Compassion fatigue can be conceptualized as a combination of burnout and secondary traumatic stress (STS). Burnout is considered as one element of compassion fatigue, which is related to workplace stressors and associated with feelings of hopelessness and difficulty coping with work; the second element which is STS relates to exposure to traumatic stressful events, resulting in fear, difficulty in sleeping, intrusive thoughts or avoidance. Burnout, also known as Occupational Burnout, is a psychological term referring to a general exhaustion and lack of interest or motivation regarding one’s work. The difference between compassion fatigue and burnout is their origin. More specifically, compassion fatigue originates from dealing with victims of trauma, while burnout originates from occupational stress and being overworked. 

Compassion fatigue can be accompanied by various symptoms that affect the seven domains described by Figley namely cognitive (e.g. decreased concentration, disorientation, apathy), emotional (e.g. powerlessness, anxiety), behavioral (e.g. irritability, withdrawal, hyper-vigilance), spiritual (e.g. loss of purpose, questioning prior beliefs, lack of satisfaction), personal relations (e.g. decreased interest in intimacy, isolation from others, increased interpersonal conflicts), somatic (e.g. sweating, rapid heartbeat, dizziness) and lastly work performance (e.g. lowered motivation, absenteeism, exhaustion).

 Furthermore, studies have shown that the negative effects of helping are often described under various terms such as compassion fatigue, secondary traumatic stress or vicarious trauma and although there has been some discussion on whether these terms all refer to the same construct,5 there is so far no evidence of differences between these concepts.6 However, it is important to note that some authors have attempted to differentiate between compassion fatigue, secondary traumatic stress and vicarious traumatization. 

Additionally, some helping professionals experience the negative impact of helping in the form of compassion fatigue, many of them may also experience the positive side of helping, labeled as compassion satisfaction.6 These professionals may experience pleasure derived from being able to help others and continue to be committed and effective in their work. 

Compassion fatigue is often experienced by helping professionals such as nurses, social workers, psychotherapists, and others who are often required to provide a high degree of care to clients. Helping professionals can be defined as those entailing professional interaction between a helping expert and client, initiated to nurture the growth of, or address, the person’s physical, psychological, intellectual or emotional constitution, including through medicine, nursing, psychotherapy, psychological counseling, social work, education or coaching.

Majority of researchers focus on studying compassion fatigue in various helping professions such as Van Mol et al who conducted a systematic review of professionals working in intensive care units which revealed based on two studies, that the prevalence of compassion fatigue was 7.3% and 40%, respectively, while the prevalence of secondary traumatic stress, based on five studies, ranged from 0% to 38.5%, and lastly, the prevalence of burnout was between 0% and 70.1%. Another study done in Serbia and Bosnia & Herzegovina among physicians showed that the majority of family physicians had moderate levels of compassion satisfaction (70%), burnout (75%), and secondary traumatic stress (55.8%). A meta-analysis of  studies among oncology nurses showed that the prevalence of compassion fatigue was 19% with low compassion satisfaction, 56% for medium and high burnout and 60% for medium and high compassion fatigue. Furthermore, a study by Johnson, reported the presence of compassion fatigue 11% among pediatric nurses. Similarly, a study of compassion fatigue among mental healthcare providers showed that the majority experienced the average levels of compassion fatigue. Another research reported that only 5% of psychologists and social workers were at high risk of compassion fatigue. A study among social workers revealed that many social workers were likely to experience at least some compassion fatigue symptoms, with 70% of social workers in this study experiencing at least one symptom of secondary traumatic stress in the last week, while 55% met the criteria for at least one of the core symptom cluster, and 15% met the criteria for Post-Traumatic Stress Disorder. The prevalence among teachers and pedagogues in high poverty public schools is alarmingly high, with 90% scoring within the high range.18 Another study investigating teachers revealed that 70.3% of participants had experienced secondary trauma.  

Although police officers face trauma in their work, experiences of compassion fatigue are understudied among this population. Nonetheless, a study of police officers working with sexual assault victims showed that around 84% of participants had low compassion fatigue and 16% had medium compassion fatigue. None scored high. This is similar to the findings in a study done among police officers which revealed very low levels of compassion fatigue and also found in a recent study where 82.5% of police officers reported having moderate or high levels of compassion fatigue. 

A study among 240 Slovakia psychologists, social workers, and health professionals showed that the prevalence of compassion satisfaction among helping professionals was higher than the prevalence of compassion fatigue. Furthermore, helping professionals also reported experiencing more positive than negative emotions in their work, this shows that the positive aspects of helping are more common among helping professionals in Slovakia. 

In Nigeria, study among doctors and nurses in University of Port-Harcourt Teaching Hospital revealed a low prevalence of burnout but highlighted the role of work-related characteristics in its development. Another study in multiple centers revealed a high prevalence of burnout among physicians with 75.5% experiencing burnout. A systematic review revealed a prevalence of burnout ranging from 23.6% to 51.7% among physicians in Nigeria. 

Dealing with emotions and problems 

Those who know how to deal positively with their own emotions and problems as and when they arise are more likely to avoid becoming fatigued because of the emotional aspects of work. Although it is important to recognize that there are cultural differences in terms of the expression of emotions, it is important to acknowledge the emotionality of the work including the fact that it can be extremely painful at times. 

Personal history 

As adults, it is likely that we have experienced personal loss and pain and perhaps even some trauma. These experiences and associated emotions may have an adverse impact if they have not been resolved psychologically. If they have become part of us in a healthy way, then they could increase our understanding and empathy for others in similar situations. However, if we have not addressed these, then they could make us more vulnerable and some of the past may be triggered by present events and this may negatively impact coping and work performance.28  

Work and organizational environment 

A positive work environment that is supportive of all employees is crucial in helping staffs manage and cope with the emotional aspects of work. This includes being compassionate and accommodating of each other regardless of who the person is. An environment that encourages poor behavior such as discrimination and harassment can lead to individuals not coping well with their work.

Current life 

Factors in our current life can make us susceptible, e.g., going through a divorce, family death or illness especially if these are competing needs. The way in which we cope with day to day and the associated stresses also has a bearing on us.

Social support 

Poor quality social support is also a risk factor as this limits our ability to process and deal with the sensitive aspects of our life and work. Having someone to talk to is key but we need to understand that sometimes friends and family who are not directly involved in our work may not be able to cope with what we face as they may have their own issues.

What might a person with compassion fatigue look like? The classic symptom is a decline in the ability to feel sympathy and empathy, and accordingly, act from a place of compassion. Sympathy is “I care about your suffering,” empathy is “I feel your suffering,” and compassion is “I want to relieve your suffering.” With compassion fatigue, the caring, feeling, and acts of compassion decline, replaced by an outwardly impassive detachedness. The person becomes more task- and less emotion-focused, and may increasingly pull away from others, becoming socially isolated. The other classic symptom is profound physical and emotional exhaustion. It has been described as, “feeling fatigued in every cell of your being”. Such fatigue can significantly affect thinking, feeling, and behavior — the keystones of day-to-day functioning.

Compassion fatigue can give rise to a gamut of negative emotions, including anger, annoyance, intolerance, irritability, skepticism, cynicism, embitterment, and resentfulness. These symptoms often lead to interpersonal problems, including difficulties getting along with others and problems with intimacy, resulting in hurt feelings, disappointments, and disconnection. There may be mood swings, tearfulness, anxiety, irrational fears, melancholy, sadness, and despair, and in some instances, even suicidal thoughts or gestures. As well as changes in emotional valence, there may be changes in cognitive functioning. The ability to think clearly, use good judgment, and make decisions may decline. It can become difficult to concentrate on tasks. There may be lapses in memory or forgetfulness. Over time, the person may develop a negative self-image and feelings of inadequacy and helplessness. Essentially, compassion fatigue disturbs the ability to think clearly, modulate emotions, feel effective, and maintain hope. The consequences of these changes are significant. Compassion fatigue can contribute to a wide range of stress-related physical and psychiatric disorders. 

In the short term, compassion fatigue can underlie a number of physical health complaints, including headaches and migraines; nausea, vomiting, and diarrhea; and chronic pain and fatigue, all psychosomatic. With high circulating cortisol, it can increase susceptibility to illness. Over the longer term, compassion fatigue can increase the incidence of cardiovascular disease, obesity, and diabetes, as well as various gastrointestinal conditions and immune dysfunction. While some people manifest physical health problems, others manifest mental health problems. Compassion fatigue can lead to a range of psychiatric conditions, including hypochondria, dissociative disorders, mood disorders (e.g., anxiety and clinical depression), addictions (including smoking, alcohol, drugs, and gambling), eating disorders, and personality disorders.

Compassion fatigue is insidious. As a person’s ways of thinking, feeling, and behaving change, and these changes impact physical and mental health, the person’s ability to carry him/herself well through each day — including within the workplace — deteriorates. For the veterinary caregiver, there are professional as well as personal implications. Compassion fatigue can impact everyone and everything in veterinary practice.

As the ability to effectively sympathize, empathize, and “engage with care” declines, the quality of patient and client care that is provided will also decline, leading to less-than-optimal care and outcomes. When clients experience less-than-optimal care and outcomes, it damages the trust within the healthcare professionals-client-patient relationship upon which services are based. Many clients will quietly leave, never to return, while others will speak up, voicing their concerns. Some may refuse payment. Others will file a complaint. Such complaints may indeed be valid since mistakes are more common when services are performed less conscientiously.

Longtime clients may notice changes in the caregiver’s attitudes and behaviors, and may, out of concern, question the person directly or ask co-workers about them. Co-workers may also be concerned. They may notice the difficulties with decision-making or missteps in clinical judgment. Co-workers may see the inefficiencies and lack of reliability as performance declines. Work habits and patterns can become increasingly unpredictable. While some people with compassion fatigue will spend less time at work, with sick days or a leave of absence, others will spend more time at work, trying to keep up, or will take work home with them. For the latter, it can become difficult to separate work life from personal life.

Some individuals may develop an exaggerated sense of responsibility, “an inflated sense of importance” in relation to their work, and become addicted to the need to be needed.34 When this happens, they may fail to develop and nurture pursuits outside of work or lose touch with the replenishing activities they used to enjoy (e.g., hobbies, sports, and social get-togethers), intensifying the downward spiral into fatigue.

Compassion fatigue can cause a sense of dread working with certain patients and clients, and in certain situations (e.g., euthanasia), and with this, the inclination to avoid these patients, clients, and situations. Some people with compassion fatigue may eventually find professional life unfulfilling. No longer enjoying work, and disappointed, disheartened, and disillusioned, they may turn to alcohol or drugs to ease the discomfort. They may engage in premature job changes, believing the problem to be specific to the place, or type, of employment. Experiencing increasingly poor job performance and plummeting self-esteem, they may eventually drop out of practice and take a job that doesn’t require much interaction with the public, minimizing the risk of compassion stress. Compassion fatigue has driven both promising and seasoned professionals out of their professions entirely, permanently altering the direction of career paths. Beyond this, careers become jeopardized. The declines in efficiency, productivity, and professional competence, and the risk of medical errors and litigation can lead to dismissal, and even career loss.

Lastly, compassion fatigue can negatively impact practice culture, eroding the sense of trust, optimism, and mutual support that characterize a healthy work environment. Co-worker relationships can become strained, leading to unsavory competition, gossip, incivility, conflict, and even aggression. Without team cohesion, it becomes difficult to achieve shared goals. Morale then further declines, and a vision for the future is lost.

Altogether, when compassion fatigue compromises patient and client care; reduces client satisfaction, loyalty, and referrals; risks medical errors and consequent litigation; increases absenteeism and staff turnover; reduces productivity; promotes incivility, conflict, team dysfunction, and workplace toxicity; leads to job dissatisfaction; and reduces morale; practices are unable to sustain profitability or realize growth potential. Incapacitating the person to the practice, the consequences of compassion fatigue are far-reaching.

Therefore, recognizing the signs and symptoms of compassion fatigue and burnout is crucial for mitigating these consequences. Early intervention and proactive strategies can help maintain well-being and prevent long-term damage.

Untreated compassion fatigue and burnout can impair one’s health as well as work performance. 

It also can negatively impact one’s personal and family life. Some preventive measures include: 

1. Talk with someone you trust:  

Just voicing your feelings and fears can help you feel more in control and less alone. A supervisor, mentor or trusted colleague can remind you of what’s typical and can help you anticipate challenges that may lie ahead.  

2. Take care of yourself:  

Eat well-balanced meals, get enough sleep and make time to exercise, even if you only take a few minutes for a short walk. Practice deep breathing and other relaxation techniques. 

Avoid using alcohol or non-prescription drugs to help you manage your emotions.  

3. Give yourself time:  

Compassion fatigue isn’t a sign of weakness. Be patient with yourself and ask others to be patient with you. Telling people how they can help will make you feel useful and help you get the support you need.  

4. Know your own limits:  

You may need to stop or change your assignment, even if it’s only temporarily. You can’t be effective if you’re exhausted or know you can’t help. Take time for a well-deserved break. When you return, you may be better able to help others because you have a refreshed attitude, more energy and a different perspective.   

5. Focus on the good you are doing:  

You are giving the gift of yourself and your experience and training. 

6. Other measures: 

Here are some other preventive measures  

• Be kind to yourself.  
• Be aware of what you’re experiencing and educate yourself. 
• Accept where you are on your path at all times. 
• Understand that those close to you may not be there when you need them most.  
• Exchange information and feelings with people who can validate what you’re experiencing. 
• Listen to others who are suffering. 
• Clarify your personal boundaries: what works for you; what doesn’t. 
• Express your needs verbally. 
• Take positive action to change your environment.