Do you care for someone with a mental health condition? What about someone with several mental health conditions? Perhaps you also care for someone with behavioral problems as well. Either way, it is very easy to begin to feel burned out, overwhelmed, and exhausted. For many parents, families, caregivers, and friends of individuals with mental health or behavioral health conditions, the road can seem almost endless. The road can also be emotionally draining, primarily when a loved one is frequently admitted to psychiatric hospitals, needing multiple safety precautions in the home if there are suicide attempts or cutting behaviors, and multiple calls to the police for protection. As a child and adolescent therapist who works with many families, I have seen my fair share of compassion fatigue, secondary trauma, and burn-out. Unfortunately, many caregivers (friends, family, spouses, children, etc) are uninformed about these things and neglect to care for themselves. This article will discuss burn-out, secondary trauma, and compassion fatigue and ways to examine if you are a sufferer.
I once saw a family for weekly family sessions to discuss not only the identified patient’s behavioral concerns (sexually explicit behaviors, risk taking, drinking and using multiple drugs, skipping school, physical and verbal aggression, and cutting), but also the toll this young man was having on the entire family unit, including extended family. This young man, 16 years old, had grown up in an emotionally unstable and neglectful home where both of his parents were substance abusers with mental health conditions. He longed for a stable childhood home environment including cognizant parents who would show him love and affection. Instead of love and affection, he received multiple beatings from dad 3x per week when dad would drink and use illegal narcotics sold on the corner in their neighborhood. Instead of motherly attention and direction, he received a punishment everytime he would ask his mother, while she gossiped on the phone daily, for help with his homework. After years of repeated torture and emotional/physical/psychological and verbal abuse, he began to drift slowly into chronic depression. His first episode lasted for months and included periods of suicidal ideation (i.e., thoughts) mixed with an intense desire to kill his father that only illegal drugs could dull. Although this young man was a wonderful person with so much enthusiasm for life, his upbringing was a big hindrance to any kind of success. As a result, his 70-year-old maternal grandfather and 62-year-old grandmother decided to finish raising their grandchild. Instead of going through the courts, the family arranged for this young man to stay with his grandparents every weekend. Sadly, these grandparents realize just how burned out they were when they had taken him back to the emergency room for the 30th time in 2 years.
Sadly, the above case is not an abnormal one and many families, especially extended families, find themselves having to step in and help those with mental health and behavioral problems. I’m sure you can fully relate to the psychological and emotional exhaustion that results from trying to care for someone with mental health and behavioral problems. It is important that you understand what the psychological, emotional, and physiological symptoms of burn-out, secondary trauma, and compassion fatigue are. As a result, I have listed some of the symptoms which include but are not limited to:
- Physiological: Little to no appetite, poor sleep (sleeping too much or not enough), chronic headaches or migraines, shakiness or anxiety, vomiting or feeling nauseated, weight loss or weight gain, achiness in muscles or joints, sensitivity to hot and cold temperatures, chills, or getting sick and feeling run-down.
- Psychological/emotional: crying spells, depressed or anxious mood, increased levels of stress, irritability, poor wake and sleep cycles, anhedonia (or lack of pleasure), sluggishness or fatigue, thoughts of suicide or death and dying, withdrawal from family and friends, and poor hygiene.
It is also important to be able to identify signs of compassion fatigue, burnout, and secondary trauma. Below are specific descriptions of each:
- Compassion Fatigue: Charles Figley (1995), a leading component providing research on compassion fatigue, identified compassion fatigue symptoms based on his work within the field. He proposed that the combined effects of a caregiver’s repeated visualization of someone’s traumatic experience added to the effects of burnout and often led to “compassion stress” or compassion fatigue. For example, if you are working with someone who has a traumatic history and you are frequently exposed to this person’s “story” through conversation, you can begin to feel the effects of the following symptoms:
- Intrusive Symptoms: Thoughts and images associated with the traumatic experience, obsessive and compulsive desire to help certain people, thoughts and feelings of inadequacy as a caregiver, and personal activities interrupted by caregiving duties.
- Avoidance Symptoms: loss of enjoyment in activities once enjoyed, loss of hope and sense of dread as a caregiver, isolation, secretive self-medication using alcohol or drugs, and relational dysfunction.
- Arousal Symptoms: Increased anxiety, impulsivity/reactivity, increased perception of demand or threat, increased frustration/anger, sleep disturbance, difficulty concentration or poor attention span, changes in weight or appetite and somatic symptoms (headaches, muscle tension, etc).
- Secondary Traumatic stress: Secondary traumatic stress is also referred to as vicarious traumatization. It includes trauma symptoms that you might be exhibiting as a result of caring for someone with a traumatic history. For example, nurses and doctors who provide care to war veterans are probably exposed to trauma on a daily basis which can result in the above intrusive symptoms, avoidance symptoms, and arousal symptoms. The best way to think of secondary traumatic stress is by remembering that being repeatedly exposed to someone else’s trauma story can lead to the same amount of distress that the person with the trauma history has experienced.
- Burn-out: Although the above categories seem similar, they are very different in terms of how symptoms are manifested. Unfortunately, burn-out is often confused with compassion fatigue and secondary traumatic stress. Christine Maslach, a social psychologist and developer of the Maslach Burnout Inventory, described burn out as a “psychological syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment.” She believed that burn-out is a result of the environment in which you care for someone. For example, if you work in a toxic work environment and you care for patients, you are certainly likely to experience burn-out. But Eric Gentry (researcher and trainer offering services through the International Association of Trauma Professionals) and Baranowsky (in 1998) defined burn out as “the chronic condition of perceived demands outweighing perceived resources.” When you feel the demands of caring for someone with a mental health condition outweigh the benefits of doing so, you are likely to burn out.
One thing I always remind families of is the importance of caring for themselves (i.e., self-care) before they can care for someone else. You have to take care of your mind, your heart, your soul, and your body in order to help yourself cope and help the loved one who needs you the most.
As always, feel free to post some of the symptoms you have experienced and perhaps even the ways you have learned to cope. If you would like to take a self-test to see if you might be suffering from compassion fatigue, visit my website here.
I wish you well
Compassion fatigue awareness project. Suffering from compassion fatigue? Life stress? Retrieved November 12, 2015 from, http://www.compassionfatigue.org/pages/selftest.html.
Gift From Within. (2015). PTSD resources for survivors and caregivers. Retrieved online from, http://www.giftfromwithin.org/html/What-is-Compassion-Fatigue-Dr-Charles-Figley.html.
The Institute of Stress. (2015). Definitions. Retrieved online November 13, 2015 from, http://www.stress.org/military/for-practitionersleaders/compassion-fatigue/.