Coping With Survivor's Guilt

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Symptoms

Causes

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Survivor’s guilt develops in people who have survived a life-threatening situation in which others died. Some people with survivor’s guild believe they could have done more, others feel guilty that another person died saving them.

Although survivor’s guilt originally described feelings that Holocaust survivors experienced, it has also been applied to other life-threatening situations such as car accidents, wars, and natural disasters.

Survivor’s guilt is also common in those who have survived medical traumas such as the AIDS epidemic.Some cancer survivors experience this guilt if they survive a diagnosis but others don’t.

Is Survivor’s Guilt a Disorder?In the current version of the diagnostic manual,the DSM-5, survivor’s guilt is a symptom of post-traumatic stress disorder (PTSD). It may be viewed as one of the cognitive and mood-related symptoms of PTSD, which include having distorted feelings of guilt and negative thoughts about oneself.It is important to note, however, that people can experience survivor’s guilt without having PTSD. They can also have PTSD without feeling survivor’s guilt.

Is Survivor’s Guilt a Disorder?

In the current version of the diagnostic manual,the DSM-5, survivor’s guilt is a symptom of post-traumatic stress disorder (PTSD). It may be viewed as one of the cognitive and mood-related symptoms of PTSD, which include having distorted feelings of guilt and negative thoughts about oneself.It is important to note, however, that people can experience survivor’s guilt without having PTSD. They can also have PTSD without feeling survivor’s guilt.

In the current version of the diagnostic manual,the DSM-5, survivor’s guilt is a symptom of post-traumatic stress disorder (PTSD). It may be viewed as one of the cognitive and mood-related symptoms of PTSD, which include having distorted feelings of guilt and negative thoughts about oneself.

It is important to note, however, that people can experience survivor’s guilt without having PTSD. They can also have PTSD without feeling survivor’s guilt.

The extent and severity of survivor’s guilt vary. Symptoms of survivor’s guilt can be both psychological and physical, often mimicking those of PTSD.

The most common psychological symptoms include:

Common physical symptoms can include:

Survivor’s guilt can have a serious impact on a person’s life and functioning, suggesting that further research is needed to explore effective ways to help people deal with feelings of guilt.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see ourNational Helpline Database.

Regret, Rumination, and Hindsight Bias

There are times when guilt may have a legitimate cause (such as causing an accident that led to another person’s death or injury), but in a lot of these instances, there is little or nothing that a person could do to prevent or change the outcome.

Press Play for Advice On Dealing With RegretThis episode ofThe Verywell Mind Podcastfeaturing best-selling author Daniel Pink, shares how to cope with the feeling of regret. Click below to listen now.

Press Play for Advice On Dealing With Regret

This episode ofThe Verywell Mind Podcastfeaturing best-selling author Daniel Pink, shares how to cope with the feeling of regret. Click below to listen now.

Survivor’s guilt occurs in people who have experienced some type of trauma. However, not everyone who lives through such an experience develops these feelings of guilt.

A person’slocus of controlmight play a role in determining whether they will experience survivor’s guilt. Some people are more likely to internalize blame. When explaining events, they tend to attribute causation to personal characteristics rather than outside forces.

This can be good forself-esteem. By taking credit for good outcomes, people feel better about themselves and their abilities. But it can be devastating when people blame themselves for events out of their control.

Additional factors that may increase a person’s risk of survivor’s guilt include:

Getting appropriate treatment if you are experiencing such symptoms is important. Not only can it reduce your mental well-being and quality of life, but it can also present serious risks, particularly if other symptoms of PTSD are also present. In fact, researchers have found that trauma-related guilt is closely linked to suicidal thoughts in veterans.

Cognitive behavioral therapy(CBT) is one approach that can be particularly effective. Through CBT, clients work with a therapist to explore automatic negative thoughts that contribute to feelings of guilt. Examining unrealistic thoughts and replacing them with more realistic ones can help alleviate feelings of guilt and self-blame.

Other forms of psychotherapy, group therapy, support groups, and medications may also be helpful in the treatment of survivor’s guilt symptoms.

If you find yourself experiencing feelings of guilt following an aversive event, there are things you can do to manage those emotions. Some self-help strategies that you may find effective:

Talk to your doctor if your symptoms are severe or your feelings of guilt are interfering with your ability to function normally.

The Takeaway

Survivor’s guilt can feel overwhelming at times, but it is not uncommon to feel this way after you have survived a traumatic or difficult life event. It’s important to acknowledge your guilt and get help if these feelings become too difficult to manage on your own. Appropriate treatment can help you address feelings of excessive or overwhelming guilt.

How Cognitive Therapy Works for Stress Relief

8 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Boykin FF.The AIDS crisis and gay male survivor guilt.Smith Coll Stud Soc Work. 1991;61(3):247-259. doi:10.1080/00377319109517367Glaser S, Knowles K, Damaskos P.Survivor guilt in cancer survivorship.Soc Work Health Care. 2019;58(8):764-775. doi:10.1080/00981389.2019.1640337Street AE, Gibson LE, Holohan DR.Impact of childhood traumatic events, trauma-related guilt, and avoidant coping strategies on PTSD symptoms in female survivors of domestic violence.J Trauma Stress. 2005;18(3):245-52. doi:10.1002/jts.20026Gros DF, Price M, Magruder KM, Frueh BC.Symptom overlap in posttraumatic stress disorder and major depression.Psychiatry Res. 2012;196(2-3):267-270. doi:10.1016/j.psychres.2011.10.022Simmen-Janevska K, Brandstätter V, Maercker A.The overlooked relationship between motivational abilities and posttraumatic stress: A review.Eur J Psychotraumatol. 2012;3. doi:10.3402/ejpt.v3i0.18560Simon N, Roberts NP, Lewis CE, van Gelderen MJ, Bisson JI.Associations between perceived social support, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD): Implications for treatment.Eur J Psychotraumatol. 2019;10(1):1573129. doi:10.1080/20008198.2019.1573129Wild J, Smith KV, Thompson E, Béar F, Lommen MJJ, Ehlers A.A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression.Psychol Med. 2016;46(12):2571-2582. doi:10.1017/S0033291716000532Tripp JC, McDevitt-Murphy ME.Trauma-related guilt mediates the relationship between posttraumatic stress disorder and suicidal ideation in OEF/OIF/OND veterans.Suicide Life Threat Behav. 2017;47(1):78-85. doi:10.1111/sltb.12266Additional ReadingAmerican Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.Hutson SP, Hall JM, Pack FL.Survivor guilt: Analyzing the concept and its contexts.ANS Adv Nurs Sci. 2015;38(1):20-33. doi:10.1097/ANS.0000000000000058

8 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Boykin FF.The AIDS crisis and gay male survivor guilt.Smith Coll Stud Soc Work. 1991;61(3):247-259. doi:10.1080/00377319109517367Glaser S, Knowles K, Damaskos P.Survivor guilt in cancer survivorship.Soc Work Health Care. 2019;58(8):764-775. doi:10.1080/00981389.2019.1640337Street AE, Gibson LE, Holohan DR.Impact of childhood traumatic events, trauma-related guilt, and avoidant coping strategies on PTSD symptoms in female survivors of domestic violence.J Trauma Stress. 2005;18(3):245-52. doi:10.1002/jts.20026Gros DF, Price M, Magruder KM, Frueh BC.Symptom overlap in posttraumatic stress disorder and major depression.Psychiatry Res. 2012;196(2-3):267-270. doi:10.1016/j.psychres.2011.10.022Simmen-Janevska K, Brandstätter V, Maercker A.The overlooked relationship between motivational abilities and posttraumatic stress: A review.Eur J Psychotraumatol. 2012;3. doi:10.3402/ejpt.v3i0.18560Simon N, Roberts NP, Lewis CE, van Gelderen MJ, Bisson JI.Associations between perceived social support, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD): Implications for treatment.Eur J Psychotraumatol. 2019;10(1):1573129. doi:10.1080/20008198.2019.1573129Wild J, Smith KV, Thompson E, Béar F, Lommen MJJ, Ehlers A.A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression.Psychol Med. 2016;46(12):2571-2582. doi:10.1017/S0033291716000532Tripp JC, McDevitt-Murphy ME.Trauma-related guilt mediates the relationship between posttraumatic stress disorder and suicidal ideation in OEF/OIF/OND veterans.Suicide Life Threat Behav. 2017;47(1):78-85. doi:10.1111/sltb.12266Additional ReadingAmerican Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.Hutson SP, Hall JM, Pack FL.Survivor guilt: Analyzing the concept and its contexts.ANS Adv Nurs Sci. 2015;38(1):20-33. doi:10.1097/ANS.0000000000000058

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Boykin FF.The AIDS crisis and gay male survivor guilt.Smith Coll Stud Soc Work. 1991;61(3):247-259. doi:10.1080/00377319109517367Glaser S, Knowles K, Damaskos P.Survivor guilt in cancer survivorship.Soc Work Health Care. 2019;58(8):764-775. doi:10.1080/00981389.2019.1640337Street AE, Gibson LE, Holohan DR.Impact of childhood traumatic events, trauma-related guilt, and avoidant coping strategies on PTSD symptoms in female survivors of domestic violence.J Trauma Stress. 2005;18(3):245-52. doi:10.1002/jts.20026Gros DF, Price M, Magruder KM, Frueh BC.Symptom overlap in posttraumatic stress disorder and major depression.Psychiatry Res. 2012;196(2-3):267-270. doi:10.1016/j.psychres.2011.10.022Simmen-Janevska K, Brandstätter V, Maercker A.The overlooked relationship between motivational abilities and posttraumatic stress: A review.Eur J Psychotraumatol. 2012;3. doi:10.3402/ejpt.v3i0.18560Simon N, Roberts NP, Lewis CE, van Gelderen MJ, Bisson JI.Associations between perceived social support, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD): Implications for treatment.Eur J Psychotraumatol. 2019;10(1):1573129. doi:10.1080/20008198.2019.1573129Wild J, Smith KV, Thompson E, Béar F, Lommen MJJ, Ehlers A.A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression.Psychol Med. 2016;46(12):2571-2582. doi:10.1017/S0033291716000532Tripp JC, McDevitt-Murphy ME.Trauma-related guilt mediates the relationship between posttraumatic stress disorder and suicidal ideation in OEF/OIF/OND veterans.Suicide Life Threat Behav. 2017;47(1):78-85. doi:10.1111/sltb.12266

Boykin FF.The AIDS crisis and gay male survivor guilt.Smith Coll Stud Soc Work. 1991;61(3):247-259. doi:10.1080/00377319109517367

Glaser S, Knowles K, Damaskos P.Survivor guilt in cancer survivorship.Soc Work Health Care. 2019;58(8):764-775. doi:10.1080/00981389.2019.1640337

Street AE, Gibson LE, Holohan DR.Impact of childhood traumatic events, trauma-related guilt, and avoidant coping strategies on PTSD symptoms in female survivors of domestic violence.J Trauma Stress. 2005;18(3):245-52. doi:10.1002/jts.20026

Gros DF, Price M, Magruder KM, Frueh BC.Symptom overlap in posttraumatic stress disorder and major depression.Psychiatry Res. 2012;196(2-3):267-270. doi:10.1016/j.psychres.2011.10.022

Simmen-Janevska K, Brandstätter V, Maercker A.The overlooked relationship between motivational abilities and posttraumatic stress: A review.Eur J Psychotraumatol. 2012;3. doi:10.3402/ejpt.v3i0.18560

Simon N, Roberts NP, Lewis CE, van Gelderen MJ, Bisson JI.Associations between perceived social support, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD): Implications for treatment.Eur J Psychotraumatol. 2019;10(1):1573129. doi:10.1080/20008198.2019.1573129

Wild J, Smith KV, Thompson E, Béar F, Lommen MJJ, Ehlers A.A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression.Psychol Med. 2016;46(12):2571-2582. doi:10.1017/S0033291716000532

Tripp JC, McDevitt-Murphy ME.Trauma-related guilt mediates the relationship between posttraumatic stress disorder and suicidal ideation in OEF/OIF/OND veterans.Suicide Life Threat Behav. 2017;47(1):78-85. doi:10.1111/sltb.12266

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.Hutson SP, Hall JM, Pack FL.Survivor guilt: Analyzing the concept and its contexts.ANS Adv Nurs Sci. 2015;38(1):20-33. doi:10.1097/ANS.0000000000000058

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.

Hutson SP, Hall JM, Pack FL.Survivor guilt: Analyzing the concept and its contexts.ANS Adv Nurs Sci. 2015;38(1):20-33. doi:10.1097/ANS.0000000000000058

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