Understanding And Overcoming Survivor’s Guilt
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Living through a life-threatening, traumatic experience can deeply affect a person in many ways. Feeling guilty for living through such an experience when others either do not survive or experience more tangible or more extreme harm is a well-documented phenomenon known as survivor’s guilt. Below, we’ll explore the definition, key symptoms, and available treatments for this symptom so you can find out how to overcome survivor's guilt.
What is survivor’s guilt?
Survivor's guilt, or survivor’s remorse, is a feeling many people experience after living through a life-threatening situation—especially when one or more people who experienced the same situation did not survive or experience additional harm. It’s a complicated emotional reaction that often stems from the individual feeling like they could have done more to save lives or prevent damage, regardless of whether they could have actually, realistically changed the situation.
As a 2021 study puts it, "Survivor's guilt typically arises in people who have been exposed to or witnessed death and have stayed alive, leading to emotional distress and negative self-appraisal. Often, survivors feel responsible for the death or injury of others, even when they had no real power or influence in the situation."
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), survivor's guilt is not a diagnosable condition on its own, but a symptom. It’s when a person feels guilty either as a trauma response and/or as a sign of complicated grief or post-traumatic stress disorder (PTSD).
Complicated grief extends beyond the typical parameters of grief after loss or other trauma. Symptoms often include a fixation on the circumstances that led to it and what the individual wishes they’d done differently.
Post-traumatic stress disorder (PTSD) is a trauma- and stressor-related disorder that can develop in people who have experienced a specific traumatic event such as a natural disaster, a serious car accident, or an assault. Those who have survived abuse, war, or a dangerous migration, such as refugee minors, may also be prone to survivor’s guilt.
Unaddressed survivor’s guilt has the potential to impact a person’s daily functioning and overall well-being. It could also cause an individual to develop depression, substance use disorders, or other diagnosable disorders.
Signs that you may be experiencing survivor’s guilt
Looking out for signs of survivor’s guilt after experiencing a traumatic event could help you identify any point at which you may need to seek professional support. Common thought patterns associated with survivor’s guilt can make you feel like it will last forever at the same intolerable intensity. However, it is possible to reduce and healthily manage these feelings with the right support, which we’ll discuss in more detail below.
Only a trained healthcare provider can properly distinguish between survivor’s guilt on its own and survivor’s guilt as a symptom of PTSD or another disorder.
Some symptoms of survivor’s guilt may include the following:
Flashbacks or frequently reliving the traumatic event
Obsessive fixation on the event
Intrusive thoughts about the event
Feelings of helplessness
Drastic changes to eating and sleep habits
Physical symptoms like headache, nausea, racing heart, or stomachache
Irritability
Decreased motivation
Mood swings and emotional outbursts
A strong sense of guilt or shame
Avoiding thoughts, conversations, or reminders of the event
Fear of the situation occurring again
Suicidal ideation or actions
Who is at risk for survivor’s guilt?
Many occupations expose people to significant trauma that could lead to survivor's guilt, including military personnel, first responders, and other medical staff like doctors and nurses. Survivor's guilt is also often seen in cancer survivors, transplant recipients, crash survivors, those who lose loved ones to suicide, parents who outlive their children, and survivors of other traumatic experiences.
Not everyone who lives through a life-threatening trauma develops survivor's guilt, though researchers suggest it is common. Consider a 2018 study involving individuals who were receiving mental health treatment after surviving a traumatic event. It reports that 35% of those involved experienced an event where others died, and 90% of participants overall reported feelings of survivor's guilt.
Whether a person might develop survivor’s guilt after a traumatic experience can depend on many factors. Just some of these potential risk factors for survivor’s guilt include:
The particulars of the event
Any preexisting mental health conditions
Genetics
Personality type
Quality of coping mechanisms
Quality of social support
Whether they received counseling or therapy after the event
How to overcome survivor's guilt: Treatment methods
The most common treatment for survivor's guilt is psychotherapy. A few different therapy modalities may be used depending on the extent of the client's symptoms and their goals for treatment. Two common types include:
Cognitive behavioral therapy (CBT). Cognitive behavioral therapy focuses on helping clients identify distorted thought patterns so they can shift them in a healthier direction, potentially causing more positive feelings and behaviors. Numerous scientific studies have suggested that CBT can substantially improve function and quality of life for people facing a variety of different challenges.
Eye movement desensitization and reprocessing therapy (EMDR). EMDR was developed specifically to treat PTSD, so it may help people alleviate the psychological distress associated with traumatic memories. Studies suggest that specific eye movements and bilateral brain stimulation while processing traumatic memories—which is what EMDR treatment sessions involve—may lead to mental and emotional healing with faster results than many other treatments.
If a person is experiencing survivor’s guilt as a result of PTSD or another mental health condition, their care provider may also recommend medication in some cases.
Coping mechanisms for survivor's guilt
Working with a qualified mental health care provider like a therapist is typically the recommended approach for someone experiencing survivor’s guilt or any other distressing effects after living through a traumatic event. In addition to receiving professional treatment, the following coping mechanisms could also help you manage troubling feelings and work toward healing.
Look at the event realistically and with compassion
You may fixate on what you could have done differently or how you may have been able to prevent harm, negative outcomes, or the circumstances leading to your trauma. Taking a more realistic approach and granting yourself some grace and compassion could be helpful in this case.
You can’t expect perfect performance from yourself in all situations, especially in life-or-death scenarios. It’s not uncommon to freeze, run, struggle, or go into shock during a traumatic event. Comparing your actual reaction to one that you imagined after the fact with all the benefits of foresight, planning, and calm is not fair to yourself.
Give yourself time and space to grieve
Part of working through survivor's guilt may include giving yourself the time and space you need to grieve at your own pace. Your guilt may make you feel you don't have the right to grieve since you're the one who lived, but this is an example of distorted thinking. You deserve the opportunity to feel and then process your feelings and work toward relief, even if your guilt tells you otherwise.
Make a positive impact
Some people find it helpful to direct some of their energy toward making a positive impact as a way to work through trauma and/or guilt. You might donate to a cause, volunteer for a charity, or find new ways to support friends and neighbors.
You may also find it healing to work in prevention or education related to the cause of the event. For example, someone who is experiencing survivor’s guilt after losing a loved one to cancer may find meaning and comfort in joining efforts to educate others on the importance of getting a particular type of cancer screening or recognizing the warning signs.
Know that you aren’t alone
Finally, it can help to remember that you’re not alone in what you’re feeling. After all, survivor’s guilt is common enough that the American Psychiatric Association (APA) names it in the DSM. To remind yourself that you’re not alone in this relatively common response and to find solidarity and peer support, you might also consider seeking out support groups.
Addressing survivor’s guilt with a mental health professional
Again, those experiencing survivor’s guilt, signs or significant symptoms of PTSD, and/or other maladaptive responses to trauma may benefit from working with a licensed therapist. They can offer you a nonjudgmental space in which to process the event and your feelings around it plus healthy coping mechanisms to manage the effects moving forward. For example, they may encourage you to journal, meditate, lean on family members and friends, and practice self-care on your road to healing.
For many types of talk therapy, you can choose between online and in-person treatment. Those who are looking to avoid potentially spending months on a waitlist and want to receive more immediate care might be interested in trying online therapy instead of seeking out an in-person provider.
Online therapy is often less expensive, has shorter wait times, and allows you to connect with a licensed therapist remotely from the comfort of home. According to the American Psychological Association, online therapy can generally be considered a viable treatment option, with results often comparable to in-person sessions.
Takeaway
How do you overcome survivor's guilt?
Survivor’s guilt is closely related to post-traumatic stress disorder and may be difficult to manage without the help of a mental health professional. If you’re experiencing survivor’s guilt, you have most likely undergone significant trauma, and overcoming your feelings of guilt may be easier if you seek professional help. A therapist can help you manage painful emotions like guilt and other trauma-related symptoms.
If you’re experiencing the effects of survivor guilt, it is recommended that you not try to manage the problem without help and support from others, ideally a therapist, psychologist, psychiatrist or other qualified mental health practitioner. It may also be worthwhile to leverage your support network to ensure that you have kindness and empathy at hand while you overcome your guilt.
How do you love someone with survivor's guilt?
Supporting someone with survivor’s guilt might seem daunting, but people who are overcoming survivor’s guilt usually need the help and support of their loved ones. One of the best ways to help someone overcome trauma is to be a good listener. Here are a few things to remember about listening to someone with survivor’s guilt:
- The person may need to talk about their guilt repetitively; be prepared to hear the same themes repeated.
- The person may say things that are difficult to hear or provoke strong emotional reactions, depending on what circumstances led to their survivor’s guilt.
- Encourage the person to express their thoughts and feelings openly.
- Do not offer advice or guidance to the person unless they request it.
- Avoid platitudes like “Everything will be okay.” or “Everyone goes through struggles sometimes.”
It may also be helpful to educate yourself about survivor’s guilt, if possible, before speaking with your loved one. When not discussing their traumatic experience, try to do “normal” things you and the person would regularly do. Finally, take steps to manage your own stress; maintaining good self-care can help you gain the extra energy it takes to support someone conquering survivor’s guilt.
Why might survivors of life-threatening situations feel guilt?
The exact mechanisms of how survivor’s guilt develops are not well known. It is closely associated with posttraumatic stress disorder and experiencing a traumatic event. According to one model of survivor's guilt, a person may experience feelings of guilt and shame in response to a perceived unjust positive inequity. A positive inequity is any situation that benefits one person over another, and an unjust inequity is one in which the person benefits unfairly.
Researchers believe survivor’s guilt requires involvement in a traumatic event in which others died, and the chances of overall survival were low, such as surviving a natural disaster. Upon perceiving that their life has been spared unfairly, the person may ruminate to make sense of the situation, increasing the activation of guilt and shame.
For example, war veterans might replay a traumatic event in their mind repeatedly in order to understand why they survived and others did not. They may attempt to correct this by restoring balance or repairing the inequity, such as by living a better life to “earn” their survival. They may also develop false beliefs, like believing their guilt is a just punishment for their survival or that if they don’t feel guilty, they are letting down those who did not survive.
How do you deal with traumatic guilt?
Dealing with traumatic guilt can be challenging sometimes, and you may wish to consider working with a mental health professional to help you address your feelings. Traumatic guilt is often associated with traumatic stress, and experiencing traumatic stressors can lead to several mental health issues, like PTSD. A knowledgeable mental health professional can help you get to the root of your trauma and grief, learn valuable coping strategies, and initiate effective treatments for trauma-related symptoms.
If you’re not interested in pursuing therapy now, leveraging your support network as you process your traumatic guilt may be helpful. Spending time with others can boost your overall well-being and may make your feelings of guilt easier to manage.
How do you help someone let go of guilt?
Letting go of guilt can sometimes be a challenging process. If the person you’re trying to help has been struggling to overcome their feelings of guilt, you may want to recommend that they seek help from a therapist. Guilt, especially guilt associated with traumatic experiences, can sometimes be difficult to address. Supporting someone in their journey may mean reminding them that help is available and effective.
You can also help someone manage guilt by developing strong active listening skills. A person may need to speak about their feelings repeatedly as they process them. If you are willing to listen, projecting a welcoming atmosphere that demonstrates engagement is important. Here are a few tips for active listening:
- Adopt an open posture and make eye contact with the person speaking.
- When the person finishes their current thought, briefly paraphrase it back to them to demonstrate that you understand their feelings.
- If you struggle to understand their feelings, ask polite, clarifying questions after they finish speaking.
- Do not give advice or judgment unless it is requested.
- If the person brings up traumatic events, they may be difficult to hear. Try not to display shock, horror, or other negative emotions.
How do you deal with regret and guilt after death?
Feeling regret and guilt after a person has died occurs frequently. In many cases, someone may feel guilty that they did not take advantage of opportunities to spend more time with the person who died, or they may regret fights or other negative interactions they had while the person was alive. For most people, guilt of that nature tends to fade over time as they progress through the grieving process.
In some cases, guilt can become severe or persistent. This may occur for several reasons, but survivor’s guilt is one of the more common ones. Survivor’s guilt usually occurs when a person is involved in a traumatic event in which others die, or they survive something that typically has a very low survival rate. In cases like those, the survivor may feel that they did not deserve to survive more than others or that surviving was unfair to those who died.
In cases where guilt is associated with a traumatic experience, it is worth considering whether professional help is warranted. Managing feelings of guilt that are associated with trauma can sometimes be challenging. It may mean addressing a traumatic experience directly; outcomes are generally better when working with a therapist.
How can guilt and worry affect someone's life?
Guilt and worry can adversely affect a person’s overall well-being. Both raise stress, and a high stress level is associated with several physical and mental health impacts. Guilt and worry can be intrusive, distracting a person from feeling happiness in daily life. Worrying about the future that is difficult to control may be a sign of anxiety disorder, and worrying about the past may lead to rumination. Rumination is a form of persistent thinking that is overwhelmingly negative and generally difficult to ignore.
If guilt and worry affect your life, it may be worthwhile to prioritize self-care first. Ensuring you eat a nutritious diet, exercise regularly, and get enough sleep can help prevent guilt and worry from compounding. If there is something you can do to address your feelings, take the time to do it, but if your guilt is due to factors beyond your control, it may be worthwhile to consult with a therapist to figure out how to proceed.
How can guilt affect a person?
Guilt can significantly reduce a person’s overall well-being. It is a significant weight to carry and the secret burden of guilt can drastically increase a person’s stress level. Every person will likely experience guilt and its negative sensations at some point in their lives, and evidence suggests that guilt serves an important social function. Feelings of guilt help people change their behavior and act in a more pro-social manner.
Guilt due to factors beyond a person’s control or is overwhelming enough to interfere with a person’s daily life is likely not serving an important social function. Chronic guilt can lead to chronic stress, which is associated with a reduction in physical and mental well-being. Managing guilt is important; if there is anything you can do to directly address what is causing your guilt, it is likely worth taking the time to do so. However, if guilt is long-lasting, persistent, or uncorrectable, it may be worth working with a mental health professional to help avoid the worst effects of long-term guilt.
How do I get rid of my guilt complex?
If you are working to overcome persistent feelings of guilt, it may be worthwhile to consider working with a therapist or other mental health practice. Complex, long-lasting guilt is often associated with depression and other mental health issues. If you have been unable to stop feeling guilty, working with a professional may help you identify the underlying causes of your guilt, what you can do to address it directly, and how you can better cope with your feelings in daily life.
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