FAQ’s about Survivor’s Guilt

By Tana Whitt, MSN, APRN, PMHNP-BC

Survivor’s Guilt can be a difficult subject to confront. People who have survived their traumas, whether personal or on a worldwide scale, have internalized the experience and taken on the responsibility and guilt for themselves. No one should have to feel bad for still being alive. And yet, what has happened to them can cause this psychological response. To clear up some of the questions many people have, Tana Whitt, MSN, APRN, PMHNP-BC, Director of Clinical Affairs of Psych360 answers some FAQs about survivors guilt.

What is Survivor’s Guilt?

Survivor’s guilt, or survival guilt, can be defined as feelings of extreme guilt or shame after experiencing a traumatic event. People may develop these feelings after they have survived a traumatic event where others did not or after not being harmed in a traumatic situation where others were. With the publication of the DSM-V, “Survivor’s Guilt” was removed as its own specific diagnosis and added as a specific symptom of PTSD. There is some controversy to this in the mental health field, because people may experience symptoms of Survivor’s Guilt, but not meet full criteria for PTSD (post-traumatic stress disorder) or another Trauma and stressor-related disorder.

What other events could a person experience survivor’s guilt as a result of?

Survivor’s Guilt can occur in any individual who has experienced and survived a traumatic event. It is important to understand that what is considered traumatic is subject to the individual and how they perceive the event. This can occur on a large scale with natural disasters, mass shootings, combat, epidemics and /or terrorism, to name a few.  This can also occur on a smaller or more individual scale with sexual/physical/emotional abuse victims, murders, Motor Vehicle and other transportation accidents, in family and friends of those who have died by suicide, lung transplant recipients, survivor’s of chronic illness and much more.

How common is survivor’s guilt? How can this apply to those that have survived mass shootings?

There is not a lot of data on the occurrence of Survivor’s Guilt. This could be contributed to lack of reporting, lack of research and the multitude of events that can cause a person to experience Survivor’s Guilt. Two individuals may react differently to the same stressor or trauma, which can produce different perceptions of that trauma. With that being said, it is not uncommon to experience symptoms of Survivor’s Guilt or PTSD when exposed to traumatic events.

How normal is it to feel this way after surviving something that other people didn’t?

Once again, there is no specific data on the rates of those experiencing Survivor’s Guilt, but it is acknowledged as a common reaction to traumatic events. I think it is important for people who have experienced a traumatic event to understand that they are not alone and there are other people out there with similar thoughts and feelings.

What are some signs and symptoms of survivor’s guilt?

The signs and symptoms of Survivor’s guilt vary based on the individual, and can range in intensity, frequency and duration.

Some of the common symptoms include:

  • Questioning why they survived and others did not
  • People may be wondering “why them and not me?”
  • Having repetitive thoughts about things they could have or should have done differently that could have produced a different outcome
  • Nightmares/Flashbacks
  • Difficulty sleeping
  • Loss of motivation
  • Numbness
  • Thoughts of the meaning of life

More severe symptoms include:

  • Symptoms of anxiety, depression or PTSD and/or Suicidal ideation
  • Anxiety: Characterized by nervousness, stress, fear, apprehension, worry, restlessness, problems concentrating, Panic-like symptoms, irritability and/or sleep disturbance.
  • Depression: depressed mood, loss of interest or pleasure, weight loss or weight gain, insomnia or hypersomnia, psychomotor agitation, fatigue or loss of energy, feelings of worthlessness or inappropriate guilt, diminished ability to think or concentrate, recurrent thoughts of death, and/or suicidal ideation
  • PTSD: Characterized by recurrent, involuntary and intrusive distressing memories, nightmares and/or flashbacks related to a traumatic event, avoidance of stimuli associated with traumatic events, negative alterations in cognition and mood (inability to recall key features of the trauma, overly negative assumptions about oneself or the world, exaggerated blame of self or others for causing the trauma, negative affect, decreased interests in activities, feeling isolated, difficulty experiencing positive emotions)  alterations in arousal and reactivity (irritability, aggression, hypervigilance, difficulty sleeping, difficulty concentrating, risky or destructive behavior, heightened startle reaction) for longer than one month.
  • Suicidal ideation: Thoughts about or planning death by Self-Harm.

We’ve had recent suicides from survivors and parents of survivors from Sandy Hook and Parkland. What, in, your opinion likely led to this?

Without knowing the victims and their stories personally, it would be difficult for me to give an opinion on what contributed to their unfortunate deaths. With that being said, the Center for Disease Control and Prevention (CDC), has reported that suicide rates are increasing in the United States. Suicide is now reported as the 10th leading cause of Death. My opinion on what is contributing to an increase in suicide rates is the continued stigma associated with mental illness, lack of education surrounding mental illness and lack of resources and treatments for mental illness in the United States.

If a person finds themselves in this situation of being a survivor of a mass shooting and is experiencing guilt — what are some ways in which they can address that? What is the treatment for Survivor’s Guilt?

Survivor’s of mass shootings and/or any other traumatic event, who are experiencing grief and guilt need to know that they are not alone and that there is help out there. In addition, it is important for survivors to acknowledge their feelings and work through them by developing and practicing healthy coping mechanisms. As mentioned earlier, symptoms can range from person to person. I would personally recommend that anyone experiencing even the mildest symptoms discuss those symptoms with a Health Professional. This can start with any health provider, but the easiest place to start is usually with their Primary Care Provider. A brief assessment can help determine if the pt will need further a Mental Health Evaluation. Treatment will vary based on how severe the pts symptoms are.

Common treatment modalities include:

  • Developing and utilizing Healthy Coping Mechanisms
  • Counseling/Support Groups
  • Cognitive Behavioral Therapy
  • Utilize psychiatric services to obtain medication to help alleviate symptoms or co-occurring mental illness.  
  • If anyone is experiencing Suicidal Ideation or recurring thoughts of Death they should call the National/Local Suicide Helpline or Crisis Center, Dial 911 or go to their nearest Emergency Room.
  • National Suicide Prevention Lifeline: Call 1-800-273-8255

Anything else we should know about this

Survivor’s guilt is unfortunately only one of the many undertreated and underrecognized mental conditions in the United States. The World Health Organization (WHO), defines Health as “a state of complete physical, mental and social well being, not merely in the absence of disease or infirmity.” With that definition in mind, we need to focus on not only improving physical health but also mental health. Efforts to provide education and awareness, and to decrease the stigma associated with mental illness are crucial to better health outcomes in the United States.

If you are experiencing feelings of guilt, understand that you are not alone. You can help support others who feel the way you do and allow them to help you in counseling with a therapist or a support group. Yes, your trauma happened, but you are alive and there is a process to move forward and heal so there does not have to be more suffering. Allow your family and friends to help.

Hopefully, this answered some of the FAQs about survivor’s guilt and helped to bring some understanding to the issue.