Curbside Consultation

Identifying and Addressing Vicarious Trauma

 

Am Fam Physician. 2021 May 1;103(9):570-572.

Case Scenario #1

A 35-year-old patient, J.P., presented to my office with difficulty sleeping and anxiety about job performance. J.P. is a lawyer who started a position six months ago to assist unaccompanied minors seeking asylum. The patient has been feeling more anxious recently and worries that something might happen to the children in her family if she is not constantly watching them. J.P. has difficulty sleeping for more than three hours at a time and drinks as many as five cups of coffee during the day to combat low energy. I suspect that the patient's work might be causing these symptoms, but what is the best and most efficient way to confirm the source of J.P.'s stress?

Case Scenario #2

Earlier this year, my colleague, L.R., led an initiative at our clinic to integrate medication-assisted treatment for substance use disorder. L.R. often provides staff training sessions on this topic and incorporates stories of people who have experienced addiction and overdose as an educational tool. My colleague has recently been asking for last-minute coverage on their clinic days and has been increasingly delayed in closing charts. Staff have mentioned that L.R. has become uncharacteristically impatient and irritable. When they ask whether there is anything wrong, L.R. brushes off their concern, saying, “Everything is fine. My patients have it much worse than me.” What is the best way to approach my colleague about these changes in behavior?

Commentary

Many people, including health care professionals, law enforcement professionals, journalists, and lawyers, may encounter situations that result in secondhand exposure to trauma. Often, family physicians are vicariously exposed to the trauma of their patients as they share stories of domestic violence, war, gun violence, child abuse, homelessness, and life-changing diagnoses, including cancer and COVID-19. These clinical experiences can be compounded by other forms of witnessed trauma, including exposure to repeated violence portrayed in the news and social media. Chronic exposure to secondhand trauma can lead to vicarious trauma, whereby an individual internalizes the emotional experiences of others as though that individual had personally experienced them. Vicarious trauma can result in a change of worldview and disturb a person's sense of justness and safety of the world. See the Office for Victims of Crime toolkit1 for a glossary of terms related to vicarious trauma (https://ovc.ojp.gov/program/vtt/glossary-terms). Unaddressed vicarious trauma can compromise a physician's ability to provide care or professional services and can affect their own personal health and relationships.

Risk Factors and Symptoms

Vicarious trauma is part of a spectrum of responses to trauma exposure, including secondary traumatic stress, caregiver fatigue, compassion fatigue, and burnout. These conditions have varying definitions and categorizations, with overlapping symptoms, diagnostic criteria, and management strategies.2,3

Several personal and professional issues may predispose an individual to developing vicarious

Address correspondence to Anita Ravi, MD, MPH, MSHP, FAAFP, at Anita@PulpLEHealthFoundation.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

1. Office for Victims of Crime. Vicarious trauma toolkit: what is vicarious trauma? Accessed October 10, 2020. https://ovc.ojp.gov/program/vtt/what-is-vicarious-trauma...

2. van Dernoot Lipsky L, Burk C. Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others. Berrett-Koehler Publishers; 2009.

3. Jenkins SR, Baird S. Secondary traumatic stress and vicarious trauma: a validational study. J Trauma Stress. 2002;15(5):423–432.

4. Bride BE, Robinson MM, Yegidis B, et al. Development and validation of the Secondary Traumatic Stress Scale. Res Soc Work Pract. 2004;14(1):27–35.

5. Kintzle S, Yarvis JS, Bride BE. Secondary traumatic stress in military primary and mental health care providers. Mil Med. 2013;178(12):1310–1315.

6. Fitzgerald RM. Caring for the physician affected by substance use disorder. Am Fam Physician. 2021;103(5):302–304. Accessed March 18, 2021. https://www.aafp.org/afp/2021/0301/p302.html

7. Benson J, Magraith K. Compassion fatigue and burnout: the role of Balint groups. Aust Fam Physician. 2005;34(6):497–498.

8. Bell H, Kulkarni S, Dalton L. Organizational prevention of vicarious trauma. Fam Soc. 2003;84(4):463–470.

Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous. Send scenarios to afpjournal@aafp.org. Materials are edited to retain confidentiality.

This series is coordinated by Caroline Wellbery, MD, associate deputy editor.

A collection of Curbside Consultation published in AFP is available at https://www.aafp.org/afp/curbside.

Please send scenarios to Caroline Wellbery, MD, at afpjournal@aafp.org. Materials are edited to retain confidentiality.

 

 

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