PTSD Coping What Is Survivor's Guilt? By Kendra Cherry Kendra Cherry Facebook Twitter Kendra Cherry, MS, is an author and educational consultant focused on helping students learn about psychology. Learn about our editorial process Updated on February 20, 2021 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Verywell / Brianna Gilmartin Table of Contents View All Table of Contents What It Is Symptoms Causes Treatments Coping What Is Survivor’s Guilt? Survivors guilt is a particular kind of guilt that develops in people who have survived a life-threatening situation. Some survivors feel guilty that they survived when others died. Others believe they could have done more to save the lives of others. And then there are those who feel guilty that another person died saving them. While survivor's guilt was originally used to describe feelings that survivors of the Holocaust experienced, it has also been applied to a number of life-threatening situations, including car accidents, wars, and natural disasters. Survivor's guilt is also common in those who have survived medical traumas. For instance, those who lived through the AIDS epidemic have described feelings of guilt related to their own survival while others, including friends or family, died. Some cancer survivors also experience this guilt if they survive a diagnosis but others don't. Is Survivor’s Guilt a Disorder? In the current version of the diagnostic manual, the DSM-5, survivor's guilt is a symptom of post-traumatic stress disorder (PTSD). It may be viewed as one of the cognitive and mood-related symptoms of PTSD, which include having distorted feelings of guilt and negative thoughts about oneself. It is important to note, however, that people can experience survivor’s guilt without having PTSD. They can also have PTSD without feeling survivor’s guilt. Symptoms The extent and severity of survivor’s guilt varies between people. Symptoms of survivor’s guilt can be both psychological and physical and often mimic those of PTSD. The most common psychological symptoms include: Feelings of helplessnessFlashbacks of the traumatic eventIrritabilityLack of motivationMood swings and angry outburstsObsessive thoughts about the eventSuicidal thoughts Common physical symptoms can include: Appetite changesDifficulty sleepingHeadachesNausea or stomachacheRacing heart Survivor's guilt can have a serious impact on a person’s life and functioning, suggesting that further research is needed to explore effective ways to help people deal with feelings of guilt. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database. Regret, Rumination, and Hindsight Bias Following a trauma, people may also experience feelings of regret. They may ruminate over the events that took place and think about things they could have or should have done that (they think) would have altered the outcome. This rehashing of the events can further exacerbate feelings of guilt, particularly if people feel that their own actions (or inactions) may have worsened the consequences. In many cases, this rumination is influenced by what is known as the hindsight bias. People look back and overestimate their ability to have known the outcome of an event. Because they feel like they should have predicted what happened, people may become convinced that they should also have been able to change the outcome. There are times when guilt may have a legitimate cause (such as causing an accident that led to another person’s death or injury), but in a lot of these instances, there is little or nothing that a person could do to prevent or change the outcome. Press Play for Advice On Dealing With Regret Hosted by Editor-in-Chief and therapist Amy Morin, LCSW, this episode of The Verywell Mind Podcast, featuring best-selling author Daniel Pink, shares how to cope with the feeling of regret. Click below to listen now. Follow Now: Apple Podcasts / Spotify / Google Podcasts Causes Survivor’s guilt occurs in people who have experienced some type of trauma. However, not everyone who lives through such an experience develops these feelings of guilt. A person’s locus of control might play a role in determining whether they will experience survivor's guilt. Some people are more likely to internalize blame. When explaining events, they tend to attribute causation to personal characteristics rather than outside forces. In a lot of situations, this can actually be a good thing for self-esteem. By taking credit for good outcomes, people are able to feel better about themselves and their abilities. But it can be devastating when people blame themselves for events out of their control. Additional factors that may increase a person's risk of experiencing survivor's guilt include: History of trauma: Some research has indicated that experiencing trauma during childhood can increase the likelihood of feeling negative emotions following other life-threatening events. History of depression: People who are already depressed or who experienced it in the past may also be more likely to experience guilt and anxiety following trauma. Low self-esteem: People with low self-esteem may place less value on their own well-being. When faced with the experience of surviving where others have perished, they may be more likely to question whether they “deserved” their good luck. This can lead to feelings of inadequacy and even guilt. Lack of social support: People who do not have a solid network of social support may be more likely to experience symptoms related to survivor’s guilt. Poor coping skills: People are more susceptible to PTSD if they have avoidant styles of coping with stress. Examples of avoidance coping include behavioral disengagement and wishful thinking. Treatments Getting appropriate treatment if you are experiencing such symptoms is important. Not only can it reduce your mental well-being and quality of life, but it can also present serious risks, particularly if other symptoms of PTSD are also present. In fact, researchers have found that trauma-related guilt is closely linked to suicidal thoughts in veterans. Cognitive behavioral therapy (CBT) is one approach that can be particularly effective. Through CBT, clients work with a therapist to explore automatic negative thoughts that contribute to feelings of guilt. Examining unrealistic thoughts and replacing them with more realistic ones can help alleviate feelings of guilt and self-blame. Other forms of psychotherapy, group therapy, support groups, and medications may also be helpful in the treatment of survivor’s guilt symptoms. Coping If you find yourself experiencing feelings of guilt following an aversive event, there are things you can do to manage those emotions. Some self-help strategies that you may find effective: Allow yourself to grieve. It is important to acknowledge the people who were lost and allow yourself to mourn. Give yourself time and take things at your own pace. Do something positive. Whether it is for yourself or for others, take those feelings and direct them toward making a change in the world. Sometimes just doing simple things for another person can help alleviate feelings of guilt. Focus on the outside factors that led to an event. Shifting your focus on the external variables that created the situation can help you let go of the self-blame that contributes to feelings of guilt. Practice self-forgiveness. Even if your actions were responsible for harm to another person, learning how to forgive yourself can help you move forward and regain a positive outlook Remember that these feelings are common. Experiencing guilt doesn’t mean that you’re guilty of doing anything wrong. Sadness, fear, anxiety, grief, and, yes, guilt are completely normal responses in the aftermath of a tragedy. It’s OK to feel happy about your own luck while at the same time mourning the fate of others. Talk to your doctor if your symptoms are severe or your feelings of guilt are interfering with your ability to function normally. A Word From Verywell Survivor’s guilt can feel overwhelming at times, but it is not uncommon to feel this way after you have survived a traumatic or difficult life event. It's important to acknowledge your guilt and get help if these feelings become too difficult to manage on your own. Appropriate treatment can help you address feelings of excessive or overwhelming guilt. How Cognitive Therapy Works for Stress Relief 8 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Boykin FF. The AIDS crisis and gay male survivor guilt. Smith Coll Stud Soc Work. 1991;61(3):247-259. doi:10.1080/00377319109517367 Glaser S, Knowles K, Damaskos P. Survivor guilt in cancer survivorship. Soc Work Health Care. 2019;58(8):764-775. doi:10.1080/00981389.2019.1640337 Street AE, Gibson LE, Holohan DR. Impact of childhood traumatic events, trauma-related guilt, and avoidant coping strategies on PTSD symptoms in female survivors of domestic violence. J Trauma Stress. 2005;18(3):245-52. doi:10.1002/jts.20026 Gros DF, Price M, Magruder KM, Frueh BC. Symptom overlap in posttraumatic stress disorder and major depression. Psychiatry Res. 2012;196(2-3):267-270. doi:10.1016/j.psychres.2011.10.022 Simmen-Janevska K, Brandstätter V, Maercker A. The overlooked relationship between motivational abilities and posttraumatic stress: A review. Eur J Psychotraumatol. 2012;3. doi:10.3402/ejpt.v3i0.18560 Simon N, Roberts NP, Lewis CE, van Gelderen MJ, Bisson JI. Associations between perceived social support, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD): Implications for treatment. Eur J Psychotraumatol. 2019;10(1):1573129. doi:10.1080/20008198.2019.1573129 Wild J, Smith KV, Thompson E, Béar F, Lommen MJJ, Ehlers A. A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression. Psychol Med. 2016;46(12):2571-2582. doi:10.1017/S0033291716000532 Tripp JC, McDevitt-Murphy ME. Trauma-related guilt mediates the relationship between posttraumatic stress disorder and suicidal ideation in OEF/OIF/OND veterans. Suicide Life Threat Behav. 2017;47(1):78-85. doi:10.1111/sltb.12266 Additional Reading American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013. Hutson SP, Hall JM, Pack FL. Survivor guilt: Analyzing the concept and its contexts. ANS Adv Nurs Sci. 2015;38(1):20-33. doi:10.1097/ANS.0000000000000058 By Kendra Cherry Kendra Cherry, MS, is an author and educational consultant focused on helping students learn about psychology. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for PTSD Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.