Compassion Fatigue: When Caregivers Go Beyond Burnout

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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.

Those times have come dangerously close to burnout, but I have always gotten through them 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 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.

What Is Compassion Fatigue and How Does It Differ from Caregiver Burnout?

Most caregivers have probably heard about burnout, but many are unfamiliar with the concept of compassion fatigue and how these two conditions differ. 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 York and New Jersey where she works with adults experiencing anxiety related to work, relationships, caregiving and chronic diseases.

Unlike caregiver burnout, compassion fatigue is considered 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, counselors, 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, like mental health days, peer support and professional counseling, that many employers offer. The effects of forgoing breaks, respite and meaningful support add up, and the result isn’t good.

“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 compassion and love. While compassion fatigue exists on a spectrum, once one has developed a certain level of indifference or insensitivity for 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 and Prevent 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 the 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

  • 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

If you begin noticing any of these 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 where 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 a loved one,” 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.”

Start small and then try to increase the time you set aside for yourself. 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.

Read: Care Plan 101: Set Yourself Up for Success as a Caregiver

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.

Carol Bradley Bursack

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Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Her experiences inspired her to pen, "Minding Our Elders: Caregivers Share Their Personal Stories," a portable support group book for caregivers.

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86 Comments

Perfect timing for me. I have an appointment today with an atty to see about getting someone else to take over my mother's care. It's been 8 yrs. Time after time I have had to endure verbal abuse from her, including attempts to embarrass me in front of others (for example, at MD's offices etc. where she will imply I don't care about her, etc.) I just feel I can't take it after 8 yrs. of this. I am soon to be 74, and feeling that my own Golden Years have become nothing but some badly tarnished silver.
Nothing I do ever pleases her and I now feel why bother??? I had hoped we'd develop a good relationship as we are both alone. Foolish to expect something she cannot give.
I've had counselling. I've gone through severe depression. I've seen a psychiatrist who told me a few years ago to stop seeing her, but I kept on forgiving. I now feel like it's my life or hers. Since she is never happy, perhaps I can be. Ready to give up. I always want her to be well cared for, but I just can't be the one to do it any more. This website has been so helpful all these years, and so many of you are truly saints. I've had times where I thought I had things in hand, and in fact did, but I am at a truly low point now, and get so anxious when I even have to talk to her, that I have to do something. It's good to read this and find I'm not alone, but during her last attack, I actually had some very bad thoughts. What if I snapped and hurt her? I'd be in prison and she'd truly have "won the war".
Love and courage to all of you in this very difficult job.
Every personality is different, be it the patient, or the caregiver. So many emotions come into play when it's a parent/child situation. Much more so than a hired caregiver. Past memories, both good and bad, as well as upbringing, family relationships and much more can make this arrangement much more challenging. For me, I am sole caregiver of my mother. She has been with me for a year now, and has transitioned from mid to late stage Alzheimer's rather quickly. It has been a very long year.

Days can range from what I term as "good days" to days when I feel like I can't bear another minute! I find myself feeling resentful because my mother has always been selfish and manipulative. She always made it clear that since I was her only girl, I was expected to care for her in her later years. I feel like I have taken care of her all of my life, not visa versa. I have very few happy, loving memories of my mother. She has always been mean, nasty and needy, and the Alzheimers compounded that personality.

I hope it doesn't sound insensitive, but the later stage has been a blessing. I say that because when she first came with me, she was very disagreeable, combative and downright impossible. She was not ambulatory, but if I left her sight even for 5 minutes, she would manipulate herself out of her chair, or bed and onto the floor. She would yell and scream for me all day and night. Nights were a horror because she wouldn't sleep. She would get out of bed, and fall. I lay awake every night watching her on a baby monitor. She fought me every step of the way. She would spit in my face, throw her food tray across the floor, and cuss me out. I felt helpless. Nothing I did seemed to make her happy.

After I got rundown and contracted pneumonia, I passed it on to her. She recovered in a NH. I became physically ill at the thought of bringing her back home, and made up my mind to leave her there. She cried and pleaded so that the NH was calling me constantly. After a month, and careful thought, I agreed to bring her home, but reevaluated my needs, instead of hers this time.

My new plan was to put her on MY schedule, and not cater to her every whim. I explained to her that I had only had so much to give, and that had to be enough for her. If she wanted to come home with me, it was going to be on my terms, and that hitting, spitting and yelling and screaming was a deal breaker. As strange as it seems, she shook her head and said, "ok", and I honestly think she knew and remembered that I really meant it. I could see it in her eyes.

Now I get up an hour before her. I have my breakfast, get dressed, and even have a second cup of coffee before going to her. I give her breakfast in bed, and while she eats, I do light chores. Then I get her up, toileted, and settled in her chair with her favorite morning tv show. I go about my daily household activities, checking in on her occasionally, until lunchtime. Often, I will sit and have lunch with her. After lunch, I take her to the toilet. Now, I have the afternoon, and she often naps. At this point in her disease, she is unable to get up from her chair, or out of bed. Walking only a few steps using her walker, and me holding her with a a gait belt.

The best purchase I ever made was a camera that allows me to watch her on my cell or iPad from anywhere. I can go anywhere in the house, outside, or go across the street and visit my friend, or even make a quick run to the grocery store while she naps.

After dinner, another aided walk to the toilet, and into bed where she sits up watching tv till she falls asleep. Then I lower her bed and she's in for the night. From that time on my time is my own. She will sleep until morning, and so do I since I no longer worry about her getting out of bed.

She needed me to take charge. Her reasoning was impaired. Why would I expect her to be making decisions in her own best interest? I get it now, and my life has improved 100%, which means I'm a much better caregiver to Mom.
Very good article. Compassion fatigue or burnout, whatever you want to call it, it can happen to the best of caregivers. The idea of self care is wonderful, but I found it unrealistic in my care giving experience and from what I've read on this site, that is common for caregivers. SELF AWARENESS is so important for us. Read articles on burnout and compassion fatigue. Be aware of the symptoms and have the courage to act when you see the symptoms in yourself. For me, I knew caregiving was physically and mentally killing me. I was 62 and forced to live the life of a 90yo. No exercise, no time for myself or to enjoy the things I liked to do. I was a prisoner to caregiving. When I began to easily loose patience with Mom I knew it was time for me to take control of the situation. It was then that I made the decision to place her in a memory care facility. It was the best decision for her and for me. I do not regret it for one moment. She has adjusted well and gets the good care she deserves and I'm slowly regaining my own life back.
There is no shame in admitting you have compassion fatigue or burnout. The only shame is not doing whatever you can about it.