Secondary Stress in Caregivers of PTSD Victims

Woman with a headache man on sofa behind her

Secondary stress experienced by those who care for individuals suffering with post-traumatic stress disorder (PTSD) has been given a number of names in the past few decades. Although not officially recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM), secondary stress in caregivers has been a source of clinical concern and research for decades, and the symptoms caretakers experience are very real.

Secondary Stress

Secondary stress is the stress caretakers experience from taking care of traumatized victims with PTSD. Secondary stress occurs when the caregivers experience a host of symptoms that arise in the course of, and due to the care of, the trauma victim. Healthcare workers, emergency workers, and wives and husbands of veterans are examples of caregivers who can be affected with secondary stress.

This condition occurs in caretakers in varying degrees and for a variety of reasons. Some symptoms have been clinically observable and researched. Other types of secondary stress have been theorized as to why they occur. However, there is little research to support these theories.

Caregiver burnout and compassion strain are examples of secondary stress in caregivers.

Caregiver Burnout

Caregiver burnout occurs from the constant stress of caring for an individual with PTSD over an extended period of time. It often occurs in family members who give 24 hour care to their loved ones, or it can occur in workers who care exclusively for victims of trauma.

It can be difficult on family members to see the one they care about suffer with the symptoms of PTSD. At times, these symptoms can be severe, even violent.

The gradual and long term effects of caring for people with PTSD can produce a number of symptoms, including:

  • Insomnia
  • Headaches
  • A feeling of being unable to promote change
  • Questioning one's own values and beliefs
  • Irritable mood
  • Exhaustion
  • Poor work performance (for healthcare and mental health workers)

Compassion Strain

Compassion strain is seen mostly in healthcare or emergency workers who care for highly traumatized victims. This happens most often where there is a rescuer-victim relationship between the worker and the victim.

  • Workers experiencing compassion strain feel overwhelmed and exhausted.
  • Workers might experience insomnia and feel like they don't have any energy left to offer anyone else.
  • Workers experience the physical and emotional strain of stress because of the constant, intense environments in which they work.

Secondary Traumatization

Some workers caring for trauma victims or loved ones of veterans or other traumatized individuals can themselves come to exhibit symptoms that are the same as PTSD. This is not the same thing as secondary stress. This is referred to as Secondary Traumatic Stress Disorder, Secondary Traumatic Stress, or Vicarious Traumatization. This is differentiated from burnout and compassion strain in that it comes on suddenly, rather than a culmination over time.

It has been theorized that secondary traumatization occurs because workers or caretakers are compassionate about their work or about their loved one. It is through this compassion that they can take on the victims' symptoms and become traumatized.

The reasons why some caretakers seem to exhibit PTSD symptoms through caring for a trauma victim may instead be related to over-identification with the victim for various reasons or personal issues that cause them to take on other's pain. One reason can be that the victim's trauma reminds the healthcare worker or caretaker of their own personal past trauma. Blurred personal boundaries may also be another reason.

Help for Caregiver Stress

Caregiver stress, for both family members and for people in helping careers, is a real phenomenon. Living with a person with severe PTSD is a stressful situation where 24 hour care is necessary. Most people see the effects of this stress within a few months. Heath care workers, since their exposure is limited to the client, might experience symptoms of depression and other issues related to constant stress within a year in the field.


Self-care is extremely important for both physical and emotional health. If you are experiencing health issues related to the constant stress of caring for PTSD victims, don't wait to seek out support medically, socially, or mentally. It is important to obtain help immediately, especially if your loved one's case of PTSD is severe, otherwise you could deal with the long term effects of constant caregiver stress. Reach out early on to make sure you obtain the support you need.

If you are a health care worker, you need to be aware of your own issues and make sure you reach out for help before the effects of the stress take their toll. If you are the caregiver of a loved one, you will be better able to help your loved one if you remain in good health, physically, emotionally, and mentally.

Get Help

There is no shame in seeing a qualified mental health professional to help you deal with the stress of caring for your family member. A good place to start is to call a crisis hotline, where they can address your needs immediately and refer you to other resources within your community.

Secondary Stress in Caregivers of PTSD Victims