Secondary post-traumatic stress disorder can occur when an empathetic listener experiences accounts of violence or other painful events.
Major Nidal Malike Hasan had heard many accounts of the horrors of war in his position as army psychiatrist at Walter Reed. Some of his clients were visibly maimed, and a significant percentage of his clients suffered from PTSD. Since PTSD is becoming increasingly prevalent among members of the U.S. military, their caregivers and family members are also increasingly at risk for secondary stress.
Secondary PTSD Risk Factors in the U.S. Military
Respected researchers such as Figley, Pearlman and Saakvitne have been documenting cases of secondary PTSD in psychotherapists since 1995. Figley, who refers to the condition as “compassion fatigue” notes that empathy is an important part of a therapist’s role, but acknowledges that it can have a cost. Pearlman and Saakvitne, who describe this condition as “vicarious trauma” state that sometimes “the therapist’s inner experience is negatively transformed through empathic engagement with clients’ trauma.” The result may be Secondary Traumatic Stress Disorder (STSD).
However, anyone who gives care to a traumatized person is susceptible to STSD, including children and spouses of active duty military personnel. It seems to be more likely to occur among people who have experienced prior traumatic events themselves. People who have other types of mental illness may also be at risk. However, social isolation or a lack of inner resources, such as a strong spirituality, can cause anyone involved in the care of a traumatized person to be debilitated by STSD.
Symptoms of Secondary Traumatic Stress Disorder
People with STSD may experience the same symptoms as the traumatized person. These symptoms include depression with suicidal thoughts and feelings, as well as feelings of loneliness and betrayal. This condition may also lead to substance abuse. Many people with STSD will have difficulty carrying out regular tasks at work and home. In some cases, their ability to cope will be severely impaired.
Family members of traumatized persons will often develop hyper-vigilance. Since they are impacted by the traumatized person’s emotional crises, they become sensitive to small mood changes or other risks to stability. Eventually they may find it difficult to relax and feel as if they are “walking on eggshells.” This may also make sleep difficult.
If the stress continues over a long period of time, mental health professionals, caregivers or family members may eventually develop negative feelings toward the traumatized person. They may become unwilling to provide care. They may even become verbally or physically abusive toward the traumatized person. Therefore, it is important to treat STSD as soon as possible.
Treating Secondary Stress among Caregivers
Therapists are often unwilling to acknowledge the extent to which they are suffering from secondary stress. They may see their symptoms as failure, or may be unwilling to discuss their inability to treat their clients. Family members may feel guilty about their anger toward the traumatized person in their lives, or may minimize their own feelings of depression. These responses do not help the traumatized person. Anyone with symptoms of STSD ought to seek treatment.
The treatment of first choice is usually counseling. Since hearing about traumatic events may reactivate memories, the mental health practitioner or family member may benefit from counseling to transcend these prior events. Some may benefit from individual sessions with a therapist, while others may participate in a support group. Support groups can be very useful in helping family members or mental health professionals to overcome their feelings of isolation or inadequacy.
Another important step in treating secondary stress is for the family member or mental health professional to engage in meaningful activities unrelated to caring for the traumatized person. Family members may feel guilty enjoying activities outside the home, while therapists may feel that hobbies will prevent them from achieving professional success. However, caregivers who do not develop a fulfilling personal life may lose their ability to serve the primary sufferer well.
Continued Stress in the U.S. Military
Active duty members of the military are subject to a great deal of stress and trauma as the U.S. continues to fight two prolonged wars. This can impact their mental health professionals, caregivers and family members in significant and challenging ways. Cases of secondary traumatic stress disorder may increase and must be acknowledged and treated as efficiently as possible or the costs will continue to rise.
Beth Ellen McKinney - I am a credentialed teacher with many years of experience in a variety of settings. I currently teach at an alternative high school in an ...
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