Helping professionals such as those who sit with terminal patients, child abuse social workers, therapists who listen to people who have experienced violence and paramedics who attend disaster situations often find that their effectiveness relies on their ability to engage emotionally with others. However, this can lead to them becoming desensitised to the people they help, as they have repeatedly engaged emotionally without adequate recovery periods. They often describe feeling detached, going through the motions, intruding upon stories that are not their own and developing a cynical attitude towards those they are trying to help. Researchers have used different terms to describe these symptoms, including compassion fatigue, secondary traumatic stress, vicarious traumatisation, and burnout (Newell & MacNeil, 2010). However, studies do not use these terms consistently (Cocker & Joss, 2016).
“Empathy fatigue” is not a formal diagnosis. This essay uses the term as a broad description of the emotional exhaustion, detachment, and cynicism that helpers may develop after repeatedly witnessing others’ suffering over a long period. It overlaps with compassion fatigue but is not identical to it. Researchers commonly use the term compassion fatigue. They define it in different ways, but most often describe it as stress caused by exposure to someone who has experienced trauma (Cocker & Joss, 2016). Klimecki and Singer (2011) go further and question the label itself, asking in a chapter title whether “empathic distress fatigue” would be a more accurate name, a question that fits the evidence discussed below.
Where this essay says compassion fatigue, it follows the cited authors’ usage. This essay argues that empathy fatigue is a natural response to prolonged exposure to suffering, especially when people lack adequate time to recover, control over their work, and support. It is not a sign of poor compassion or personal weakness. It first sets empathy against compassion, then examines secondary traumatic stress and vicarious trauma alongside burnout to show where compassion fatigue sits between them, and finally considers risk factors, detachment as a coping strategy, and the limited evidence on what helps.
Read More: The Compassion Trap: How Empathy Could Become a Liability
When Empathy Becomes Distress
People often view empathy as a positive trait, but psychological research distinguishes empathy from compassion. Empathy is the capacity to share another person’s feelings, often described as feeling with them, whereas compassion is a feeling of concern for another person’s suffering combined with the motivation to help, often described as feeling for them (Singer & Klimecki, 2014). Empathic distress is an unpleasant, self-focused response to another person’s suffering. It often creates a desire to withdraw. In contrast, compassion focuses on the other person and encourages helpful behaviour (Singer & Klimecki, 2014).
When people do not turn empathy into caring actions, they may experience empathic distress, which can lead them to avoid others (Singer & Klimecki, 2014). Neuroimaging work offers a possible mechanism. In a study by Klimecki et al. (2013), healthy volunteers watched videos of people in distress. Their initial empathic responses were accompanied by negative feelings and activity in the anterior insula and anterior midcingulate cortex, regions associated with sharing pain. After compassion training (compared with a memory-training control group), participants reported more positive affect when watching similar videos, along with activity in a network that included the medial orbitofrontal cortex and striatal regions (Klimecki et al., 2013). Klimecki et al. (2014) then compared empathy training with compassion training.
Empathy training increased negative affect and activity in the anterior insula and anterior midcingulate cortex. Subsequent compassion training reduced negative affect, increased positive affect and engaged a different network, including the ventral striatum, pregenual anterior cingulate cortex and medial orbitofrontal cortex (Klimecki et al., 2014). These findings need careful interpretation. The study involved healthy volunteers, not helping professionals. The training lasted only a short time. Researchers measured participants’ self-reported feelings and brain activity while they watched videos. They do not show that empathic distress causes burnout, secondary traumatic stress or compassion fatigue in practice, and they do not show that compassion training protects helpers.
These findings suggest a possible explanation that researchers still need to test among helping professionals. Distress may build up when people repeatedly experience empathy without responding with the caring actions associated with compassion (Singer & Klimecki, 2014). On this view, empathy fatigue would reflect not too little caring but empathic distress without compassion to balance it. This explanation aligns with how helpers describe their emotional detachment, but researchers have not yet confirmed it.
Secondary Traumatic Stress and Vicarious Trauma
Joinson (1992) introduced the term compassion fatigue in nursing. Later, Figley (1995) argued that people who work with trauma survivors can also experience the effects of trauma. He used compassion fatigue as a more sympathetic term for secondary traumatic stress (STS). STS refers to the behavioural and emotional reactions to knowing about a traumatic event experienced by someone else, and the stress involved in helping or wanting to help. It is recognised within the diagnostic framework.
The DSM-5 criteria for post traumatic stress disorder (PTSD) clarify that secondary exposure, such as repeatedly hearing about traumatic events through work, can cause impairing symptoms requiring treatment (American Psychiatric Association, 2013; Hensel et al., 2015). STS resembles PTSD. The Secondary Traumatic Stress Scale (Bride et al., 2004) is a 17-item self-report measure of three symptom groups: intrusion, avoidance and arousal. Items on unintended thoughts about work with clients fall within intrusion. While items on emotional numbness, the closest the scale comes to measuring detachment, fall within avoidance. A related concept is vicarious traumatisation.
McCann and Pearlman (1990) proposed that working with trauma survivors can change the therapist’s cognitive schemas, psychological needs, memory systems and frame of reference. This can happen even after the work has finished and can last for months to years. Pearlman and Saakvitne (1995) described vicarious traumatisation as the cumulative transformative effect on the trauma therapist of working with trauma survivors. Whilst STS relates to PTSD-like symptoms, vicarious trauma relates to lasting changes in the helper. These terms are often discussed interchangeably, but vicarious trauma and STS should be separated from professional burnout (Newell & MacNeil, 2010).
Burnout
Burnout is an older concept. It was first used by Freudenberger (1974) in an article about staff burnout. Maslach and Jackson (1981) measured burnout through the Maslach Burnout Inventory. This has three sub-scales: emotional exhaustion, depersonalisation and personal accomplishment. Burnout is defined as a prolonged response to chronic interpersonal and emotional stressors in the job, resulting in exhaustion (individual stressor), cynicism or depersonalisation (interpersonal stressor) and inefficacy (self-evaluation) (Maslach et al., 2001).
Burnout is theorised to be caused by chronic stressors within the job, not the content of the trauma. It has mainly been researched in human service occupations such as healthcare (Maslach & Leiter, 2016). The job demands-resources model is widely used in this literature. It focuses on the balance between job demands and job resources such as social support, feedback and autonomy (Bakker & Demerouti, 2007). The World Health Organisation (2019) classifies burnout in ICD-11 as an occupational phenomenon rather than a medical condition. This reflects its link to the work context: it can affect anyone in a job, such as a call centre worker, teacher or accountant who may never hear a traumatic story.
Compassion Fatigue vs Burnout
Burnout and STS are distinguished conceptually, but they overlap in practice, and their definitions vary across studies. Burnout is tied to job conditions and can occur in any occupation, whereas STS is tied to exposure to the suffering of others (Newell & MacNeil, 2010). Compassion fatigue sits uncomfortably between them. Some authors describe it as the convergence of STS and cumulative burnout, and the Professional Quality of Life Scale (ProQOL; Stamm, 2010) measures it through burnout and STS subscales alongside compassion satisfaction (Cocker & Joss, 2016).
This is, however, one model rather than a universally accepted definition. Figley (1995) used compassion fatigue and STS interchangeably, and later described compassion fatigue as distinct from both simple burnout and countertransference (Figley, 2002). Cocker and Joss (2016) note that compassion fatigue has been variously defined and that the related concepts are often used interchangeably and incorrectly. It is therefore important to check how any given study defines and measures its terms. The empirical overlap is substantial. A meta-analysis of 41 studies covering 8,256 workers with indirect exposure to trauma found a strong association between burnout and STS (weighted r = .69).
The association was stronger when both were measured within the compassion fatigue framework (r = .74) than when other frameworks and measures were used (r = .58), which the authors read as substantial overlap between measures (Cieslak et al., 2014). A professional who reports one is therefore likely to report similar levels of the other. Emotional detachment appears in both: within burnout, depersonalisation is adopted as a way of conserving energy, while within STS, emotional numbing forms part of an avoidance response to trauma reminders (Bride et al., 2004; Maslach et al., 2001). The distinction still has practical value.
Burnout is generally expected to respond to changes in workload, autonomy and support, whereas STS typically also requires attention to the trauma itself, which may include supervision, processing difficult content and clinical intervention if symptoms are severe. This is best read as a reasonable expectation rather than a tested finding. Someone with a manageable workload may still develop STS because of their clients’ trauma, and an administrator may develop burnout from an overloaded schedule with no exposure to trauma.
In practice, though, the two often go hand-in-hand. Longitudinal evidence from two small studies of trauma-exposed helpers (N = 135 and N = 194) found that burnout at the first time point predicted STS six months later, but STS did not predict later burnout (Shoji et al., 2015). This needs replication, but it suggests that exhaustion may reduce the ability to cope with distressing content.
Prevalence and Risk Factors for Helpers
Research consistently shows that secondary trauma is an occupational risk. In a survey of master’s-level social workers, those working in direct practice were highly likely to be secondarily exposed to traumatic events through their clients; many experienced some symptoms of STS, and roughly 15 per cent met the criteria for PTSD (Bride, 2007). Nurses are also affected. A systematic review found that STS was reported in all seven studies identified, which covered forensic, emergency department, oncology, paediatric and hospice nurses (Beck, 2011).
Compassion fatigue, compassion satisfaction and burnout have also been examined as factors affecting professionals’ quality of life (Sprang et al., 2007). Studies have identified risk factors for developing STS. A meta-analysis of 38 studies of professionals working therapeutically with trauma victims found that trauma caseload volume, frequency and ratio, and personal history of trauma had small positive effects, while work support and social support were negatively associated with STS (Hensel et al., 2015). This supports the idea that STS arises from exposure, personal history and context.
Professionals who regularly experience the traumatic experiences of others are vulnerable to compassion fatigue, which can affect the quality of care they provide, their relationships with colleagues and, in more severe cases, lead to PTSD, anxiety or depression (Cocker & Joss, 2016). It is important to note that much of this research relies on self-report questionnaires and cross-sectional designs. It therefore cannot be determined whether symptoms are caused by exposure to trauma or whether people who are already distressed see their job as more demanding.
Instruments differ across studies, and some measure general psychological distress, so prevalence varies with the sample, scale and cut-off (Beck, 2011; Cieslak etal., 2014). Nevertheless, it is consistently found that people who engage with suffering are at increased risk of secondary trauma and burnout. The practical implication is that the modifiable features of the work, such as caseload and the availability of support, matter, and the next section considers how strong the evidence is for acting on them.
Emotional Detachment as a Symptom and Coping Strategy
Why does too much caring cause a lack of feeling? Figley’s (2002) multi-factor model highlights the negative aspects of caring, empathy and emotional investment. It suggests that compassion fatigue can be reduced by reducing compassion stress, processing traumatic memories, managing workload, increasing satisfaction and learning to detach emotionally and physically from the work. Emotional detachment is therefore a coping strategy as well as a symptom. The avoidance and numbing captured by traumatic stress scales can reduce the pain of ongoing exposure.
This also links to the empathic distress described earlier: if empathising with someone else’s pain becomes unpleasant and cannot be turned into effective helping behaviour, avoidant behaviour is likely (Singer & Klimecki, 2014). However, emotional detachment is not selective. Whilst it reduces the pain of hearing a client’s story, it also reduces feelings of warmth, curiosity and enjoyment. That is why it can serve as an early warning sign as well as a coping strategy. The practical implications follow from the risk-factor research, but the strength of evidence differs across them. Some are supported by associations. Work support and social support are associated with lower STS, and heavier trauma caseloads with slightly higher STS (Hensel et al., 2015).
Clinical supervision has been reported as a protective factor for vicarious traumatisation (Baird & Kracen, 2006). The job demands-resources model gives a theoretical rationale. Since manageable demands and adequate resources such as support, feedback and autonomy are expected to reduce burnout (Bakker & Demerouti, 2007). Together, these are consistent with manageable workloads, access to clinical supervision, support from colleagues and teams, and time to recover between exposures. However, these are associations from largely cross-sectional, self-report studies.
Peer support is inferred here from the broader work-support and social-support findings. Which did not isolate peers, and recovery time rests on theory rather than direct evidence in the sources reviewed here. Evidence that interventions work is thinner. Cocker and Joss (2016) found only thirteen studies of interventions to reduce compassion fatigue among healthcare, emergency and community service workers. Ten involved nurses, three involved community service workers and none involved emergency workers.
Seven reported a significant difference after the intervention in burnout (four studies) or STS (three studies). So not all did, and the authors described the evidence as relatively recent and called for more research. For burnout, Maslach and Leiter (2016) note a relative lack of research on interventions. Compassion training has been tested in healthy volunteers rather than helpers (Klimecki et al., 2014). So whether it reduces empathy fatigue in practice remains untested. This suggests that while it is valuable to look after yourself, individual self-care is unlikely to be enough to combat what is partly an occupational risk.
Conclusion
Empathy fatigue is best treated as an umbrella for a group of related conditions whose definitions vary across studies. Burnout is caused by chronic stress within the job and consists of exhaustion, cynicism and reduced efficacy. Secondary traumatic stress and vicarious trauma are caused by engaging with the traumatic experiences of others and consist of intrusion, avoidance and changes to the helper’s core beliefs.
Compassion fatigue, the term most commonly used today, is often described as the combination of these two, although this is one model rather than a settled definition, and the two sets of symptoms overlap considerably in practice. Emotional detachment can be seen as a symptom, a coping strategy and a warning sign. Social neuroscience suggests a plausible mechanism: empathic distress without the balance of compassion, recovery and support. But this has so far been tested in healthy volunteers rather than in helpers.
In practice, caring can be costly, but this does not mean helpers are weak. Those who are emotionally detached, intrusive and cynical are often simply reacting to prolonged exposure without adequate conditions. The most justifiable response is to recognise this and to treat secondary trauma as an occupational risk, with manageable workloads, clinical supervision, peer and team support, and protected time for recovery. These measures are supported by associations and theory, whereas evidence that specific interventions work is still developing. The evidence for the need is clearer than the evidence for any single solution.
References +
- Stringer, H. (2025). Addressing compassion fatigue. Https://Www.Apa.Org.https://www.apa.org/topics/psychotherapy/compassion-fatigue
- Bakker, A., & Demerouti, E. (2007). Journal of Managerial Psychology. The Job Demands-Resources model: state of the art. Article information. Journal of Managerial Psychology, 22(3), 309–328. https://peopleful.io/Job-Demands-Resource-Model-research.pdf
- Beck, C. T. (2011). Secondary traumatic stress in nurses: a systematic review. Archives of Psychiatric Nursing, 25(1), 1–10. https://doi.org/10.1016/j.apnu.2010.05.005
- Bride, B. E. (2007). Prevalence of Secondary Traumatic Stress among Social Workers. Social Work, 52(1), 63–70. https://doi.org/10.1093/sw/52.1.63
- Bride, B. E., Robinson, M. M., Yegidis, B., & Figley, C. R. (2004). Development and Validation of the Secondary Traumatic Stress Scale. Research on Social Work Practice, 14(1), 27–35. https://doi.org/10.1177/1049731503254106
- Cocker, F., & Joss, N. (2016). Compassion Fatigue among healthcare, Emergency and Community Service workers: a Systematic Review. International Journal of Environmental Research and Public Health, 13(6), 618. https://doi.org/10.3390/ijerph13060618
- Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatised. Psycnet.Apa.Org. https://psycnet.apa.org/record/1995-97891-000
- Freudenberger, H. J. (1974). Staff Burn-Out. Journal of Social Issues, 30(1), 159–165. https://doi.org/10.1111/j.1540-4560.1974.tb00706.x
- Hensel, J. M., Ruiz, C., Finney, C., & Dewa, C. S. (2015). Meta‐Analysis of Risk Factors for Secondary Traumatic Stress in Therapeutic Work With Trauma Victims. Journal of Traumatic Stress, 28(2), 83–91. https://doi.org/10.1002/jts.21998
- Joinson, C. (1992). Coping with compassion fatigue. Nursing, 22(4), 116, 118–119, 120. https://pubmed.ncbi.nlm.nih.gov/1570090/
- Klimecki, O. M., Leiberg, S., Lamm, C., & Singer, T. (2012). Functional Neural Plasticity and Associated Changes in Positive Affect After Compassion Training. Cerebral Cortex, 23(7), 1552–1561. https://doi.org/10.1093/cercor/bhs142
- Maslach, C., & Jackson, S. E. (1981). The Measurement of Experienced Burnout. Journal of Organizational Behavior, 2(2), 99–113. https://doi.org/10.1002/job.4030020205
- Maslach, C., & Leiter, M. P. (2016). Understanding the Burnout experience: Recent Research and Its Implications for Psychiatry. World Psychiatry, 15(2), 103–111. https://doi.org/10.1002/wps.20311
- Burn-out an “occupational phenomenon”: International Classification of Diseases. (n.d.). Www.Who.Int. Retrieved October 25, 2026, from https://www.who.int/news-room/detail/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases
- Sprang, G., Clark, J. J., & Whitt-Woosley, A. (2007). Compassion Fatigue, Compassion Satisfaction, and Burnout: Factors Impacting a Professional’s Quality of Life. Journal of Loss and Trauma, 12(3), 259–280. https://doi.org/10.1080/15325020701238093
- Newell, J. M., & MacNeil, G. (2010). Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue: A review of theoretical terms, risk factors, and preventive methods for clinicians and researchers. https://www.semanticscholar.org/paper/37aa59deafaca845ce22843d398310df14fbf576
- McCann, L., & Pearlman, L. A. (1990). Vicarious traumatisation: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3(1), 131–149. https://doi.org/10.1007/bf00975140
