Vicarious Trauma: The Cost of Care and Compassion

Mature Overworked healthcare worker looking through a window, very concerned, very tired

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Also known as “compassion fatigue” or the “cost of caring,” vicarious trauma occurs when an individual develops trauma symptoms related to the pain and fear they witness in those they serve who have experienced trauma and stress. The American Counseling Association defines vicarious trauma as “the emotional residue of exposure to traumatic stories and experiences of others through work; witnessing fear, pain, and terror that others have experienced; [and] a preoccupation with horrific stories told to the professional.”

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, vicarious trauma can cause symptoms meeting the criteria for post-traumatic stress disorder (PTSD); however, not everyone who experiences vicarious trauma will meet the criteria for PTSD, just like not everyone who experiences other traumatic events develops a trauma-related disorder.

What Causes Vicarious Trauma?

Vicarious trauma occurs in response to repeated exposure to traumatic events that others experience. Witnessing, hearing about, and supporting others through their trauma is often traumatic, even if the responder does not directly experience trauma themselves. Anyone with this exposure can develop vicarious trauma, but those with their own trauma history are more likely to experience vicarious trauma compared to those without trauma history.

Additionally, those who do not have access to appropriate support or have learned coping skills are more likely to experience vicarious trauma compared to those with strong emotional defenses. Essentially, those who already struggle to care for their emotional needs in a healthy way are at higher risk for developing vicarious trauma compared to those with healthy coping and defense mechanisms in place.

What Are the Symptoms of Vicarious Trauma?

For some, vicarious trauma manifests in a way that meets the diagnostic criteria for PTSD: involuntary and intrusive memories of the traumatic events; frightening dreams or nightmares about the events; dissociative symptoms; and psychological distress in response to reminders of the events. C, who worked in an emergency room, shared: “There’s a hall in the ER at the hospital where I used to work that I can’t even look at.”

However, not all vicarious trauma looks like PTSD. Some experience the following symptoms:

  • Sleep problems
  • Appetite changes
  • Increased substance use
  • Self-harm
  • Panic attacks
  • Issues with concentration
  • Depression or anxiety
  • Illness (or being prone to illness)

Interpersonally, they may withdraw from loved ones or become irritable. In some instances, they may become overly protective of their loved ones and experience significant worry that a traumatic event may happen to them.

In the workplace, vicarious trauma can manifest as overworking or avoiding professional responsibilities. Those who have experienced vicarious trauma may change jobs frequently or experience conflict with colleagues. Vicarious trauma can cause issues with motivation and increased mistakes.

What Is the Difference Between Vicarious Trauma and Secondary Trauma?

Secondary trauma and vicarious trauma can have similar symptoms, but the two experiences are defined differently. Both occur as a result of exposure to another person’s traumatic experience.

Secondary trauma refers to trauma symptoms that occur after hearing or witnessing someone else’s trauma on one occasion, whereas vicarious trauma refers to trauma symptoms that develop over time in response to long-term exposure to many people’s pain.

Secondary trauma symptoms tend to emerge quickly, whereas vicarious trauma develops over time.

Is Vicarious Trauma a Form of PTSD?

PTSD and vicarious trauma are a venn diagram. As noted, the DSM-5-TR indicates that vicarious trauma can cause PTSD. However, many with PTSD experience primary trauma and not secondary trauma. Additionally, many who experience vicarious trauma symptoms do not meet the symptom criteria for PTSD.

Those who have personal trauma history are more likely to experience PTSD symptoms or develop PTSD in response to vicarious trauma compared to those who do not have preexisting trauma history.

What Is the Difference Between Burnout and Vicarious Trauma?

Researchers have documented a connection between work stress and burnout since the 1970s. Burnout refers to the “long-term stress reaction and process that occurs among professionals who work with people in some capacity.” Unlike vicarious trauma, burnout does not exclusively impact those who are exposed to other people’s pain and suffering as a component of their work. Anyone can experience burnout in response to exhaustion, fatigue, and overwork.

Some symptoms of burnout look similar to vicarious trauma, including irritability, interpersonal conflict, and feelings of overwhelm. People who experience burnout may leave jobs or exhibit decreased motivation.

Although there is symptom overlap, vicarious trauma is a specific phenomenon that occurs in response to direct exposure to other people’s trauma.

What Are Some Examples of Vicarious Trauma?

Vicarious trauma can look different for different people, and this is not an exhaustive list of all possible causes or symptoms of vicarious trauma. However, some examples include:

  • Medical professionals. K, a registered nurse who has worked bedside in a hospital throughout the COVID-19 pandemic, shared his experience of vicarious trauma in this role. He shared, “We went from maybe one death on our floor every year to about four deaths per shift. … I felt numb, helpless, [and] I dreaded going to work.” K disclosed that he had to take time off from work due to the trauma of witnessing so much pain and death.
  • Mental health professionals. Many therapists, particularly those who specialize in treating trauma, develop trauma symptoms, including intrusive thoughts about the stories they hear through their work. R, a therapist, shared that they were often the first responder to traumatic events. Even years later, R said, “I still think about some of the stories I’ve heard.”
  • Child welfare professionals. Those who work with neglected and abused children often develop trauma symptoms following exposure to the narratives and stories of the children they support.

How to Treat and Cope With Vicarious Trauma

People with vicarious trauma can experience symptom relief through therapies that treat other forms of trauma. Specifically, cognitive behavioral therapies and eye movement desensitization and reprocessing can successfully address symptoms of vicarious trauma.

If you experience vicarious trauma, you may benefit from therapy services to treat your trauma symptoms. You might also need increased self-care and rest, which can include taking a leave from the position that exposes you to other people’s trauma. For some, vicarious trauma can become so intense that they are unable to return to that role.

You deserve support and care, and it is okay to seek help if you are experiencing vicarious trauma.

If you or a loved one are struggling with vicarious trauma, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

Protecting Yourself From Vicarious Trauma

If you are at risk for vicarious trauma due to your job or a volunteer position, there are steps you can take to reduce your risk of developing trauma symptoms. People have individual self-care needs, so you may have to try out different skills to see what works for you.

  1. Attend to your needs. Notice your emotional state and how you respond to the trauma you are exposed to. Take breaks and time off as needed when you start to struggle.
  2. Find and stick to an appropriate sleep schedule. When you are well-rested, it is easier to take care of yourself. 
  3. Set strong boundaries. Many people in roles at risk for vicarious trauma are empathetic and care for the people they work with, which is a good thing, but it can be difficult to set that aside when you are “off the clock.” Make sure that you have boundaries around your work.
  4. Seek support. Have your own therapy if needed, and engage with your social circle for support.
  5. Have a self-care routine. What is important to you outside of your work? What things do you enjoy? What recharges your battery or fills your cup? Making time for these activities helps prevent vicarious trauma.
7 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.
  1. California Department of Corrections and Rehabilitation. Fact Sheet: Vicarious Trauma.

  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

  3. Aafjes-Van Doorn K, Békés V, Luo X, Prout TA, Hoffman L. What do therapist defense mechanisms have to do with their experience of professional self-doubt and vicarious trauma during the covid-19 pandemicFront Psychol. 2021;12:647503.

  4. Jenkins SR, Baird S. Secondary traumatic stress and vicarious trauma: A validational studyJ Traum Stress. 2002;15(5):423-432.

  5. Freudenberger HJ. Staff burn-outJournal of Social Issues. 1974;30(1):159-165.

  6. Molnar BE, Meeker SA, Manners K, et al. Vicarious traumatization among child welfare and child protection professionals: A systematic reviewChild Abuse & Neglect. 2020;110:104679.

  7. Torres PB, Ignacio DA, Gottlieb M. Reducing the cost of caring: indirect trauma exposure on mental health providersJ EMDR Prac Res.

By Amy Marschall, PsyD
Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health.