Vicarious Trauma Redefining PTSD

Abstract

Vicarious trauma occurs when individuals are exposed indirectly to the direct trauma experienced by others, usually through sensory contact with graphic, traumatic content. This indirect exposure can produce symptoms of distress that fall on a continuum of mild to severe, with subcategories of vicarious trauma often referred to as secondary traumatic stress (STS), compassion fatigue, and vicarious traumatization. STS is a trauma condition that parallels post-traumatic stress disorder (PTSD) and includes the symptom domains of re-experiencing, avoidance, disturbances of arousal and reactivity, and alterations of cognitions and mood. The term STS is used broadly to include both threshold and subthreshold symptoms of PTSD caused by indirect exposure. It is assumed in the definition of STS that Criterion A for PTSD, an exposure to a traumatic stressor (including vicarious exposure) has occurred. In application and reference, this term is used primarily to refer to professionals or others whose occupations or experiences require the solicitation or receipt of trauma details. Compassion fatigue is used inconsistently in the literature to refer to symptoms of STS, burnout, moral distress, empathic strain, and interchangeably with STS. In Pearlman and Saakvitne’s 1995 book, Trauma and the Therapist, vicarious traumatization is defined as a permanent “transformation in the inner experience of the therapist that comes about as a result of empathic engagement with client’s trauma material” (p. 280). It is considered to be the consequence of long-term exposure to indirect trauma. In the 2017 article “Toward a Mechanism for Secondary Trauma Induction and Reduction: Reimagining a Theory of Secondary Traumatic Stress,” Marne Ludick and Charles Figley offer a model of compassion fatigue resilience that describes the occurrence of STS given varying levels of exposure and competence. This model has some promise as a guide to research and practice. Prevalence estimates are difficult to determine based on the wide range of criteria used to establish caseness. The severity of trauma symptoms following indirect exposure is not well documented and understood in the context of PTSD following direct exposure. This remains an area warranting further investigation.