Understanding the Difference Between Compassion Fatigue, Trauma and PTSD in First Responders

tired firefighters sitting on fire truck

By Libby Timmons, National Clinical Outreach Director

Police, firefighters, EMS workers and other first responders see more tragedy and despair in an average day than people in most professions. And they are sometimes unaware of how it affects their mental health.

Educating first responders on the different ways they are impacted by trauma and helping them understand the cumulative effect of exposure to daily disasters is an important step toward healing. Research shows that the amygdala, medial prefrontal cortex and hippocampus areas in the brain are involved with trauma and PTSD. Traumas are interrelated and may be connected in the brain. While some people develop anxiety disorders and other mental health issues as a result of trauma, others can prevent these issues from developing if they are more resilient or can recognize what is happening and get the needed support.

Not All Traumas Are Created Equal

Compassion fatigue and post-traumatic stress disorder (PTSD) are common among first responders. These can be compounded by childhood trauma, especially if it is unresolved. Here are a few ways these three issues are both similar and different:

1. Unresolved childhood trauma

For many first responders, trauma begins at an early age, being raised in homes where there is addiction, abuse or neglect. It’s not uncommon for people with childhood trauma to go into adrenaline-oriented professions, becoming nurses, doctors, police officers, firefighters and EMTs. They’re already groomed to be caretakers. Because these individuals are always on high alert, watching out for everyone else, they make natural first responders. They also have a high tolerance for stress and are usually the first to volunteer to help with something, even when off duty. If they don’t practice good self-care, this ultimately stresses the body and wears down the emotions and spirit.

Some of the signs of unresolved childhood trauma include:

    • Unexplained anxiety in certain situations
    • Irrational rage reactions
    • Deep feelings of shame and unworthiness
    • Trauma recreation and experiences where old trauma can be relived
    • Avoidance or utter disdain for certain people, places or activities
    • Feeling detached or dead inside
    • Disassociation from childhood or current events
    • Thoughts of suicide or attempts
    • Hypervigilance and constantly being on guard
    • Abusing drugs or alcohol or engaging in destructive behaviors to help “forget”

2. Compassion fatigue

If first responders have been working a lot and do not have healthy self-care practices in place, then they don’t have a way to recharge. They are running on empty but continue to work, taking care of everyone except themselves. Sometimes a vacation or some time off can help remedy some of the stresses, but this condition needs therapeutic help too. We often hear, “I can’t take a vacation because I used all my days taking care of my sick parent/child.” With no let up on the amount of energy put out, and continuing to put their life force into helping others, stress builds and they burn out. Some of the symptoms of compassion fatigue include:

    • Mental and physical fatigue
    • Irritability or feeling easily annoyed
    • Being preoccupied, distracted and unable to concentrate
    • Overreacting to situations with anger or rage
    • Feeling apathetic, uninterested or joyless
    • Bottling up emotions or blaming others excessively for their problems
    • Isolating from others
    • Constant complaining and possibly receiving complaints
    • Compulsive spending, overeating, gambling, sex and other addictive behaviors
    • Using substances to cope with emotions

3. Post-traumatic stress disorder (PTSD)

This is an anxiety disorder that involves persistent mental and emotional stress. It results from experiencing or witnessing frightening events. Symptoms may be mild to severe, depending on the trauma and the individual’s coping skills.

It is important to address trauma as it occurs to try to prevent it from becoming PTSD. For example, a rookie cop was called out to a crime scene where the victim was decapitated. He’d just graduated from the Police Academy, and he did his job and held himself together at the scene, but when he got back to the station he confided in another cop that he couldn’t get the grotesque scene out of his mind. The cop took him out for a beer and told him “Get used to it.” A week later, still haunted by the scene, he reached out to a veteran cop who worked with first responder trauma. He got help dealing with a situation that could have defined his career.

The term post-traumatic stress injury (PTSI) is sometimes used to replace PTSD. But the symptoms of both are the same and may include:

  • Flashbacks and reliving the trauma over and over
  • Physical reminders of the trauma that create racing heart or sweating
  • Nightmares
  • Anxiety and frightening thoughts
  • Dissociation from the present moment when lost in frightful visions
  • Avoidance of places or objects that trigger traumatic memories

Everyone Handles Trauma Differently

Some people are tough on the outside but inside they are like sponges, soaking up the pain and energy around them until it interferes with their own functioning and their family life. Others can be exposed to multiple horrors in a day but have resilience and a way to soothe themselves that does not involve compulsive behaviors or substances. The best medicine is knowing where you are on the spectrum and allowing yourself to experience your authentic emotions rather than stuffing them down until they turn into destructive behaviors.

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