling, professional counseling, and peer support can be beneficial.

It’s imperative to understand that while professionals like educators, medics, therapists, and legal practitioners have a duty to support their clients, they also need safeguards against the risk of secondary traumatic stress. Collective responsibility is key to mitigating these adverse outcomes.


Boscarino, J. A., Adams, R. E., & Figley, C. R. (2010). Secondary Trauma Issues for Psychiatrists. The Psychiatric Times, 27(11), 24-26.

The National Child Traumatic Stress Network. (n.d.). Secondary Traumatic Stress. NCTSN.

The National Child Traumatic Stress Network, Secondary Traumatic Stress Committee. (2011). Secondary Traumatic Stress: A Fact Sheet for Child-Serving Professionals. NCTSN.

Proskauer For Good. (2019, February 5). How to Identify and Address Secondary Trauma – Insights. Proskauer.

Secondary Traumatic Stress. (n.d.). The Administration for Children and Families., R., & Gulliver, S. B. (2003, April 1). Secondary Traumatization in Mental Health Care Providers. Psychiatric Times, 20(4).

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