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PTSD, Compassion Fatigue, and Burnout

Traumatic stress in the First Responder has some significant differences from that which is experienced by the military soldier or other trauma survivors. For the most part, the trauma a First Responder experiences generally is not a direct threat but comes from experiencing another’s trauma. For instance, when a police officer responds to a call involving child abuse and has to witness the physical and psychological effects from the child; or a paramedic has to inform a patient’s wife that he was not able to revive her husband, and she falls to her knees and cries out in anguish. Until the recent addition in the DSM 5 of this type of trauma, which is called vicarious trauma, was not considered a significant trauma to warrant cause for the development of PTSD. If the paramedic, EMT, police officer, or firefighter did not experience a direct threat to life or limb, or witness direct trauma to another, they did not meet the criteria for PTSD. Now, however, with the changes in the DSM 5, the trauma experienced while “on the job” is finally recognized and First Responders can get the help they need to treat their PTSD. Unfortunately, there is another type of trauma that is not yet officially recognized. This trauma that is very subtle yet insidious is the kind that comes from the sheer act of being compassionate. The First Responders give of themselves incessantly, and frequently thanklessly, and eventually becomes fatigued from the constant giving. This accumulates over time to the point where the compassion wounds the soul too much, and the First Responder develops Compassion Fatigue. Its signs and symptoms are similar to PTSD, but the avoidance is directed mainly towards the job or situations where the First Responder has to demonstrate any form of compassion. This could include avoiding family and friends. Because it’s so subtle and insidious, it may not be noticed until the First Responder is entrenched delaying treatment and possibly exacerbating family or social issues. Compassion Fatigue and PTSD both contribute to the higher than average divorce rates, substance abuse, and suicides plaguing First Responders. They are conditions that can be recognized by coworkers and family generally before the First Responder notices. Early interventions can include Peer Support, Resiliency training, Narrative training, EMDR. Neurofeedback, Life Coaching, and talk therapy. Long-term therapy will need more aggressive EMDR, Neurofeedback, CBT/REBT, and other forms of treatment. In either case, recovery is possible, and return to normal job functioning can occur. Life Coaching can be a valuable tool in helping the First Responder move on from the trauma and achieve a healthier life and restore a sense of purpose to the job. Compassion Fatigue and PTSD should also be distinguished from Burnout. Burnout is a temporary condition where the First Responders becomes fatigue due to the daily stresses of the job wearing them down. It is not caused by traumatic events but by the unrelenting daily stress. The stress builds from the job, family, school, and other activities the First Responder engages in. It builds and saps the energy of the First Responder and then builds some more. Eventually, the First Responder begins to wear down and feels like it is never going to end. Discouragement and depression can set in if no relief is found. Moral and motivation diminishes and despair sets in. Everyday activities become less appealing and more bothersome. Sleeping is ineffective in restoring the First Responder’s energy and rehabilitation because the next day brings more stress. The image of burning the candle at both ends becomes an understatement because it now burns in the middle also. Fortunately, the treatment for burnout is not as involved at those for PTSD or Compassion Fatigue. Disengaging from the stress and resting can restore the First Responder to health. It can be as easy as taking a two-week vacation to restore the First Responder. If left untreated, however, it can significantly contribute to Compassion Fatigue. SC4I offers a wide variety of counseling services to meet the needs of each First Responder’s situation. Contact us at 719-822-3387 or email us at

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