Your shift is over and, back in the car, you can still see the face of the patient you could not help. At home someone asks how your day was and you answer with a curt "fine", because you have nothing left for conversation. A few years ago you left work tired but with the feeling that you had helped. Now you count the hours and, what worries you most, you notice that it affects you less when someone cries in front of you.

If this sounds familiar, it may be compassion fatigue, the emotional wear and tear that comes from caring for people who are suffering. It is common in healthcare, psychology, social work and the emergency services, and also among people caring for a relative. This guide explains what it is, what the symptoms are, how it differs from burnout, why empathy is tiring too, which test can guide you and what helps.

What is compassion fatigue?

The term was coined to describe the stress that comes from contact with a traumatised person rather than from the trauma itself. According to the review by Cocker and Joss, compassion fatigue arises when two things come together:

  • Secondary traumatic stress: an often extreme state of tension and constant preoccupation with the emotional or physical pain of the people you help.
  • Cumulative burnout: physical and mental exhaustion caused by a depleted ability to cope with everyday life.

The most widely cited definition, by the researcher Charles Figley, describes it as a state of biological, psychological and social exhaustion and dysfunction resulting from prolonged exposure to compassion stress. The research tool most often used to measure it is the ProQOL, which separates those two parts and also measures a third, compassion satisfaction: the good that helping others leaves you with.

It is not the same as burnout

The World Health Organization defines burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed, with three dimensions: exhaustion, mental distance or cynicism about your job, and reduced professional efficacy. It adds that the term refers only to the occupational context and should not be used for other areas of life.

Compassion fatigue shares the exhaustion but adds something else: the weight of watching other people suffer. The review by Cocker and Joss explains this with two separate routes. Burnout appears when you cannot achieve your goals, and it leaves frustration, a sense of losing control and steadily falling morale. Secondary traumatic stress appears when you cannot rescue or save someone, and it leaves guilt and distress. That is why compassion fatigue does not depend only on how your work is organised, and why someone caring for a relative can experience it without having a job at all.

Symptoms of compassion fatigue

The review by Cocker and Joss describes it with these features:

  • Exhaustion.
  • Anger and irritability.
  • Unhealthy ways of coping, such as drinking more or using drugs.
  • Less ability to feel sympathy and empathy.
  • Less enjoyment of or satisfaction with work.
  • More time off work.
  • A reduced ability to make decisions and to care for patients or clients.

The risk rises with the severity of what you witness, especially with direct contact with victims or very graphic scenes. And if it is not addressed, it can lead to more serious problems such as depression, anxiety or even post-traumatic stress disorder.

Who it affects

A meta-analysis by Cavanagh and colleagues, covering 71 studies, found compassion fatigue in every group of healthcare practitioners studied and concluded that no health profession is immune, although the figures varied widely from one study to another. In nursing, another meta-analysis of 79 studies and 28,509 nurses from 11 countries found moderate levels, higher in intensive care units and rising between 2010 and 2019.

It also appears outside work. A review of studies with family carers found moderate levels of compassion fatigue, which points to a real risk for people caring at home. If that is your situation, we explain it in Therapy for carers: carer burnout, when to get help and how to choose.

Woman caring for her elderly father in bed, one of the situations in which compassion fatigue also appears

Why empathy is tiring too

The name can be misleading, because it suggests you have run out of compassion from using it so much. The research by Klimecki and Singer points elsewhere. In one experiment, they trained a group of people first in empathy, resonating with other people's pain, and then in compassion, feeling warmth and a wish to help without sinking into that pain. When watching videos of people suffering, empathy training increased negative emotions; compassion training reversed that and increased positive ones, and each activated different brain networks.

The study concludes that training compassion may be a way to cope with empathic distress and build resilience. That is why Klimecki and Singer proposed speaking of "empathic distress fatigue" rather than compassion fatigue: what wears you out is suffering alongside someone again and again, not the wish to help them.

Is there a compassion fatigue test?

The ProQOL is used mainly in research. If you want a first indication, the Burnout Test from MyPsicoTest measures the wear-and-tear side, and several of its statements fit what compassion fatigue describes. For example: "I have become colder, more distant or more sarcastic with the people I work with or serve", or "The weekend or holidays are not enough for me to recover".

There are 15 statements about the last three months at work or in your studies, each from "Never" to "Very often". The score runs from 0 to 60, with four guidance levels (no signs of burnout, early signs of burnout, moderate burnout and high burnout), and it is broken down into three areas: emotional exhaustion, mental distance and cynicism and professional efficacy. The second is the closest to the loss of empathy the studies describe. The result is calculated on your device and your answers are not stored.

Other tests that may help

If you care for a relative and have no job to relate the questions to, or if what you notice most is tension and poor sleep, the Stress Test will suit you better; one of its statements is "I have found it hard to fall asleep or have woken in the early hours turning things over in my mind". And because compassion fatigue can lead to depression, if your mood has been low for weeks, try the Depression Test as well. All the questionnaires, free and anonymous, are in the psychological tests catalogue.

What helps with compassion fatigue

It can be worked on, and there is evidence to back that up. A meta-analysis by Lipsa and colleagues reviewed 82 intervention studies and, pooling the 11 randomised trials, found that psychological interventions markedly reduced compassion fatigue in the helping professions, especially those delivered online. The older review by Cocker and Joss had already found improvements in burnout or secondary traumatic stress in 7 of the 13 studies it analysed, while calling for more research.

Some ideas you can start applying:

  • Name what is happening. Knowing that it is compassion fatigue, and not that you have become a bad person, takes some of the weight off the guilt.
  • Close the shift. A small ritual when you leave, such as changing clothes, walking for a while or writing down what you are carrying, helps you not to take it all home.
  • Talk about the difficult cases. Sharing them with trusted colleagues or in supervision stops them staying bottled up.
  • Look at the conditions too. Because burnout comes from poorly managed workplace stress, according to the WHO, not everything depends on you: workload, shifts and team support all count.
  • Rest properly. We explain how to recover from exhaustion in Emotional exhaustion: symptoms, causes and how to tell if it is burnout.

If your test result is moderate or high, if you notice that you no longer care about the people you look after or if symptoms of depression or anxiety appear, ask for help. We explain what therapy works on in work-related exhaustion in Therapy for work stress and burnout: when to get help and what works.

At the end of the test you will find our recommendation of a licensed psychologist who works with work stress, anxiety and depression, online too.

If your result worries you or you want a professional assessment, you can talk to Xènia Capel Salcedo, a licensed psychologist (COPC reg. 14982), who offers a free first consultation call and online therapy from anywhere.

MyPsicoTest team · Updated: