What Is Secondary Trauma? 7 Signs You May Be at Risk
Those in the helping professions can often experience PTSD-like symptoms; don’t miss the early warning signs
Disclaimer: I’m not a health professional. This article shouldn’t be treated as professional health advice and is for informational purposes only.
Sitting in a room with three women twice my age, I realized: I couldn’t run this support group anymore.
We were in the middle of a reflective listening exercise. The point was first to listen, then to repeat the story back to the person who shared it. This was a way of letting them know they’d been heard.
What I found myself reflecting involved lots of physical and emotional abuse which had happened decades earlier. That’s how long the woman in front of me had been kepeing her story in silence.
As she shared it in the group after all these years, I felt myself freezing.
According to researchers from the University of Bristol, “secondary trauma (ST) refers to the impact of indirect exposure to traumatic experiences; effects [of] which can be ‘disruptive and painful’ and can ‘persist for months or years’ (…). The effects, as described by McCann, in relation to working directly with clients, are considered to be a usual response which results from witnessing a distressing traumatic event or from knowledge about such an event.”
At the time, I didn’t know the term “secondary trauma.” But I intuitively felt that the emotional load I took on with that support group was bigger than I was prepared for.
As I continue to work and live in a community setting, I become aware of how many people spend years and decades supporting trauma survivors full-time and potentially dealing with secondary trauma themselves. In this article, you’ll hear their voices, as well as academic takes on this psychological phenomenon.
By the end, you’ll be better equipped to recognize and deal with secondary trauma.
Table of Contents
- First Things First: What Is Trauma?
- What is Secondary Trauma?
- The Difference Between Secondary Trauma, Compassion Fatigue, and Burnout?
∘ A change in world view
∘ Compassion fatigue
∘ Secondary traumatic stress
∘ Social worker burnout
∘ Positive responses to secondary trauma - 7 Signs You May Be at Risk of Vicarious Trauma
∘ Sign 1: You work in a high risk profession
∘ Sign 2: You’re experiencing PTSD-like symptoms
∘ Sign 3: You feel under-resourced to deal with emotional challenges of your work
∘ Sign 4: You justify negative behaviors by the positive things you do at work
∘ Sign 5: People who know you strongly suggest you take a break
∘ Sign 6: You believe that if you care enough about your work, you need to just “suck it up”
∘ Sign 7: You carry unresolved personal trauma - The Earlier You Spot Secondary Trauma, the Better (not just for you)
First Things First: What Is Trauma?
If you’re clicked on this article, I imagine you know what trauma is. But just as a recap, here are a few definitions.
The American Psychological Association (APA) defines trauma in simple terms. They say it’s “an emotional response to a terrible event like an accident, rape, or natural disaster. Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships, and even physical symptoms like headaches or nausea.”
The APA definition points to short-term and long-term responses to trauma. While the short-term response often has to do with self-preservation, the long-term effects can include changes in behavior, emotions, and personality. Traumatic stress re-shapes the brain. This can result in memory and cognitive problems, changing reactions to stress, mental health issues, and many more.
The word “trauma” often refers to the bodily response to a distressing event. But in some contexts, it’s also used to describe the event itself. Matthew Tull from VeryWellMind writes that “trauma is any type of distressing event or experience that can have an impact on a person’s ability to cope and function.”
Professionals sometimes distinguish between “big T” and “little t” trauma. “Big T” trauma is often associated with a physically threatening event, such as a car crash, sexual assault, or war. It’s also more often linked to PTSD (post-traumatic stress disorder) symptoms. “Little t” trauma is usually a distressing experience that impacts a person’s psyche without being physically threatening. Common examples include parental neglect, invalidation, financial scarcity, and other challenges that many people encounter at some point in their lives.
Finally, another layer in the conversation is systemic trauma. In the words of Rachel E. Goldsmith, it refers to — “contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses.” A vivid example of this is racial trauma, experienced through interacting with a culture that continuously displays bias and stereotypes at best, and race-based violence at worst.
Many people experience some form of trauma in their lives — “big T,” “little t,” or both. However, an even bigger group encounters secondary trauma — which is the main topic of this article.
What is Secondary Trauma?
The term secondary trauma (also known as vicarious trauma) was coined by Beth Stamm, Charles Figley, and their colleagues in the early 1990s. The researchers were trying to understand why service providers were experiencing symptoms similar to PTSD, without necessarily encountering a traumatic event themselves.
One way to explain how secondary trauma works is through a story. Laura van Dernoot Lipsky is an author, founder of The Trauma Stewardship Institute, and trauma worker and researcher with decades of experience. Before she tells her story in a TED talk, she sets the scene with this critical observation:
“What we know is that when humans are exposed to suffering, hardship, crisis, trauma of humans, other living beings or the planet itself, there’s a cumulative toll. There’s a toll on us individually, there’s a toll on your immediate relationships, there’s a toll organizationally for those of you have this exposure in your work, institutionally, systemically, we see it in movements we’re a part of, we see it throughout all of our communities, and a society as a whole.” — Laura van Dernoot Lipsky
Lipsky certainly knows a thing or two about being exposed to others’ suffering and hardship. As a 13-year old, she lost her mother to lung cancer. At 18, she found her purpose in volunteering at a homeless shelter. She then went on to work with survivors of domestic violence, sexual assault, natural disasters, and other kinds of traumatic events. Simultaneously, she was involved in environmental movements and community organizing.
It took her a decade of full-time exposure to suffering to realize how much it’s been affecting her life. As the first “aha” moment, she recalls hiking with her family on one of the Caribbean islands. Standing on top of a cliff, appreciating the sunset, it only took a few seconds for her mind to start producing thoughts like:
- I wonder how many people have killed themselves by jumping off of these cliffs?
- Where would an emergency helicopter land here?
- Is there a level 1 trauma center in the Caribbean? If there isn’t, would they fly to Miami? Would they be stopped at customs?
When she voiced those thoughts to her family, there was a long silence first. Then, Lipsky’s stepdad asked: “Are you sure all this trauma work hasn’t gotten to you?”
Of course it has. Her experience was a classic display of secondary trauma.
Secondary trauma is often experienced by people who routinely interact with victims of trauma, violence, natural disasters, and other dramatic life events. Prolonged exposure to expressions of suffering can result in negative psychosocial symptoms. It can affect your nervous system, mental health, and behavior in similar ways as a traumatic event experienced first-hand. A systematic review from 2016 showed that signs of secondary trauma can look like PTSD symptoms.
The Office for Victims of Crime (OVC) highlights the professional dimension of secondary trauma. As examples of work-related trauma exposure, they cite: “listening to individual clients recount their victimization; looking at videos of exploited children; reviewing case files; hearing about or responding to the aftermath of violence and other traumatic events day after day; and responding to mass violence incidents that have resulted in numerous injuries and deaths.”
Some professions who are likely to suffer from secondary trauma are:
- Child welfare workers
- Medical and mental healthcare providers
- Emergency response personnel, such as firemen and paramedics
- Caregivers
- Law enforcement officers, e.g. police force, security guards
- Social workers
- Therapists
- Educators
- Volunteers helping at homeless shelters, crisis centers, or otherwise working with survivors of trauma.
Even though secondary trauma is often discussed in a work context, it can also occur elsewhere. Examples include children of war-traumatized parents, partnering with someone who has PTSD, or watching footage from a catastrophic event over and over on the news. A 2002 study reported that after the attack on the World Trade Centre, people who were exposed to the media coverage of the tragedy were more likely to show PTSD symptoms — even when they lived outside of the terrorist attack sites.
Secondary trauma can occur in various contexts. However, for the rest of this article, I will focus specifically on the work context and what factors increase the risk for you as a professional.
The Difference Between Secondary Trauma, Compassion Fatigue, and Burnout
The term “secondary trauma” has only been around for the past 20–30 years. Like with a lot of specialist vocabulary, it often gets mixed with other similar concepts.
“Compassion fatigue,” “secondary traumatic stress,” and “social worker burnout” are often used interchangeably with secondary trauma. While these terms have overlapping definitions, they are not the same.
The Office for Victims of Crime created a Vicarious Trauma Toolkit (VTT) to systematize the language around secondary trauma. For the purpose of this article, I’m using the terms “secondary trauma” and “vicarious trauma” interchangeably. This seems to be the consensus among most academics (although some recognize subtle differences between them, too).
In the VTT model, vicarious (or secondary) trauma refers to an event of being exposed to someone else’s trauma. Separate from that event, there are consequences: a change in world view and a spectrum of responses. Possible responses to vicarious trauma include secondary traumatic stress and compassion fatigue.
Below is a breakdown of the main elements of the VTT diagram. It will help you understand the difference between secondary trauma and other phenomena.
A change in world view
Most researchers agree that a change in world view is an inevitable consequence of secondary trauma. Remember Lipsky’s story of standing on the cliff and thinking through suicide scenarios? Not everyone who climbs a cliff has those thoughts. But she did. Being exposed to other people’s suffering had changed the ways in which her mind worked.
According to Pearlman & Saakvitne’s definition, vicarious traumatization involves “the profound shift in worldview that occurs in helping professionals when they work with individuals who have experienced trauma. Helpers notice that their fundamental beliefs about the world are altered and possibly damaged by being repeatedly exposed to traumatic material. A domestic violence shelter worker may stop being able to believe that any relationship can be healthy. A child abuse investigator may lose trust in anyone who approaches their child.”
Those changes in worldview can occur in five areas: sense of safety, ability to trust others, self-esteem, intimacy, and sense of control. Depending on what your work involves and what kind of trauma you were exposed to, you may observe changes in one or more of these areas.
Compassion fatigue
Alongside the change in the worldview, secondary trauma results in some kind of a response. As you can see in the VTT diagram, that response can be negative, neutral, or positive.
Compassion fatigue is one possible negative response to secondary trauma. It’s a consequence of extending empathy over prolonged periods of time at the cost of your own wellbeing.
Charles Figley, who first coined the term in 1992, described it as “the emotional and physical burden created by caring for others in distress.” Another, more recent definition comes from Newell & MacNeil (2010) and points to “the overall experience of emotional and physical fatigue that social service professionals experience due to chronic use of empathy when treating patients who are suffering in some way.”
Both definitions mention the physical and emotional aspects of compassion fatigue. This suggests that the depletion that comes with it runs deep — and, requires proper self-care for a balance to be established.
Finally, author SaraKay Smullens speaks of compassion fatigue simply as “an inability to establish proper boundaries.” She points out that often, it’s the worker’s own unresolved trauma that leads them to bending over backwards, trying to help everyone around them.
Secondary traumatic stress
In the VTT model, secondary traumatic stress is another possible response to vicarious trauma. It doesn’t happen to everyone who’s exposed. But when it does, it looks pretty similar to PTSD (post-traumatic stress disorder).
Secondary traumatic stress is seen as a behavioral and emotional symptom. You can recognize it by seeing actions and feelings that weren’t present before. In their glossary of terms, The Office for Victims of Crime define it as “the natural consequent behaviors and emotions that often result from knowing about a traumatizing event experienced by another and the stress resulting from helping, or wanting to help, a traumatized or suffering person.”
Similarly to compassion fatigue, secondary traumatic stress is rooted in wanting to help more than we have capacity for.
Social worker burnout
“Burnout is characterized by emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment. Although burnout also is work related, burnout develops as a result of general occupational stress; the term is not used specifically to describe the effects of indirect trauma exposure.” — Royal School District
Secondary trauma can sometimes be mistaken for social work burnout. That’s because some symptoms — such as physical and emotional exhaustion or trouble with sleep —look quite similar.
However, the roots of the two are quite different.
In her TED talk, Amy Cunningham, a social worker of many years, names that difference very clearly. She says that burnout has to do with losing the meaning in your job and ceasing to enjoy it. On the other hand, secondary trauma changes your psyche. It’s not that you don’t see meaning in what you do. Quite the opposite — you assign so much meaning and importance to your work that you start filtering your whole experience through that lens.
Cunningham says that secondary trauma, unlike burnout, relates to being scared. It may make you hypervigilant and overly cautious, and lead to avoiding certain experiences as dangerous.
Positive responses to secondary trauma
It’s possible to have positive responses to secondary trauma, too. Concepts like vicarious resilience or compassion satisfaction are still new in the academic world. But intuitively, most people understand that working with survivors can bring about many positive changes.
For example, vicarious resilience is built on hearing someone’s story of trauma and deriving strength from it. And example can be seeing a mother bounce back after losing her children to a natural disaster. You may think: If she can find meaning and peace after that, I surely can overcome my problems.
Compassion satisfaction arises when you feel the benefits of offering your support to a survivor of trauma. You stretch yourself enough to make a difference in another person’s life. But, you’re not stretched to the point of losing your wellbeing to the job.
7 Signs You May Be at Risk of Vicarious Trauma
To catch yourself before having a full-blown secondary trauma response can be tricky. The big challenge is that most people don’t experience symptoms overnight. As Amy Cunningham says, they “creep up on you over time.”
You may be exposed to vicarious trauma months and years before you notice its impact. Luckily, there are things you can spot in your environment, psychological makeup, and behavior of others that can alert you.
This way, you can mitigate the negative consequences sooner rather than later. One way to do that may be joining the CivLead community of changemakers and receive support you wouldn’t otherwise have.
Sign 1: You work in a high risk profession
One sign you’re at risk of vicarious trauma is if you work in a high-risk profession. This means your job exposes you to interacting with survivors of trauma, natural disasters, and other forms of suffering.
Some of these professions include — and aren’t limited to — social workers, therapists, health practitioners, emergency responders, and child welfare workers. However, it can also be that you provide a service like cutting hair or bartending in a highly traumatized community, and that exposes you to stories of other people’s trauma.
Sign 2: You’re experiencing PTSD-like symptoms
Another straightforward way to spot secondary trauma is when you’re already experiencing symptoms. As mentioned before, physical, emotional, and behavioral symptoms of secondary trauma can resemble PTSD.
Laura van Dernoot Lipsky created a diagram outlining many of those symptoms (see below). She called them “trauma exposure responses.” They include:
- Dissociative moments
- Sense of persecution
- Guilt
- Fear
- Anger and cynicism
- Inability to empathize/numbing
- Addictions
- Grandiosity: an inflated sense of importance related to one’s work
- Feeling helpless and hopeless
- A sense that one can never do enough
- Hypervigilance
- Diminished creativity
- Inability to embrace complexity
- Minimizing
- Chronic exhaustion/physical ailments
- Inability to listen/deliberate avoidance.
Sign 3: You feel under-resourced to deal with emotional challenges of your work
When you’re faced with a heavy emotional load at work, you need proper support. But are you getting it?
For example, as a therapist or social worker you may not receive the level of supervision you need. Or, your caseload may simply be too big. In other professions, you may feel isolated — for example, working alone when really you need a team around you.
Being under-resourced can also mean you didn’t get appropriate training. This was my case of running the community support group. I found myself in a position of helping people to process traumatic experiences that I didn’t have the tools for.
This led to me feeling overwhelmed and closing the group. As I learned later, this was a big disappointment for those who attended, since they started relying on the group support already.
Sign 4: You justify your negative behaviors by the positive things you do at work
A shadow place of helping professions can be when you offload the stress and pressure of your work in other areas of your life. Usually, it’s the friends and loved ones who take the hit.
An example scenario goes like this.
You come back home from a day of working with underprivileged youth at a day center. They challenged you all day long, but you were calm and caring. As you arrive, your partner is cooking dinner for you — but in the meantime, manages to make a bad joke. Even though what they said was insignificant, you get triggered and lose your temper. You spill your frustration all over your partner and get into a fight.
You feel bad initially, but then you excuse yourself. After all, you have to save your patience for the kids at work. That’s what matters, right?
Obviously, this can be a trap. If you’re only showing your best self at work, it might be a sign that secondary trauma got the best of you — and, that your private relationships are suffering.
Sign 5: People who know you strongly suggest you take a break
Laura van Dernoot Lipsky recounts that well before she noticed how secondary trauma affected her, her patients did. Those she was supporting suggested she took some time off!
People who know you often can spot changes in you before you do. While you explain your vicarious trauma away, they may be feeling the impact: your increased irritability, changes in behavior, or negativity you bring into conversations.
If you think you may be at risk of secondary trauma, ask those around you whether they notice anything suspicious. Of course, it may be just one person’s feeling or opinion. It doesn’t need to be true for you.
But at least, it will give you a perspective different from your own.
Sign 6: You believe that if you care enough about your work, you need to just “suck it up”
The belief that you need to endure hardship can come from cultural upbringing. It’s present in the Christian tradition as the notion of “turning the other cheek.” In the wider culture of hustle and overwork, we learned that anything worthwhile requires “blood, sweat, and tears.” Many people wear busyness and exhaustion as a badge of honor.
When you bring such conditioning into a job that involves dealing with trauma, it can keep you from reaching out for support. Or, it can encourage self-medicating behavior — such as addictions and numbing your feelings to “get through the day.”
If you think that caring about your work means “sucking up” the hardship— secondary trauma might be at play.
Sign 7: You carry unresolved personal trauma
The National Child Traumatic Stress Network states that those “who are highly empathetic by nature or have unresolved personal trauma” are at a greater risk of secondary trauma. If you grew up in a dysfunctional family or community, this could result in an overly empathetic approach to the suffering of others.
One common example is the Adult Children of Alcoholics. These are the children who often needed to play the role of a caregiver to their parents. As a result, they may have an overdeveloped sense of responsibility for others as they grow up, coupled with reluctance to take responsibility for themselves. They are at higher risk of secondary trauma.
Another example that affects a big part of the population is racial trauma. As Kenya Downs writes in PBS news, “research suggests that for people of color, frequent exposure to the shootings of black people can have long-term mental health effects. According to Monnica Williams, clinical psychologist and director of the Center for Mental Health Disparities at the University of Louisville, graphic videos (which she calls vicarious trauma) combined with lived experiences of racism, can create severe psychological problems reminiscent of post-traumatic stress syndrome.”
If you’ve been affected by trauma during childhood, you are at higher risk of secondary trauma. This is especially true of systemic and racial trauma, but not limited to these.
The Earlier You Spot Secondary Trauma, the Better (and Not Just For You)
If you realized you’re at risk of secondary trauma — what’s next? How do you continue doing your job without sacrificing your wellbeing?
One thing to keep in mind — especially if you’re that over-empathetic, trying-to-save-the-world changemaker type — is this quote from civil right leader and author Howard Thurman:
“Don’t ask yourself what the world needs. Ask yourself what makes you come alive and then go and do that because what the world needs is people who have come alive.” — Howard Thurman
The main thing is doing what feels right for you. That’s so cliché it may not seem worth repeating. But I keep forgetting it — and I know other people do, too. We need the reminder that to benefit others, we need to do what’s good for us first.
In other words, you can only fill other people’s cups if your own cup is full. Part of your responsibility if you’re in a helping profession is to take care of yourself. And by that, I don’t mean bubble baths and expensive retreats.
Real self-care is about practicing the awareness of your body, feelings, and thoughts, moment-to-moment. It’s about practical mindfulness. By being connected to and caring for yourself, you can help those you work with do the same.
Laura van Dernoot Lipsky said that “if you are numb, you will not be able to gauge whether or not you’re doing harm.” You need to stay resourced and present to keep doing your work. You can’t afford to detach yourself from the world.
One way to stay connected to yourself and your purpose is by joining CivLead — a community of changemakers supporting each other. Take our Changemaker Quiz to find out your changemaker type, together with its shadows and self-care suggestions.
