Written by Carol Bradley Bursack, Minding Our Elders | Published in AgingCare.com
Most caregivers experience times when the fatigue and frustration of providing care for a loved one can border on burnout. Even though I’ve handled caring for multiple elders and their unique needs reasonably well, there have been moments when I’ve wondered how much longer I could keep it up.
During those times, I came dangerously close to burnout, but I always got through with a focus on faith, respite, and self-care. After my caregiving days ended, however, I learned that there is another stage that is more severe than caregiver burnout—one that can be extremely scary. Many caregivers have told me over the years that they felt they had progressed beyond burnout, and it is important to understand that there is a term for this feeling: compassion fatigue.
Caregiver Burnout vs. Compassion Fatigue
Most caregivers have probably heard of burnout, but many are unfamiliar with the concept of compassion fatigue and how these two conditions differ. Dr. Beth Hudnall Stamm, Ph.D., retired professor and researcher in the field of traumatic stress, defines compassion as “feeling and acting with deep empathy and sorrow for those who suffer.” Family caregivers are often compassionate individuals by nature. This characteristic is typically considered an asset, but it leaves them at risk for the negative “costs of caring” for others.
“Compassion fatigue is an extreme state of tension and stress that can result in feelings of hopelessness, indifference, pessimism and overall disinterest in other people’s issues,” explains Christine Valentin, LCSW, owner of a private counseling practice in New Jersey where she works with adults experiencing anxiety and/or depression related to work, relationships, caregiving, and chronic diseases.
Unlike caregiver burnout, compassion fatigue is a secondary traumatic stress disorder that results from exposure to another person’s traumatic experience(s) and creates high levels of emotional stress. Compassion fatigue is primarily considered an occupational hazard for individuals who encounter stress and trauma in their work environments, such as nurses, mental health professionals, correctional workers, and child protection workers. In fact, it is a contributing factor in why many people in these fields leave their jobs to pursue other kinds of work.
Unsurprisingly, family caregivers are also susceptible to this occupational hazard. Consider an adult child whose “job” is providing full-time care for a parent with Alzheimer’s disease and arthritis. They may not be administering high-level skilled nursing care, but they are still caring for someone in emotional and physical distress with limited options for providing comfort. While there are many similarities between professionals in high-stress jobs and family caregivers, the latter do not enjoy the same preventive measures that many employers offer, such as mental health days, peer support, and professional counseling. Forgoing breaks, respite, and meaningful support adds up, affecting one’s overall quality of life.
“While some may simplify and attribute compassion fatigue to frustration and/or resentment, it is important to understand that this is not something that occurs overnight,” Valentin notes. “It is the cumulative result of days, weeks, months, and years of managing caregiving responsibilities that are often unrecognized, seemingly endless, emotionally demanding, and physically exhausting. As a result, it is not uncommon for feelings of frustration, resentment, hopelessness, guilt, and/or a diminished sense of self to manifest.”
Compassion fatigue also differs from burnout in that it causes caregivers to experience a weakened sense of empathy for those in their care. This is an important distinction because most family caregivers take on their role out of love. Unlike nurses and social workers who are not tasked with caring for individuals they know personally, informal caregivers look after their family members and even close friends. Family caregivers are emotionally invested in their loved ones’ well-being, leaving them especially vulnerable. One study that examined 30 years’ worth of existing literature on compassion fatigue in professionals acknowledged that, “Compassion fatigue occurs when a care‐giving relationship founded on empathy potentially results in a deep psychological response to stress that progresses to physical, psychological, spiritual, and social exhaustion in the family caregiver.”
While compassion fatigue exists on a spectrum, once one has developed a certain level of indifference or insensitivity to a care recipient, it is wise to step back from the caregiving role at least temporarily.
“With regard to caregivers, compassion fatigue can manifest through actions like yelling, hitting or neglecting a loved one,” Valentin describes. “Basically, any action that is not characteristic of the caregiver’s typical behavior but is now present and consistent could be considered a result of this condition.”
How to Recognize Compassion Fatigue
There are many red flags that point to the onset of burnout and especially compassion fatigue, but caregivers must know what signs to look for and be able to detect them in their own behavior in order to act on them. Both information and self-awareness are key to preventing long-lasting emotional issues and even stress-related physical illness.
“Being proactive is one of the best ways to combat compassion fatigue or at least prevent it from getting out of hand,” urges Valentin.
Warning Signs of Compassion Fatigue in Family Caregivers
- Feeling overwhelmed, exhausted, and drained
- Avoidance and not wanting to be around your loved one (choosing to work late, daydreaming about no longer having to care for them, etc.)
- A decrease in patience and tolerance
- Angry outbursts that are uncharacteristic of your behavior
- Cynicism and hopelessness
- Heightened anxiety
- Impaired ability to make care decisions
- Difficulty sleeping
- Physical symptoms, such as headaches or gastrointestinal issues
Using Self-Care to Prevent Compassion Fatigue
If you begin noticing any of the above signs, the next step is to make yourself a priority and tend to, at the very least, some of your needs. Remember that compassion fatigue is not black and white—it is a continuum. Each caregiver has different limits, and there are times throughout the caregiving journey when one’s susceptibility to stress will increase and decrease. Many will experience these warning signs from time to time. These feelings and behaviors are undesirable but common for a demographic that is so overworked and has so few resources available. When the list above begins to describe daily life rather than fleeting behavior on a bad day, it is absolutely time to act.
“Allocate at the very least five minutes each day to eat, pray, dance, laugh, sleep, walk, sing, read an inspirational quote, meditate, or chat with a friend. Give yourself a mental and physical break from actively caring for others,” Valentin encourages. “The ability to do so in small bursts can allow you to begin the practice of adequately caring for yourself and hopefully get you to increase these efforts moving forward.”
While many caregivers feel that self-care is impossible, it is important to understand that if you don’t allocate this time, no one else will. As mentioned earlier, in fields where compassion fatigue is prevalent, employers take care to enact policies that help prevent physical and emotional stress from negatively impacting employees’ work, attitudes, and personal lives. It is up to family caregivers to be their own advocates and implement care plans that allow for regular breaks, self-assessments, respite time, professional and peer support, and changes in workload. Making these changes will not only help to minimize caregiver burden but also allow you to create a more positive and rewarding caregiving experience for you and your loved one.
“Having a non-judgmental outlet to express your thoughts can be very beneficial as well,” notes Valentin. “Outlets like writing in a personal journal, talking with a confidant, or seeking advice from a healthcare professional can help you with processing your feelings and offer a safe place to release pent-up thoughts and emotions.”
If you find yourself already experiencing these feelings and symptoms, then seek professional help and respite care immediately. “Believing the feelings will not subside, especially while you are still actively caring for a loved one, can cause some individuals to become depressed, develop panic attacks, and/or potentially put their loved ones in harm’s way,” Valentin warns.
Once you feel refreshed and regain a sense of balance and perspective, you can make some important care decisions that will help prevent future instances of compassion fatigue, such as opting for permanent placement in long-term care or fortifying your care plan with regular breaks and respite. These care decisions will help set you on the path for a different kind of caregiving experience—one that is defined by compassion satisfaction, not fatigue.