Understanding And Overcoming Survivor’s Guilt

Medically reviewed by Paige Henry
Updated March 4, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention trauma-related topics that include suicide which could be triggering to the reader. If you or someone you love is having suicidal thoughts, contact the 988 Suicide & Crisis Lifeline at 988. Free support is available 24/7. Please also see our Get Help Now page for more immediate resources.

Living through a life-threatening traumatic experience can leave lasting consequences, including when others don't make it. Feeling guilty for living when others pass or go through irreversible damage happens to many people, and you're not alone if you relate. Learning about survivor's guilt by exploring the definition, symptoms, and treatments can be beneficial in understanding your experiences and how therapy might help you cope and validate what occurred in your life.

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Mental health concerns can complicate life

What is survivor’s guilt?

Survivor's guilt is a phenomenon many people experience after living through a life-threatening situation, often when one or more people do not survive. People experiencing this complicated emotional reaction often feel guilty that they survived when others died or believe they could have done more to save lives or prevent damage, regardless of whether they could have changed the situation. 

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), survivor's guilt is not a diagnosable condition on its own. It is instead considered a symptom of post-traumatic stress disorder (PTSD). However, you can have survivor's guilt without PTSD and vice versa. PTSD is a trauma and stressor-related disorder that often develops in people who've experienced a traumatic, life-threatening event. 

How survivor’s guilt develops

Living through a traumatic experience when others die or experience damage can have far-reaching consequences that influence your thoughts and behaviors in multiple facets of life. Feeling emotionally disturbed after such an event can be a typical and expected response. Still, it may become a problem when those feelings are overwhelming and intrusively influence one or more aspects of your daily life and behavior. 

Regardless of your ability to affect the outcome, you may dwell on your trauma, confident that you "could or should have" done something more to prevent it. 

According to studies, "Survivors guilt typically arises in people who have been exposed to or witnessed death and have stayed alive, leading to emotional distress and negative self-appraisal. Often, survivors feel responsible for the death or injury of others, even when they had no real power or influence in the situation."

Recognizing survivor’s guilt after a trauma

If you or a loved one has been through a traumatic event, it can be helpful to understand how to recognize the signs and symptoms of survivor's guilt and PTSD. 

Common symptoms of survivor's guilt and PTSD may include the following:

  • Flashbacks or feelings of reliving the traumatic event
  • Obsessive fixation on the event
  • Intrusive thoughts about the trauma
  • Feeling of helplessness
  • Drastic changes in eating and sleep habits
  • Physical symptoms like headache, nausea, racing heart, or stomachache
  • Irritability
  • Decreased motivation
  • Mood swings and emotional outbursts
  • Suicidal thoughts or actions
  • Feelings of shame or guilt
  • Complicated grief
  • Avoidance behaviors
  • Fear of the situation occurring again
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Who is at risk for survivor’s guilt?

Many occupations and situations expose people to significant trauma, including the military, first responders, doctors, nurses, and natural disasters. Survivor's guilt is often seen in cancer survivors, transplant recipients, crash survivors, those who lose loved ones to suicide, parents who outlive their children, and survivors of other traumatic experiences. 

Not everyone who lives through a life-threatening trauma develops survivor's guilt, though researchers suggest it is a common symptom. According to a 2018 study, researchers found that 90% of the participants receiving treatment for traumatic stress after surviving an event where other people died reported experiencing feelings of guilt. 

Treatments for survivor’s guilt

The most common treatment for survivor's guilt is psychotherapy, also known as talk therapy. A few approaches may be used, depending on the extent of the client's symptoms and their goals for treatment, including the following.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy focuses on helping clients identify harmful behavior and thought patterns so they can shift them toward more productive, positive habits, leading to meaningful changes. Numerous scientific studies confirm that CBT substantially improves function and quality of life for many people. 

Eye movement desensitization and reprocessing therapy (EMDR)

EMDR helps people alleviate the psychological distress associated with traumatic memories. Studies show that specific eye movements or bilateral brain stimulation while processing traumatic memories can lead to mental and emotional healing with faster results than many other treatments. In addition, EMDR was specifically developed to treat PTSD.

Coping mechanisms for survivor's guilt

In addition to working with a qualified mental health professional, which is often the most effective way to address survivor's guilt, there are several methods you can use on your own to overcome the effects, including the following.

Honestly evaluate your role and responsibility

You may fixate on what you could have done differently or how you could have predicted or prevented the circumstances leading to your trauma. However, the reality might be far from the reality of the event. You are one person and are only responsible for your actions. For example, it may not be kind nor reasonable to expect someone without training as an emergency responder to overcome impossible circumstances and accomplish superhuman feats. Survivor's guilt may cause you to insist that you should have done more, but that doesn't mean it's true. 

In addition, if you have made a mistake that led to someone's death or injury in some way, self-forgiveness can still be essential. Although you may be unable to change the past, consider your intentions when the accident occurred and note that you did your best. As people cannot predict what might occur when it happens and may freeze, run, or struggle during a traumatic event, it can be difficult to react with all senses when a trauma occurs. Feeling self-loathing or shame after making a mistake may worsen your mental health and contribute to PTSD. Talking to a therapist in these circumstances may be beneficial. 

Coping with regret and avoid "what ifs"

Many people who live through life-threatening traumas often feel regret and struggle with what-if scenarios. For example, many police officers, soldiers, or firefighters may experience regret and obsess over how they might have treated a patient that passed away if they could return in time. In many cases, hindsight bias influences your view of the event and what you might have done differently based on the information you learned after the fact. In addition, you may not have had the information or logic you have now when the trauma occurred, as trauma can cause people to go into shock. 

Give yourself time and space to grieve

Part of working through survivor's guilt may be giving yourself the time and space you need to grieve. Your guilt may make you feel you don't have the right to grieve since you're the one who lived. However, identify and acknowledge your feelings. You deserve the opportunity to work on your mental health and are worthy of the efforts it takes, even if your guilt tells you that you're not. 

Make a positive impact

Try to make a positive difference in the world. One of the ways you might overcome survivor's guilt is by actively working to impact the lives of people around you positively. When you wonder why you lived when others did not, try to find ways to help others in memory of those lost. 

Identify the outside factors causing the event

Identify and focus on the outside factors that caused the traumatic event and let go of the misplaced self-blame. There may not have been much you could have done to have changed the outcome. However, even if you could have changed the outcome, understanding that other factors were at play may be beneficial.

Forgive yourself and practice self-compassion

Practice kindness and compassion for yourself, and learn self-forgiveness even if your actions led to harming someone else. People make mistakes. How you move forward can make a difference in the future.

Know that you aren’t alone

Remember that many people feel guilty after losing someone. While survivor's guilt isn't a diagnosable condition by itself, it happens enough that the mental health community has identified it as a common cognitive phenomenon, giving it an official name, characteristics, and mention in the DSM-5. 

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Mental health concerns can complicate life

How therapy may help you overcome survivor's guilt

Survivor's guilt is a common reaction after living through a traumatic event where your own life was in danger and others didn't live. Working with a licensed therapist through an online therapy platform like BetterHelp may help you process your feelings and learn adaptive, practical ways to cope. Online therapy is often less expensive, has shorter wait times, and offers treatment in the safety and convenience of your own home, on your schedule, and in the best format for you. For those feeling fear related to PTSD, leaving home can be difficult, and internet-based therapy offers a discreet solution. 

According to researchers at the American Psychological Association, online therapy is a viable treatment option with results comparable to in-person sessions with a licensed therapist. Many clients report increased therapeutic outcomes with teletherapy, often due to the convenience of attending more sessions and the added distance, making it easier to discuss complicated details with a therapist. 

Therapist reviews on BetterHelp

“Roc has been a thoughtful and trustworthy guide for me through several major life transitions. Even when i struggle to follow through on actions we have discussed in a prior session Roc never makes me feel guilty or bad for struggling. Instead he engages in a mindful conversation helping both of us explore the inner workings of my mind and work through whatever personal history and context has taken me to the place i am at today. Don’t judge a book by its cover (or do if that suits you). Roc is a very accomplished professional that knows his craft well and will help and seek to better learn and understand anyone he works with.”

“I use humor as a means to deflect so when I started my therapy with Cyre, I was like--so how long will I be healed? Will it be 6-7 sessions? Cyre has been patient with me as I deflect, invaded and struggled and she focused on helping me deal with my trauma by letting conversations unfold for me. It's a lot and I'm grateful to have her support and guidance on my healing journey. I know now that it will take as long as I need it to be.”

Takeaway

Many people experience survivor's guilt after a traumatic experience where others lost their lives or were gravely injured. If you've experienced a traumatic event, a licensed therapist may offer insight into overcoming your guilt and how therapy can help you find healthy ways to process your feelings and shift cognitive patterns.

Release the weight of guilt
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