Adapted from “The Compassion Fatigue Workbook”
We also have a more detailed example of Signs and Symptoms here.
Learning to recognise one’s own warning signs of compassion fatigue (CF) and vicarious/secondary trauma (VT/STS) serves a two-fold purpose:
First, it can serve as an important check-in process for someone who has been feeling unhappy and dissatisfied, but did not have the words to explain what was happening to them. Secondly, developing a warning system allows you to track your levels of emotional and physical depletion. It also offers you tools and strategies that you can implement right away.
Let me give you an example of what a warning system may look like:
Say, for example, that you were to learn to identify your CF/STS symptoms on a scale of 1 to 10 (10 being the worst you have ever felt about your work/compassion/energy, and 1 being the best that you have ever felt).
Then, you learn to identify what an 8 or a 9 looks like for you i.e. “when I’m getting up to an 8, I notice it because I don’t return phone calls, think about calling in sick a lot and can’t watch any violence on TV” or “I know that I’m moving towards a 7 when I turn down my best friend’s invitation to go out for dinner because I’m too drained to talk to someone else, and when I stop exercising.”
Being able to recognize that your level of CF/STS is creeping up to the red zone is the most effective way to implement strategies immediately before things get worse.
But look back to what also emerges in this process: you are starting to identify the solutions to your depletion.
If I know that I am getting close to an 8, I may not take on new clients with a trauma history, I may take a day off a week, or I may return to see my own therapist.
In order for you to develop your warning scale, you need to develop an understanding and an increased awareness of your own symptoms of compassion fatigue and vicarious trauma/STS.
In their book Transforming the Pain, Saakvitne and Pearlman (1996) have suggested that we look at symptoms on three levels: physical, behavioural and psychological/emotional. As you will see, there is often overlap between these categories.
Please take a look at the list below and notice which ones are your most frequent warning signs:
Physical Warning Signs (More detail available in extra information post)
- Increased susceptibility to illness
- Sore back and neck
- Irritable bowel, GI distress
- Rashes, breakouts
- Grinding your teeth at night
- Heart palpitations
Behavioural Signs (More detail available in extra information post)
Increased use of alcohol and drugs
- Anger and Irritability at home and/or at work
- Avoidance of clients/patients
- Watching excessive amounts of TV/Netflix at night
- Consuming high trauma media as entertainment
- Not returning phone calls at work and/or at home
- Avoiding colleagues and staff gatherings
- Avoiding social events
- Impaired ability to make decisions
- Feeling helpless when hearing a difficult client story
- Impostor syndrome – feeling unskilled in your job
- Problems in personal relationships
- Difficulty with sex and intimacy due to trauma exposure at work
- Thinking about quitting your job (not always a bad idea by the way!)
- Compromised care for clients/patients
- Engaging in frequent negative gossip/venting at work
- Impaired appetite or binge eating
Emotional/Psychological Signs (More detail available in extra information post)
- Emotional exhaustion
- Increased anxiety
- Impaired appetite or binge eating
- Feelings of hopelessness
- Suicidal thoughts*
- Reduced ability to feel sympathy and empathy towards clients or family/friends
•Cynicism at work
- Anger at work
•Resentment of demands being put on you at work and/or at home
•Dread of working with certain clients/patients/certain case files
•Diminished sense of enjoyment/career(i.e., low compassion satisfaction)
- Depersonalization – spacing out during work or the drive home
- Disruption of world view/heightened anxiety or irrational fears
•Intrusive imagery (You can read an excellent description of this in Eric Gentry’s Crucible of Transformation article).
- Hypersensitivity to emotionally charged stimuli
•Insensitivity to emotional material/numbing
•Difficulty separating personal and professional lives
•Failure to nurture and develop non-work related aspects of life
Once you have read through and circled your most frequent warning signs, try and identify your top three most frequent warning signs. I call them the “big three”. Are they all physical, emotional or behavioural or do you see a mixture of signs from each category? Would you say that you are currently in the Green (healthy), Yellow (warning sign) or Red zone with your overall functioning?
Now, ask a loved one or close colleague to share with you what they think your “Big Three” warning signs are, at home and at work.
Each warning sign has specific tools that can help reduce your levels of stress. For example, if you are experiencing a lot of secondary exposure-related symptoms, you may wish to examine your caseload, the availability of debriefing and grounding strategies and you may need to assess the level of extraneous trauma images and stories that you are exposing yourself to in your personal life. If you have a lot of emotional symptoms, you may want to consider a consultation with a well-trained mental health professional who is familiar with vicarious trauma and the nature of the work that you do.
In our post on Tools and Resources (link here) we will provide some more suggestions.
*Suicidal or hopeless thoughts? Get Help Now Please remember that no matter how stressful/traumatic our work is, it is not a normal consequence of VT/STS to experience suicidal thoughts or prolonged bouts of depression or hopelessness. Please seek help as soon as you notice these symptoms in yourself. If you are worried about confidentiality, or unsure where to turn, please consult online sources of support. There are urgent suicide support hotlines available 24/7 which you can find with a click of the web. Don’t suffer alone. Get help. You deserve it and so do the people who love you.
Figley, C.R. (Ed). (1995) Compassion Fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel.
Figley, C.R. (Ed.). (2002) Treating Compassion Fatigue, New York: Brunner/Routledge.
Gentry, E. J., (2002) Compassion Fatigue: A Crucible of Transformation in Journal of Trauma Practice, Vol 1. No. 3/4. pp.37-61.
Killian, K. (2008). Helping till it hurts? A multimethod study of compassion fatigue, burnout, and self care in clinicians working with trauma survivors in Traumatology, (14, 2) 32-44.
Mathieu, F (2012) The Compassion Fatigue Workbook – New Revised and Expanded Edition
Van Dernoot Lipsky, L. (2009) Trauma Stewardship: A guide to caring for self while caring for others. BK Publishers.
Saakvitne, K.W.; Pearlman, L. A., & the Staff of the Traumatic Stress Institute (1996): Transforming the pain: A workbook on vicarious traumatization. New York: W.W. Norton.
© Françoise Mathieu 2017