Secondary Trauma explained
What is secondary trauma?
Post-traumatic stress disorder, commonly known as PTSD, is a chronic psychological condition that emerges in the wake of highly traumatic events. PTSD is one of the most well-known psychological illnesses among the general population and is also one of the most prevalent, although rates vary widely between different countries.
But while PTSD itself is a relatively well-known and well-understood condition, there is a growing awareness among mental health professionals of the problems posed by secondary trauma; a disorder that is much less talked about and understood.
Primary PTSD and secondary trauma
Primary PTSD occurs in individuals who have experienced or witnessed a traumatic event first hand. The feelings of intense fear, horror, or helplessness that the sufferer felt in the moment can be so strong that the individual is unable to return to their previous state of mind. These traumatic events can be human-made events such as terrorist attacks, street violence, or sexual assault, or unintentional traumas like a natural disaster or serious accident. The severity of primary PTSD, like all psychological illnesses, varies from person to person. Some people only experience symptoms when something triggers a recall of their trauma. But for other people, the condition can be crippling.
Secondary trauma is an indirect experience of or exposure to a traumatic event. For example, hearing a first-hand account of the event given by a survivor can be a traumatic and emotionally-challenging experience for the person receiving it. Healthcare providers and mental health workers are both frequently exposed to traumatic events in this manner. To provide patients with appropriate medical and psychiatric care following a traumatic event, it is necessary to understand exactly what the patient has experienced, both physically and emotionally.
There is a general assumption amongst both the general population and other caregivers that mental health workers should expect to hear these vivid recollections of traumatic events and therefore be prepared for them. Coupled with a general lack of awareness of the potential psychological impact that recollections of traumatic events can have on those who hear them, secondary trauma is currently a woefully understudied phenomenon.
Despite some research suggesting that secondary trauma rates amongst mental health providers working with military veterans could be as high as 19.2%, there is still some controversy about whether secondary trauma is a legitimate concern. Some detractors assert that labelling clinicians with secondary trauma is pathologising a natural reaction to being presented with an emotionally-charged situation. They often point out that while a significant portion of those exposed directly to traumatic events will show some PTSD symptoms in the short-term, these symptoms will fade relatively quickly in most people. However, in both primary and secondary trauma cases, a small number of individuals develop chronic PTSD, with symptoms persisting indefinitely.
Following the terrorist attacks on the World Trade Centre in 2001, a study by Galea et al. shows that 20% of the residents living close to the world trade centre fulfilled the diagnostic criteria for a PTSD diagnosis in the six weeks following the event. This shows that the majority (80%) of those directly exposed to the attacks did not develop PTSD. For secondary trauma, the rate of people exposed who go on to meet the criteria for a PTSD diagnosis appears to be more or less the same. Indeed, Gulliver et al. conducted a similar study looking at the rates of PTSD among healthcare providers who treated survivors of the 9/11 attacks. While a significant portion reported experiencing PTSD symptoms linked to the survivor accounts they heard, most didn’t meet the criteria for a PTSD diagnosis. However, it should be noted that a small number of healthcare providers in this study did go on to be diagnosed with PTSD.
Who is most at risk?
The subject of secondary trauma has received renewed interest recently because of the COVID-19 pandemic. The pandemic has led to increased rates of people seeking help for mental health conditions and a small number of survivors of the virus itself have gone on to develop PTSD as a result. Other people have developed PTSD in response to witnessing their families and friends falling ill or dying from covid. Hospital workers have described their workplaces as resembling warzones, and many have remarked upon the increased psychological toll this has taken.
Healthcare providers, especially mental health workers, are the most at-risk group for the effects of secondary trauma as they are the ones that have to deal with the aftermath of traumatic events. But the impacts of secondary trauma are not limited to these groups. Anyone who has a loved one that has PTSD can experience secondary trauma. Whereas a clearly identifiable event often causes primary trauma, exposure to secondary trauma is usually far less dramatic. This is another reason that it is less well understood.
Protecting against secondary trauma
Anyone who cares for a person living with PTSD can reduce the impact secondary trauma has on them if they carefully approach the situation. The first step is to learn the signs of secondary trauma:
– Emotional exhaustion
– Increasingly negative perception of self
– Difficulty eating or sleeping
– Feelings of hopelessness
To protect against these symptoms and any other effects of secondary trauma, those who are exposed to it need to remain self-aware. Be aware of the nature of the trauma your loved one or patient has suffered and how their trauma affects you. If you experience any of the symptoms above, you should consider seeking professional assistance, both for you and the person living with PTSD. Within a professional setting, there will be colleagues you can talk to who may be able to offer advice.
If you are experiencing secondary trauma because you care for someone with PTSD in your personal life, it’s important to find the right balance between supporting them and protecting yourself. If you think their trauma is beginning to harm your own wellbeing, you should encourage them to seek professional help. You can offer to accompany them if you like. Obviously, you don’t want to make them feel like they are responsible for causing you harm, nor do you want them to feel abandoned. But allowing you both to suffer will only harm you both in the long run.
Secondary trauma has the potential to harm mental health in the same way that primary trauma does. While it isn’t discussed as often, and many people remain unaware it even exists, anyone who supports people living with PTSD in their private or professional lives should be aware of it.
- Davis GC, Breslau N. Post-traumatic stress disorder in victims of civilian trauma and criminal violence. Psychiatr Clin North Am. 1994 Jun;17(2):289-99. PMID: 7937360.
- Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical manifestations, course, assessment, and diagnosis, Jitender Sareen, MD, FRCPC
- Cieslak, R., Anderson, V., Bock, J., Moore, B. A., Peterson, A. L., & Benight, C. C. (2013). Secondary traumatic stress among mental health providers working with the military: prevalence and its work- and exposure-related correlates. The Journal of nervous and mental disease, 201(11), 917–925. https://doi.org/10.1097/NMD.0000000000000034
- Neria, Y., Nandi, A., & Galea, S. (2008). Post-traumatic stress disorder following disasters: a systematic review. Psychological medicine, 38(4), 467–480. https://doi.org/10.1017/S0033291707001353
- Warning signs of Vicarious Trauma/Secondary Traumatic Stress and Compassion Fatigue, /
- PROTECTING YOURSELF FROM SECONDARY TRAUMA, DR RAVI GILL ON
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Treatments for PTSD
It is possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it is never too late to seek help. For some, the first step may be watchful waiting, then exploring therapeutic options such as individual or group therapy – but the main treatment options in the UK are psychological treatments such as Eye Movement Desensitisation Reprogramming (EMDR) and Cognitive Behavioural Therapy (CBT).
Traumatic events can be very difficult to come to terms with, but confronting and understanding your feelings and seeking professional help is often the only way of effectively treating PTSD. You can find out more in the links below, or here.