Compassion Fatigue: When Caring Hurts

Author: IAFF

March 1, 2018

Putting the safety and wellness of others first comes naturally for IAFF members. The notion of self-sacrifice at any cost has been culturally ingrained for decades. Only in recent years has society begun to recognize the cumulative psychological toll that fire and rescue work can have on fire fighters and paramedics. While we know post-traumatic stress disorder (PTSD) impacts an estimated 20 percent of fire fighters and paramedics, less is known about the prevalence and impact of a condition called compassion fatigue.

What Is Compassion Fatigue?

While not recognized as a mental or psychiatric disorder, the term compassion fatigue was first coined by Dr. Charles Figley, director of Traumatology Institute at Tulane University. It is defined as an extreme state of tension and preoccupation with the suffering of others to the degree that secondary traumatic stress develops in the individual providing aid.


Individuals who suffer compassion fatigue typically have lost a healthy balance between work, life and self. While some individuals overextend themselves at any cost, others may become apathetic and burnt. While research on the prevalence of compassion fatigue is limited, many health experts have argued that emergency responders, such as fire fighters, paramedics, police and ER nurses, are at an increased risk.

Recognizing Compassion Fatigue

At first, compassionate fatigue may be hard to spot. Many fire fighters and paramedics are adept at internalizing daily stress while continuing to function well from the perspective of their crew members, family and friends. However, without effective coping mechanisms and strong personal boundaries in place, compassion fatigue is a real possibility for some.

Do you recognize these signs and symptoms in yourself or others?

  • Increased isolation at the firehouse and home
  • Chronic daytime fatigue and poor quality of sleep at night
  • Emotional instability, e.g., irritability, crying spells or reactivity towards others
  • Expressed or observed apathy toward work, relationships and the future
  • Use of substances or other activities in excess to numb emotions
  • Persistent rumination, preoccupation and an inflated sense of personal responsibility in the outcome of rescue operations

  • Unexplained somatic symptoms, such as gastrointestinal distress, headaches, chronic pain or lingering colds

Another common hallmark of compassion fatigue in first responders is not being able to turn work off. However, if this preoccupation progresses into intrusive thoughts, flashbacks or nightmares of a specific traumatic incident, you are experiencing more than compassion fatigue. While some of the symptoms of compassion fatigue and PTSD overlap, PTSD is a distinctly separate and more serious anxiety disorder that requires professional treatment.

The Consequences of Compassion Fatigue

Many fire fighters, paramedics, and other first responders will likely experience one or more of the symptoms of compassion fatigue at some point in their careers. But when symptoms begin to interfere with a person’s ability to function, they become a serious problem.

Impaired daily functioning can look different from person to person, but generally constitutes an inability to meet minimum obligations of work, home or self-care. Examples may include:

  • Performing less than your best on the job because you believe your efforts make no difference
  • Having a constant desire to rescue or help others that causes problems in important family or friend relationships
  • Routinely neglecting personal medical care, hygiene or exercise because the job comes first

While most would agree that compassion is a noble virtue, other personal factors usually play a role in the likelihood of experiencing compassion fatigue and other stress reactions. If you generally have poor personal boundaries, a history of unresolved trauma or lack a sense of self or interests outside of the fire service, you may be more vulnerable to experience compassion fatigue.

If you or a friend has problem turning off your rescue role to the point it’s impairing the ability to work, have relationships or practice minimum standards of self-care, it’s time to ask for help. This can start by acknowledging how you are feeling to a trusted fire chief, peer, spouse, counselor or doctor. Chances are, someone has already begun to observe changes in your mood, daily attitude or functioning. If symptoms discussed in this article have made your life unmanageable, you may benefit from a more intensive level of care than what can be accessed in your community.

The IAFF Center for Excellence for Behavioral Health and Treatment and Recovery is a comprehensive treatment facility designed exclusively for IAFF members struggling with PTSD, addiction and other co-occurring mental health problems. Call today for a non-obligation free and confidential screening for you or a loved one.

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