What Is Secondary PTSD?

What is PTSD? 

Post-traumatic stress disorder (PTSD) is a psychiatric disorder triggered by a traumatic event. This can be a single event, or long-term, ongoing trauma. 

PTSD can last from months to years, with common symptoms including nightmares, avoidance of triggers, and hypervigilance. Generally, PTSD is treated with therapy, medication, or a combination. 

What causes PTSD? 

PTSD can be caused by many different kinds of trauma. These may include:

• Death of someone close to you

• Abuse

• Physical or sexual assault

• Serious accidents

• Serious health problems

• War and conflict

• Torture.

The causes of PTSD can differ greatly from patient to patient. Just because one person suffers from PTSD due to a type of trauma doesn’t mean the next person will experience the same affliction from the same kind of trauma. 

This is why a professional diagnosis is critical.

Secondary PTSD 

Secondary post-traumatic stress disorder, sometimes called compassionate fatigue, is a condition triggered by indirect exposure to a traumatic event. For instance, this may occur through witnessing an account or narrative of someone’s first-hand traumatic event experience. 

There is a general misunderstanding that caregivers and support workers who hear accounts of such events are well equipped to respond. However, the reality is that many are underprepared and can experience significant psychological impacts. 

Symptoms

The symptoms of secondary PTSD are largely similar to those of PTSD. They can include: 

• Hopelessness

• Hypervigilance

• Fear

• Sleeplessness

• Chronic exhaustion

• Flashbacks of the event

• Frequent emotional outbursts.

The impact of secondary PTSD can be wide-reaching. You may have difficulty maintaining trust and self-control, maintaining intimate relationships, and preserving your self-esteem.

Who is at risk of secondary PTSD?

Secondary PTSD is common amongst professionals working with children who have experienced traumatic events, along with the wives of war veterans. It is also common amongst first responders and human service workers. 

Secondary trauma isn’t just restricted to individuals working in high-trauma careers – it can also occur in people who are deeply impacted by graphic news stories or direct accounts of trauma from their friends. 

Most of the research so far has emphasized providing support for non-professionals and untrained people who deliver social support.

Research has only started to delve into the importance of providing services to professionals working with traumatized clients. Part of this delay has been due to a lack of clarification – secondary PTSD has been described as compassion fatigue, vicarious trauma, and secondary traumatic stress, among other names.

Different definitions and diagnostic criteria have limited understanding of this condition. Thankfully, research has highlighted that there needs to be greater recognition of the potential risks for professionals, to protect their own needs and wellbeing. 

Emergency nurses caring for school shooting victims

One study¹ investigated the impact on emergency nurses following a 2018 school shooting in the United States. It identified that, following the care of the victims, nurses were provided with a formal debrief. 

Many of the nurses in the study found this was insufficient as it emphasized the clinical, factual component of the event while neglecting the significant emotional toll.

They also described the challenges of dealing with the acute nature of the event, as once patients have passed through emergency care, their subsequent care and outcome remain confidential and therefore unknown to the nurses. 

While this confidentiality is important, there is a gap that needs to be addressed to achieve closure. 

Overall, the study found that nurses need to be adequately trained for trauma nursing and be provided with adequate planning and preparation. They also found that peer support sessions help with coping and recovery. 

The research highlighted that emergency nurses are only one example, as many health professionals are involved in these events at different stages. Further research could focus on different clinicians to understand the risk of secondary trauma and the best prevention strategies and intervention techniques. 

Treating secondary PTSD

Given many of the symptoms of secondary PTSD resemble those of PTSD, recommended treatments are largely the same. 

Recommended therapies include:

• Cognitive behavioral therapy: CBT is a talk therapy that aims to identify and change thought patterns. CBT is a specific type of psychotherapy.

• Psychoeducation: Psychoeducation is an evidence-based intervention that aims to provide patients with information and support to cope with their illness. Understanding the condition is a key step in recovery.

• Accelerated recovery program: The ARP is a 5 stage program that aims to aid health care professionals in reducing symptoms of compassion fatigue or secondary trauma. It is a skills-based program that helps build preventative techniques and resilience to prevent subsequent development of secondary traumatic stress.  

Preventative strategies

Whether you are a professional working with individuals who have experienced trauma or a close friend or relative helping someone to overcome their trauma, you need to take steps to protect your own well-being. 

These are steps you can start to incorporate daily: 

• Maintaining life balance: have diverse interests, activities, and relations.

• Connect with nature: to help put things into perspective and build a sense of peace.

• Creative expression: creativity can help to access and express memories and see painful memories in a safe space.

• Establish boundaries: this is important for learning when to say no, and to allow yourself your own time.

• Plan for coping: this might look like identifying when symptoms surface and constructing a plan of what to do when this occurs.

The lowdown

Secondary trauma can impact mental health as much as primary trauma. There is a need for more research, education, and training to help both professionals and non-professionals to cope with the impacts of secondary trauma. 

While many people may not be aware that secondary PTSD exists, this should not undermine the significant impact of this condition and the need for adequate care.