Secondary trauma in occupations

Causes: Secondary Trauma from work

In today’s demanding work environments, certain professions expose people to distressing images and details of traumatic events, which can lead to the onset of Post Traumatic Stress Disorder (PTSD) and Complex Post Traumatic Stress Disorder (C-PTSD).

This article explores the lesser-known aspect of occupational PTSD, shedding light on the emotional toll faced by professionals who, in the course of their duties, witness and handle traumatic incidents.

Secondary Trauma

Secondary trauma, also known as ‘Vicarious Trauma’ is an indirect experience of or exposure to a traumatic event and can be described as “the experience of a professional personally developing and reporting their own trauma symptoms as a result of responding to victims of trauma”. Secondary trauma often unfolds over an extended period due to repeated exposure to traumatic events. This exposure can manifest through various mediums, such as listening to victims’ stories, viewing explicit content, or responding to the aftermath of violent or horrific events.

This secondary exposure to trauma can have profound effects on individuals, altering their worldview and emotional responses. Research shows that among people who experience secondary trauma, 7.8% may have lasting symptoms, and 3.6% meet all the criteria for PTSD over a one-year period.

Which jobs make secondary trauma a higher risk?

There are a huge number of jobs and occupations where people may be at risk of developing PTSD or C-PTSD at higher rates than the general population. We discuss others in specific articles such as Medical Staff, Military Personnel, Emergency Services Workers and Prison Employees, and the list below gives a brief insight into some of the others. Please note, this is not an exhaustive list, but is designed to give an indication of the common themes of these job types:

Journalists and photographers/videographers

Professionals like journalists, and photographers/videographers often face traumatic incidents head-on, and research shows that at least 80% of journalists have been exposed to work-related trauma. In the constant exposure to distressing events, whether they are reporting on a train crash, or conducting interviews with survivors of sexual abuse for example, journalists often encounter distressing and challenging situations which puts them at risk of developing PTSD and C-PTSD. Research suggests the overall prevalence of PTSD in journalists is around 7.2%, with rates highest in those exposed to multiple severe events like war or natural disasters: PTSD in war journalists has been reported to be 28.6%, and research shows that 30% of Journalists repeatedly reporting on the COVID-19 pandemic and its associated consequences met the criteria for a PTSD diagnosis.

Victim Support Workers

Professionals dedicated to victim services and support roles play a pivotal role in the aftermath of trauma and violence. Their daily engagements involve providing assistance, empathy, and guidance to survivors, offering a glimmer of hope in the darkest times. However, this commitment to healing comes at a significant cost, with estimates revealing that approximately 34% of individuals in these roles meet the diagnostic criteria for PTSD due to secondary exposure to trauma.

The nature of their work requires them to actively listen to survivors as they recount their harrowing experiences. Each narrative, a painful chapter etched in trauma, becomes a part of the support worker’s daily reality. The act of listening, while a crucial element of their job, exposes them to the raw and often distressing emotions that accompany stories of violence, abuse, and survival.

Beyond listening, these professionals immerse themselves in the intricate details of case files, seeking justice and closure for those who have endured trauma. The process of reviewing case materials, which may include graphic evidence and accounts of violent incidents, becomes a challenging and emotionally charged responsibility.

Courtroom Staff

Working within the legal system places individuals in positions of profound responsibility, and the emotional toll is particularly striking for judges, lawyers, and courtroom staff. These dedicated professionals can find themselves navigating the intricate web of criminal cases, frequently exposing them to the intimate and distressing details of human suffering, including cases of murder, child abuse, and domestic violence. 

As part of their routine duties, court employees, regardless of their role — be it judges presiding over cases, lawyers advocating for justice, or administrative staff managing the behind-the-scenes processes — become deeply entwined with the experiences of trauma survivors. Day in and day out, they engage with the narratives of both victims and perpetrators, bearing witness to the pain, anguish, and complexities that unfold within the legal arena.

Australia’s first empirical research measuring judicial stress and wellbeing showed that 30.4% of the judicial officers met DSM–5 criteria for PTSD.

“I will be out running, and suddenly I see the burned-off face of a 5-year-old child in my head, and it won’t go away,” wrote one judge anonymously during that same survey.

The exposure to trauma extends beyond the confines of the courtroom. Courtroom staff often find themselves handling the personal aspects of court users’ lives, whether assisting in transcript orders or guiding individuals through administrative processes. This interaction opens a window into the personal lives of those navigating the legal system — lives marked by adversity, vulnerability, and often, traumatic experiences.

Medical and healthcare workers

It’s estimated that 44% of healthcare workers have diagnosable PTSD, but it’s widely anticipated that this number is much higher, particularly after the COVID-19 pandemic as 24% of healthcare workers reported a trauma that was related to their work during the COVID-19 pandemic.

Also, this issue extends beyond frontline staff in hospitals, doctors surgeries and the ever-expanding range of community clinics. Morgue technicians, cleaners, porters and a whole host of other support staff are traumatised regularly, doing tasks that are rarely discussed in ‘normal life’.

Additionally, research shows that 40% of intensive care staff have probable symptoms of PTSD and almost one in five ICU nurses admitted to thoughts of self-harm or suicide.

Religious Leaders

A cross-denominational study conducted at the Danielsen Institute at Boston University reveals approximately 55% of clergy members exhibited scores suggesting potential concerns related to PTSD, with almost 35% meeting the criteria for a probable PTSD diagnosis. Religious leaders face a heightened risk of PTSD and C-PTSD due to several interconnected factors. Firstly, their frequent exposure to trauma, whether through direct experiences or while ministering to individuals who have undergone distressing events, contributes significantly to the elevated risk. Secondly, the inherently high-stress nature of pastoral roles, marked by substantial expectations, frequent criticism, and inadequate support, creates a challenging environment. Lastly, the lack of comprehensive training and support structures further compounds the issue. They often receive minimal training on dealing with the personal aftermath of trauma, and limited access to external counselling.

Online moderators

Similarly, online content moderators, tasked with filtering harmful content, face a unique set of challenges, encountering graphic content depicting sexual abuse, child abuse, graphic violence, exploitation, extremism, abuse and suicide on a daily basis. Infact, the Wall Street Journal recently described content moderator as ‘the worst job in the US’. To add to this, many moderators find it challenging to seek solace by talking to friends and family due to the non-disclosure agreements (NDAs) they have signed.

Avoiding traumatic content is not a viable option for moderators. They must actively engage with the material to make effective judgment calls. Additionally, they often face the challenge of meeting accuracy and speed targets, requiring them to engage with both detailed and large volumes of content.

It’s been reported that Facebook  and Youtube moderators are required to sign a disclaimer acknowledging that the content they encounter in their roles may contribute to adverse mental health effects and even PTSD. A sample contract released outlined, “I understand that exposure to this content may give me Post Traumatic Stress Disorder. I will engage in a mandatory wellness coaching session but I understand that those are not conditions and may not be sufficient to prevent my contracting PTSD.” Despite this, in a significant recognition of the impact of content moderation on its workforce, Facebook has agreed to pay $52 million to current and former moderators as compensation for mental health issues arising from their job. Each moderator was reported to receive a minimum of $1,000, with the potential for additional compensation if diagnosed with PTSD or related conditions.

Mark Little, a former TV presenter for the Irish public broadcaster RTE who reported from conflict zones, went on to found the social media agency Storyful. Little reflects,” “We were seeing the Arab uprisings and the first beheading videos… I remember realising that our journalists working on laptops in Dublin were witnessing more horrific and gruesome imagery than I had ever seen in war zones.”

The prevalence of PTSD among content moderators remains unknown. A 2019 report commissioned by Ofcom, the UK’s communications regulator, emphasised the significant psychological impact of moderating harmful content. The report, based on interviews with over 100 moderators, noted a substantial number facing PTSD, while many others developed enduring mental health symptoms like depression, anxiety, and insomnia. Despite these observations, there are currently no scientific studies quantifying the prevalence of PTSD specifically among moderators.

Sex Trafficking and Child Abuse Investigators

The role of these officers and investigators often requires them to identify the people in online material, which means they need to scrutinise graphic and disturbing images and footage in detail.

Additionally, their work often requires visits to the victims, many of which are children. This aspect of their work introduces a profound emotional dimension. Face-to-face encounters with survivors demand a delicate balance between gathering crucial evidence and providing compassionate support to those who have endured unimaginable trauma.

The findings of a survey conducted among child protection police officers in the UK revealed that out of 101 officers interviewed across 12 forces, over 30% reported suffering from secondary traumatic stress.

Detective Constable Steve Hunt developed PTSD after serving with Norfolk Constabulary’s online child sexual abuse team. Despite having specialised training from Europol and a strong belief in the importance of his work, he acknowledged the traumatic nature of connecting the analysis of footage with real-life encounters, stating, “It is difficult to keep going, but the driver is the job you are doing is so vital to kids who can’t protect themselves. That is what spurs you on.” The challenging nature of his job and the emotional toll it took eventually led to the development of PTSD.

Palliative Care professionals

In palliative medicine, professionals commonly encounter exposure to trauma. Palliative care professionals may face an elevated risk of developing PTSD or C-PTSD as they provide support to traumatised patients, routinely witness medical trauma and death, and take on the responsibility of making difficult end-of-life decisions. Palliative medicine professionals are particularly susceptible to more frequent exposure to traumatic situations due to the high patient densities resulting from the shortage of professionals trained in palliative medicine. In a recent study, 42% of palliative care professionals indicated positive for significant PTSD symptoms, and 33% indicated a probable PTSD diagnosis.

Forensic science and crime scene professionals

These professionals cover various specialties, ranging from field-based work in crime and death scene investigation to laboratory analysis of crime scene-related materials like chemicals, drugs, and DNA. Forensic science professionals are exposed to traumatic scenes, evidence, and other case materials in their line of work on a daily basis. They also face expectations for perfection, often experiencing a “zero tolerance” for errors, and operate within an adversarial legal system that necessitates providing testimony. A recent survey of 225 crime scene investigators, using a PTSD measure, identified symptoms indicative of a clinical disorder in 9.3% of participants.

Medical examiner and coroner office workers

Death investigators and administrators, who play pivotal roles in handling the aftermath of fatalities, often find themselves immersed in emotionally challenging situations. From conducting thorough investigations to managing administrative aspects, their responsibilities expose them to the raw and often heartbreaking details of tragic incidents.

A comprehensive study involving 395 workers in these offices has brought to light the staggering toll on their mental health. Among the findings, it was revealed that 12.8% of these professionals met the criteria for likely diagnostic levels of PTSD.

The study further delved into the distinct roles within these offices, shedding light on the varying impact on mental health across different positions. Notably, death investigators and administrators exhibited a higher prevalence of symptoms associated with PTSD and depression when compared to their counterparts, the medical examiners.

Within the grim landscape of medical examiner and coroner offices, the study identified a poignant predictor for heightened symptoms of PTSD and depression—infant and child-related deaths. The emotional weight carried by professionals involved in investigating and documenting these cases emerged as the strongest predictor of adverse mental health outcomes.

Social workers

Social workers play a pivotal role in addressing trauma, standing on the frontline to provide essential support for survivors striving to rebuild meaningful lives in the aftermath of catastrophic events.

In the aftermath of trauma, social workers become pillars of strength, offering not only emotional support but also practical assistance in accessing resources and navigating the intricate web of recovery. The multifaceted nature of trauma demands versatility and empathy from social workers. Whether consoling someone grieving the loss of a family member, aiding a survivor of a natural disaster in rebuilding their shattered world, or supporting a victim of abuse in finding safety and empowerment, social workers bear witness to the diverse tapestry of human suffering.

Research estimates up to 20% of social workers have PTSD as a result of the heavy burden of empathy, carried daily in their interactions with trauma survivors, combined with the sheer volume and intensity of traumatic experiences encountered.

Emergency Service Call Handlers

In the emergency response system, dispatchers and call handlers play a crucial yet often overlooked role disseminating and discussing intricate details and material of distressing incidents from callers.

The paradox of their work lies in the virtual proximity they share with crisis situations. Though physically removed from the traumatic events, dispatchers and call handlers bridge the gap between our emergency services and those in distress. This role demands an extraordinary level of empathy as they navigate distressing conversations, providing crucial guidance and support while grappling with the emotional weight of each call.

Research reveals that approximately 18-24% of emergency service call handlers experience symptoms of PTSD. The nature of their work, characterised by the constant exposure to crises, puts them at risk of developing lasting psychological symptoms, mirroring the experiences of those physically present at the scenes of emergencies.

What symptoms should you look out for if you work in one of these ‘high-risk’ occupations?

Everyone’s experience of PTSD or C-PTSD is different, however, for insight, the workplace manifestations of PTSD from secondary trauma often include:

  • Avoidance: Demonstrated by behaviours such as arriving late, leaving early, missing meetings, avoiding clients, or skipping certain questions during interviews.
  • Hypervigilance: Evident in feeling on edge, perceiving colleagues and clients as threatening, and adopting a generalised belief that all clients or patients are in danger.
  • Binary Thinking: A tendency to see things as “black or white” instead of tolerating ambiguity.
  • Argumentative Behaviour: Displaying increased argumentativeness in interpersonal interactions.
  • Emotional Shutdown or Numbing: Resorting to coping mechanisms like alcohol and drug use to numb or escape from overwhelming emotions.

PTSD or C-PTSD from secondary trauma can extend its impact beyond the workplace, often affecting individuals in their personal lives with symptoms such as flashbacks, sleeplessness, avoidance, difficulties in relationships, hypervigilance and overwhelming negative emotions, such as fear, sadness, anger, guilt, or shame.

The difference between PTSD, compassion fatigue, and burnout

Whether through direct exposure to traumatic events, secondary exposure, or the spectrum in between, the work of helping others often requires professionals to open their hearts and minds to their clients and patients.

Whilst PTSD and C-PTSD are entirely possible from these exposures, not all symptoms experienced mean PTSD or C-PTSD, so it’s important to understand the distinctions between PTSD, compassion fatigue, and burnout – although these are all highly nuanced and have many cross-over features, so often a clear definition can be tricky. Moreover, it remains uncertain whether these concepts are synonymous.

  • Post Traumatic Stress Disorder, commonly known as PTSD or Complex PTSD (C-PTSD), is a condition that emerges in the wake of highly traumatic events. Exposure to traumatic events can be through one or more of the following ways: Experiencing the traumatic event yourself, witnessing a traumatic event, learning that someone close to you experienced or was threatened by a traumatic event and repeatedly encountering graphic details of traumatic events.
  • Compassion fatigue’ has been described as the “cost of caring” for others in emotional pain. It refers to the deep emotional and physical erosion that occurs when professionals cannot replenish their reserves. It’s a term that encapsulates the physical, emotional, and psychological toll of assisting others, often amid stressful or traumatic experiences. Compassion fatigue is closely associated with careers that frequently expose individuals to stressful situations. When these triggers and experiences begin to impact thoughts, moods, and overall well-being beyond the workplace, compassion fatigue sets in. While being affected by one’s work is a normal aspect of caregiving professions, an overwhelming sensation may indicate the presence of compassion fatigue.
  • ‘Burnout’, a term in use since the early 1980s, describes the physical and emotional exhaustion resulting from low job satisfaction, feelings of powerlessness, and being overwhelmed at work. Unlike compassion fatigue, burnout doesn’t necessarily indicate damage to one’s worldview or the loss of compassion for others. Notably, burnout can be sometimes by relatively easily resolved by changing jobs, providing immediate relief.

What employers can do

As an employer, fostering a supportive environment for your staff is crucial. You could also consider the following:

  • Initiate one-on-one conversations to address the impact of work.
  • Encourage a good work-to-home balance for healthy boundaries.
  • Support basic needs like sleep, healthy eating, hygiene, and exercise.
  • Foster connections with family, friends, and co-workers.
  • Ensure options for, and refer co-workers to organisational supports, such as peer support teams or employee assistance programs.
  • Advocate for open discussions with supervisors about their experiences.
  • Introduce concepts like PTSD, Compassion Fatigue, Vicarious Trauma, and Burnout as potential risks, fostering a non-judgmental and confidential environment for staff to share insights.
  • Invest in professional development with trauma-informed care workshops and skill-building strategies, prioritising education and training.

This exploration into the intricate landscape of occupational PTSD and C-PTSD unveils the profound emotional challenges faced by some professionals routinely immersed in traumatic incidents. The prevalence of secondary trauma, evident across a spectrum of professions, underscores the critical need for heightened awareness and support.

By acknowledging these challenges we can contribute to creating environments where professionals not only thrive but also find solace amid the emotional complexities inherent in their vital roles.

 


Where to get more help

Rory Peck Trust

Established in 1995 in memory of freelance cameraman Rory Peck, who lost his life in Moscow in 1993, the Rory Peck Trust is dedicated to promoting the safety and well-being of freelance news gatherers globally. The organisation achieves this objective by offering training and online resources that provide valuable links, funding sources, and tools encompassing safety, security, and professional development. Among its resources are guides on covering riots and civil unrest, reporting guides, and tips on digital security.

Sources

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