Understanding And Overcoming Survivor’s Guilt

Medically reviewed by Paige Henry, LMSW, J.D.
Updated June 11, 2024by BetterHelp Editorial Team
Please be advised, the below article might mention trauma-related topics that include suicide, substance use, or abuse which could be triggering to the reader.
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Living through a life-threatening, traumatic experience can deeply affect a person in many ways. Feeling guilty for living through such an experience when others either do not survive or experience more tangible or more extreme harm is a well-documented phenomenon known as survivor’s guilt. Below, we’ll explore the definition, key symptoms, and available treatments for this symptom so you can find out how to overcome survivor's guilt.

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Mental health concerns can complicate life

What is survivor’s guilt?

Survivor's guilt, or survivor’s remorse, is a feeling many people experience after living through a life-threatening situation—especially when one or more people who experienced the same situation did not survive or experience additional harm. It’s a complicated emotional reaction that often stems from the individual feeling like they could have done more to save lives or prevent damage, regardless of whether they could have actually, realistically changed the situation. 

As a 2021 study puts it, "Survivor's 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."

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, but a symptom. It’s when a person feels guilty either as a trauma response and/or as a sign of complicated grief or post-traumatic stress disorder (PTSD). 

  • Complicated grief extends beyond the typical parameters of grief after loss or other trauma. Symptoms often include a fixation on the circumstances that led to it and what the individual wishes they’d done differently. 

  • Post-traumatic stress disorder (PTSD) is a trauma- and stressor-related disorder that can develop in people who have experienced a specific traumatic event such as a natural disaster, a serious car accident, or an assault. Those who have survived abuse, war, or a dangerous migration, such as refugee minors, may also be prone to survivor’s guilt.

Unaddressed survivor’s guilt has the potential to impact a person’s daily functioning and overall well-being. It could also cause an individual to develop depression, substance use disorders, or other diagnosable disorders.

Signs that you may be experiencing survivor’s guilt

Looking out for signs of survivor’s guilt after experiencing a traumatic event could help you identify any point at which you may need to seek professional support. Common thought patterns associated with survivor’s guilt can make you feel like it will last forever at the same intolerable intensity. However, it is possible to reduce and healthily manage these feelings with the right support, which we’ll discuss in more detail below.

Only a trained healthcare provider can properly distinguish between survivor’s guilt on its own and survivor’s guilt as a symptom of PTSD or another disorder. 

Some symptoms of survivor’s guilt may include the following:

  • Flashbacks or frequently reliving the traumatic event

  • Obsessive fixation on the event

  • Intrusive thoughts about the event

  • Feelings of helplessness

  • Drastic changes to eating and sleep habits

  • Physical symptoms like headache, nausea, racing heart, or stomachache

  • Irritability

  • Decreased motivation

  • Mood swings and emotional outbursts

  • A strong sense of guilt or shame

  • Avoiding thoughts, conversations, or reminders of the event

  • Fear of the situation occurring again

  • Suicidal ideation or actions

Who is at risk for survivor’s guilt?

Many occupations expose people to significant trauma that could lead to survivor's guilt, including military personnel, first responders, and other medical staff like doctors and nurses. Survivor's guilt is also 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 common. Consider a 2018 study involving individuals who were receiving mental health treatment after surviving a traumatic event. It reports that 35% of those involved experienced an event where others died, and 90% of participants overall reported feelings of survivor's guilt

Whether a person might develop survivor’s guilt after a traumatic experience can depend on many factors. Just some of these potential risk factors for survivor’s guilt include:

  • The particulars of the event

  • Any preexisting mental health conditions

  • Genetics

  • Personality type

  • Quality of coping mechanisms

  • Quality of social support

  • Whether they received counseling or therapy after the event

How to overcome survivor's guilt: Treatment methods

The most common treatment for survivor's guilt is psychotherapy. A few different therapy modalities may be used depending on the extent of the client's symptoms and their goals for treatment. Two common types include:

  • Cognitive behavioral therapy (CBT). Cognitive behavioral therapy focuses on helping clients identify distorted thought patterns so they can shift them in a healthier direction, potentially causing more positive feelings and behaviors. Numerous scientific studies have suggested that CBT can substantially improve function and quality of life for people facing a variety of different challenges.

  • Eye movement desensitization and reprocessing therapy (EMDR). EMDR was developed specifically to treat PTSD, so it may help people alleviate the psychological distress associated with traumatic memories. Studies suggest that specific eye movements and bilateral brain stimulation while processing traumatic memories—which is what EMDR treatment sessions involve—may lead to mental and emotional healing with faster results than many other treatments.

If a person is experiencing survivor’s guilt as a result of PTSD or another mental health condition, their care provider may also recommend medication in some cases.

Mental health concerns can complicate life

Coping mechanisms for survivor's guilt

Working with a qualified mental health care provider like a therapist is typically the recommended approach for someone experiencing survivor’s guilt or any other distressing effects after living through a traumatic event. In addition to receiving professional treatment, the following coping mechanisms could also help you manage troubling feelings and work toward healing.

Look at the event realistically and with compassion

You may fixate on what you could have done differently or how you may have been able to prevent harm, negative outcomes, or the circumstances leading to your trauma. Taking a more realistic approach and granting yourself some grace and compassion could be helpful in this case. 

You can’t expect perfect performance from yourself in all situations, especially in life-or-death scenarios. It’s not uncommon to freeze, run, struggle, or go into shock during a traumatic event. Comparing your actual reaction to one that you imagined after the fact with all the benefits of foresight, planning, and calm is not fair to yourself. 

Give yourself time and space to grieve

Part of working through survivor's guilt may include giving yourself the time and space you need to grieve at your own pace. Your guilt may make you feel you don't have the right to grieve since you're the one who lived, but this is an example of distorted thinking. You deserve the opportunity to feel and then process your feelings and work toward relief, even if your guilt tells you otherwise. 

Make a positive impact

Some people find it helpful to direct some of their energy toward making a positive impact as a way to work through trauma and/or guilt. You might donate to a cause, volunteer for a charity, or find new ways to support friends and neighbors. 

You may also find it healing to work in prevention or education related to the cause of the event. For example, someone who is experiencing survivor’s guilt after losing a loved one to cancer may find meaning and comfort in joining efforts to educate others on the importance of getting a particular type of cancer screening or recognizing the warning signs.

Know that you aren’t alone

Finally, it can help to remember that you’re not alone in what you’re feeling. After all, survivor’s guilt is common enough that the American Psychiatric Association (APA) names it in the DSM. To remind yourself that you’re not alone in this relatively common response and to find solidarity and peer support, you might also consider seeking out support groups. 

Addressing survivor’s guilt with a mental health professional

Again, those experiencing survivor’s guilt, signs or significant symptoms of PTSD, and/or other maladaptive responses to trauma may benefit from working with a licensed therapist. They can offer you a nonjudgmental space in which to process the event and your feelings around it plus healthy coping mechanisms to manage the effects moving forward. For example, they may encourage you to journal, meditate, lean on family members and friends, and practice self-care on your road to healing.

For many types of talk therapy, you can choose between online and in-person treatment. Those who are looking to avoid potentially spending months on a waitlist and want to receive more immediate care might be interested in trying online therapy instead of seeking out an in-person provider. 

Online therapy is often less expensive, has shorter wait times, and allows you to connect with a licensed therapist remotely from the comfort of home. According to the American Psychological Association, online therapy can generally be considered a viable treatment option, with results often comparable to in-person sessions. 

Counselor reviews

“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 help you find healthy ways to process your feelings and shift distorted cognitive patterns. Looking at the event realistically, offering yourself compassion, and connecting with others experiencing survivor’s guilt may also be helpful.

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