Coping With Survivor's Guilt

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.

Symptoms

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:

• Feelings of helplessness
• Flashbacks of the traumatic event
• Irritability
• Lack of motivation
• Mood swings and angry outbursts
• Obsessive thoughts about the event
• Suicidal thoughts

Common physical symptoms can include:

• Appetite changes
• Difficulty sleeping
• Headaches
• Nausea or stomachache
• Racing heart

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.

Regret, Rumination, and Hindsight Bias

Following a trauma, people may also experience feelings of regret. They may ruminate over the events that took place and think about things they could have or should have done that (they think) would have altered the outcome. This rehashing of the events can further exacerbate feelings of guilt, particularly if people feel that their own actions (or inactions) may have worsened the consequences.

In many cases, this rumination is influenced by what is known as the hindsight bias. People look back and overestimate their ability to have known the outcome of an event. Because they feel like they should have predicted what happened, people may become convinced that they should also have been able to change the outcome.

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.

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Causes

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’s locus of control might 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 for self-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:

• History of trauma: Some research has indicated that experiencing trauma during childhood can increase the likelihood of feeling negative emotions following other life-threatening events.
• History of depression: People who are already depressed or who experienced it in the past may also be more likely to experience guilt and anxiety following trauma.
• Low self-esteem: People with low self-esteem may place less value on their own well-being. When faced with the experience of surviving where others have perished, they may be more likely to question whether they “deserved” their good luck. This can lead to feelings of inadequacy and even guilt.
• Lack of social support: People who do not have a solid network of social support may be more likely to experience symptoms related to survivor’s guilt.
• Poor coping skills: People are more susceptible to PTSD if they have avoidant styles of coping with stress. Examples of avoidance coping include behavioral disengagement and wishful thinking.

Treatments

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.

Coping

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:

• Allow yourself to grieve. It is important to acknowledge the people who were lost and allow yourself to mourn. Give yourself time and take things at your own pace.
• Do something positive. Whether it is for yourself or for others, take those feelings and direct them toward making a change in the world. Sometimes just doing simple things for another person can help alleviate feelings of guilt.
• Focus on the outside factors that led to an event. Shifting your focus on the external variables that created the situation can help you let go of the self-blame that contributes to feelings of guilt.
• Practice self-forgiveness. Even if your actions were responsible for harm to another person, learning how to forgive yourself can help you move forward and regain a positive outlook
• Remember that these feelings are common. Experiencing guilt doesn’t mean that you’re guilty of doing anything wrong. Sadness, fear, anxiety, grief, and, yes, guilt are completely normal responses in the aftermath of a tragedy. It’s OK to feel happy about your own luck while at the same time mourning the fate of others.

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.