In This Article Expand or collapse the "in this article" section Vicarious Trauma Redefining PTSD

  • Introduction
  • Introductory Works
  • Reference Works
  • Specialized Organizations
  • Assessment Methods
  • Treatment Modalities
  • Research

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Social Work Vicarious Trauma Redefining PTSD
Ginny Sprang
  • LAST REVIEWED: 24 May 2018
  • LAST MODIFIED: 24 May 2018
  • DOI: 10.1093/obo/9780195389678-0267


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.

Introductory Works

In 1980, PTSD was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), third edition (DSM-III; Washington, DC: American Psychiatric Association, 1980) to describe symptoms of severe psychological trauma as a psychiatric disorder. Although clinicians have long been aware of the effects of countertransference when working with traumatized clients, it was Figley 1995 that developed the concept of compassion fatigue to describe the vicarious transmission of trauma from traumatized individuals to professionals. He used compassion fatigue as a less stigmatizing term to describe the post-traumatic stress symptoms caused by vicarious exposure. Vicarious trauma (or vicarious traumatization) is often referred to as secondary traumatic stress in the literature (Jenkins and Baird 2002 [cited under Research], Kassam-Adams 1995). In 2013, the Diagnostic and Statistical Manual, fifth edition (DSM-5) expanded its definition of Criterion A for PTSD to include “indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)” as the basis for establishing exposure to a traumatic stimuli (American Psychiatric Association, Diagnostic and statistical manual of mental disorders. [Washington, DC: American Psychiatric Association, 2013], p. 271). This modification to previous versions of the DSM clearly placed trauma symptoms subsequent to vicarious exposure into the framework of PTSD, thus transforming our understanding of how an individual can experience a traumatic event.

  • Baranowsky, A. B., M. Young, S. Johnson-Douglas, L. Williams-Keeler, and M. McCarrey. 1998. PTSD transmission: A review of secondary traumatization in Holocaust survivor families. Canadian Psychology 39.4: 247.

    DOI: 10.1037/h0086816

    This paper uses the trauma framework to explore intergenerational trauma transmission using terminology such as vicarious trauma, secondary traumatization, and empathic trauma. This discussion is centered on the experience of Holocaust survivors and the historical trauma that can come from the indirect transmission of trauma stories from one generation to another. This is one of the few early papers that discusses vicarious trauma in nonprofessional groups.

  • Figley, C. R. 1995. Compassion fatigue: Toward a new understanding of the costs of caring. In Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators. Edited by B. H. Stamm, 3–28. Baltimore: Sidran.

    Figley wrote about the emergence of data and theory that underscores our understanding of compassion fatigue and compassion stress, and discussed the role that empathic engagement plays in the development of these conditions. He issued a call to action to protect those who are responsible for treating vulnerable populations.

  • Figley, C. R. 2002. Introduction. In Treating compassion fatigue. Psychosocial Stress Series 24. Edited by C. R. Figley, 1–14. New York: Brunner-Routledge.

    The chapter provides a theoretical and empirical argument for compassion fatigue and offers case studies to illustrate the vicarious trauma experienced by professionals who work with traumatized populations. It provides an early perspective on prevention and intervention for those in helping professions.

  • Kassam-Adams, N. 1995. The risks of treating sexual trauma: Stress and secondary trauma in psychotherapists. In Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators. Edited by B. H. Stamm, 37–48. Baltimore: Sidran.

    This study explores the experiences of 100 therapists who worked with sexually traumatized clients to determine if there was a specific effect of trauma therapy on the therapist. Results of this study provide empirical support for the notion that psychotherapists who work with sexually traumatized clients are exposed to secondary traumatic stress, and suggest that therapist gender and personal history of trauma may impact the development of these symptoms.

  • McCann, L., and L. A. Pearlman. 1990. Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress 3.1: 131–149.

    The authors use constructivist self-development theory to explain therapists’ responses to exposure to clients’ trauma stories. The repeated exposure to traumatic material over time is described as vicarious traumatization, and conceptualized as a transformation of cognitive schemas, beliefs, and expectations about self, others, and the world.

  • Pearlman, L. A., and K. W. Saakvitne. 1995. Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York: Norton.

    This book describes the role and needs of therapists who work with trauma-exposed populations. Specifically, the authors used psychoanalytic and constructivist self-development theories to explain countertransference and the vicarious trauma experience in therapists who work with incest survivors.

  • Sexton, L. 1999. Vicarious traumatisation of counsellors and effects on their workplaces. British Journal of Guidance and Counselling 27.3: 393–403.

    DOI: 10.1080/03069889908256279

    This article presents a critical review of the literature on countertransference, compassion fatigue, and vicarious trauma in an attempt to highlight the conceptual differences in the terms. The issue of empathic engagement as the pathway for transmission of trauma from client to therapist is explored.

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