Secondary Traumatic Stress Is the Trauma Nobody Talks About

We’ve all been there…the nagging upset that comes from hearing about a friend, neighbor or family member’s catastrophic event. It happened to me recently, when a woman in my close friend group—we’ve all been pals for nearly 20 years—confided to us that she had been victimized by a convicted predator in the headlines. Hearing this accomplished, beloved and grounded woman confess her range of emotions around this assault, including her decision not to join a public case after she consulted therapists and spoke to a reporter, was deeply upsetting to me. I found myself inwardly running through a range of surprising reactions (She’s making this up, wait why is she talking about this, why is she bringing this up now, can’t she just deal, ugh this is so awful). Although I found myself saying (and meaning), "Oh dear this is so terrible, I'm so sorry you went through this and so happy you're talking about this now," I found myself depressed and angry and just...well, freaked out on and off for weeks. Why? I discovered a psychological phenomenon called Secondary Traumatic Stress, which helped me understand why someone else’s plight could sideline my serenity.

Secondary Traumatic Stress is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) as a term for the emotional duress suffered by a professional who hears about or sees trauma that one of their patients/clients suffered firsthand. But it’s not just overworked nurses who can suffer: “Secondary Traumatic Stress (STS) is not limited to professionals such as nurses, social workers, and therapists. It can affect a broader population, including individuals with personal connections to someone who has experienced trauma,” says New York City neuropsychologist Dr. Sanam Hafeex. “In the scenario you described, an adult with PTSD [post-traumatic stress disorder] triggered by a friend's traumatic event could experience STS. STS can occur when someone who has experienced trauma themselves or has a history of trauma is exposed to the traumatic experiences of others. This exposure can trigger distressing emotions, thoughts and reactions similar to those experienced during their trauma. In this case, the individual might have an outsized response due to the triggering of their past trauma.”

As mollified as I am by Dr. Hafeex’s validation of my intense upset about my friend’s experience, I couldn’t help but think that analyzing or admitting my feelings was in some way a personal failing. Was I just a narcissist, making everything about me? “I think it is possible that STS sufferers may minimize their condition for various reasons. They may feel guilty or selfish acknowledging their own symptoms of distress (I remind my clients that it is not the ‘suffering Olympics’),” says Florida-based Stacy Thiry, a licensed therapist with Grow Therapy. “Also, if a person was not directly traumatized, they may feel that their experience is not as legitimate or valid. It is possible they may be comparing their own suffering to that of the traumatized person leading to feelings of self-doubt or undeserving of validation. Sometimes, patients lack the understanding to realize that STS is a very real condition, which may cause them to be dismissive of their own emotional experiences or they may be thinking or worried that they are, or will be perceived to be, ‘overreacting.’”

The handful of therapists I spoke with described the symptoms of compassion fatigue (a similar disorder) on a Department of Health and Human Services checklist as applying to STS. We’re talking feelings of isolation, anxiety, dissociation, physical ailments, sleep disturbance, confusion and helplessness. I know what you’re thinking—the usual Tuesday afternoon, right? While it’s normal to experience all these from time to time, intense and prolonged feelings like this might qualify as STS. Therapists agreed that a personal history of trauma is not a prerequisite for developing STS, which may be bad, since that means anyone might be susceptible. Sussan Nwogwugwu, P.M.H.N.P. a psychiatric-mental health nurse practitioner in the Dallas-Ft. Worth area, says that some personality traits make a person more vulnerable to developing STS. “One such factor is sensitivity and empathy,” Nwogwugwu says. “Empathetic people are at a high risk of suffering from STS due to their robust emotional responses.” So, if you’re plagued by over-identification with a victim, it might mean you just feel so much.

“STS is not a new phenomenon, as a concept, it has been around for several decades,” according to Thiry. “There have been multiple studies on STS, as it impacts professionals in the fields of psychology, healthcare, social work,” and more. “It may seem new or more prevalent in recent years because it may be receiving more attention than it has in the past.” Of course, I credit the 800-pound prickly green virus in the room as being why secondary traumatic stress is being felt—and discussed—right now. “I believe that the Covid-19 pandemic had a great impact on mental well-being and, in this case, it is correct to say that secondary traumatic stress is among the mental conditions that emerged due to the effects of the pandemic,” says Nwogwugwu. She cites a 2021 study in the International Journal of Environmental Research and Public Health stating that the pandemic, with its uncertainties, deaths and long isolation among other effects “led to the development of an environment that exposed many people to STS. For instance, loneliness and isolation during this period led to the development of emotional distress, anxiety, and helplessness and this led to the development of emotional fatigue among a considerable population. Furthermore, the uncertainty, brought about by the pandemic triggered stress responses which in some instances led to STS.”

With so many worrisome elements of contemporary life—this morning (just for instance) I listened to a Maui resident who lost everything in the Lahaina fire talk about how he was luckier than so many who perished—what is to be done about STS? Perhaps my best answer came from another bestie, one who has a unique perspective on psychological trauma, since she’s an experienced social worker who counsels traumatized U.S. military veterans. “You learn to carry a suit of armor,” she said. “I never feel distanced in the moment, I feel great empathy, but I leave it there. And it’s a balance,” she says, saying that keeping current with exercise, a spiritual practice and therapy allows her to continue to do her job without bringing trauma into her personal life.

After my deep dive into STS, I still feel bad about my friend’s abuse experience, however today I’m able to look at it as an experience that can inform my compassion for her, but one that doesn’t have to live rent-free in my head. And note to self—and to anyone who can relate: Perhaps it’s time to move “find therapist” to the top of the daily to-do the list.