By We Level Up FL Treatment Center | Editor Yamilla Francese | Clinically Reviewed By Lauren Barry, LMFT, MCAP, QS, Director of Quality Assurance | Editorial Policy | Research Policy | Last Updated: January 06, 2022
What is Survivor’s Guilt?
Survivor guilt is a common experience following traumatic events in which others have died. Survivor guilt is a commonly-used term in both clinical descriptions and lay language and has been identified in a range of trauma-exposed populations, often linked to more severe post-traumatic mental health consequences [1]. In the current version of the diagnostic manual, the DSM-5, survivor’s guilt is a symptom of post-traumatic stress disorder (PTSD).
Guilt is a self-conscious affect and moral emotion characterized by negative self-evaluation and is a common post-traumatic experience. Survivor 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.
Although survivor guilt was initially applied to surviving tragedies such as the Holocaust or Hiroshima, the term was later applied to refer to suffering guilt for surviving HIV+ during the AIDS epidemic. Survivor guilt during the AIDS epidemic was described as a perpetuating feeling of “why not me” associated with difficulty recognizing and communicating emotional distress and a mediator of depression among this population. Since its initial application to the AIDS epidemic, survivor guilt has continued to be studied among a broad range of individuals diagnosed and treated for serious life-threatening medical conditions, including transplant survivors, cardiac arrest survivor guilt, and cancer survivor guilt.
What is the History of Survivor’s Guilt?
Survivor guilt has been documented in therapeutic writing for centuries. Freud, after the death of his father, noted his own experience of ‘self-reproach that regularly sets in among the survivors’ and wrote extensively about survivor guilt in Holocaust survivors, coining the term “survivor guilt syndrome”. A similar pattern of pathology was noted in Lifton’s (1976) detailed observations of survivors of the Hiroshima attack.
More recently, survivor guilt has been reported in a wide range of traumatized groups, including refugee populations, More recently, survivor guilt has been reported in a wide range of traumatized groups, including military veterans, refugee populations, survivors of terrorist attacks (survivor’s guilt 9/11), HIV-negative gay men, survivors of mass-casualty accidents, and grandparents who had lost a grandchild.
The term “survivor guilt” was coined by Drs. Stanley Cobb and Erich Lindemann in 1943. They defined survivor guilt as the presence of tension, loneliness, or mental pain that was precipitated by visits from loved ones, by mentioning the deceased, and by receiving sympathy. Robert Jay Lifton further explored survivor guilt, noting “psychic numbing,” or the cessation of feeling, as a dominating lifestyle characteristic experienced by those who suffered feelings of death guilt.
Survivor’s Guilt Symptoms
The extent and severity of a survivor’s guilt vary between people. Survivor’s guilt meaning and its symptoms can be both psychological and physical and often mimic those of PTSD.
The most common psychological survivor guilt 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 survivors guilt symptoms can include:
- Appetite changes
- Difficulty sleeping
- Headaches
- Nausea or stomachache
- Racing heart
Survivors guilt examples and symptoms 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.
What Are the Traits of Survivor’s Guilt?
During a traumatic experience, the brain is sometimes unable to process the event due to its intensity. The high levels of stress overwhelm the brain, and the hippocampus, which is responsible for chronicling memories, has difficulty differentiating if the event is in the past or the present. Flashbacks can develop when the brain struggles to store the memory in its proper place. As time goes on, this processing issue can trigger mental and emotional issues as well as psychosomatic symptoms, which are physical ailments associated with increased stress and internal conflict.
Some traits of survivor’s guilt are:
- Headaches
- Excessive sweating
- Dizziness or breathlessness
- Increased heart rate
- Flashbacks
- Nausea or stomachaches
- Frequent nightmares
- Apathy
- Irritability and anger
- Insomnia or altered sleep
- Depression
- Anxiety
- Fatigue

Skip To:
- What is Survivor’s Guilt?
- What is the History of Survivor’s Guilt?
- Survivor’s Guilt Symptoms
- What Are the Traits of Survivor’s Guilt?
- PTSD Statistics
- PTSD Facts
- DSM-5 Criteria for PTSD
- Survivors Guilt Causes
- End the Emotional Pain. Get Your Life Back.
- Is Survivors Guilt a Disorder?
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- How to Deal with Survivors Guilt?
- World-class, Accredited, 5-Star Reviewed, Effective Mental Health Dual Diagnosis Programs. Complete Integrated Inpatient Rehab with Free Post Discharge Therapy Planning.
- What is Cancer Survivor Guilt?
- PTSD and Survivor Guilt
- Start a New Life
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- What is Suicide Survivor Guilt?
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In the current version of the diagnostic manual, the DSM-5, survivor’s guilt is a symptom of post-traumatic stress disorder (PTSD). It may be viewed as one of the cognitive and mood-related symptoms of PTSD, which include having distorted feelings of guilt and negative thoughts about oneself. PTSD can occur after you have been through trauma. About 6 of every 10 men (or 60%) and 5 of every 10 women (or 50%) experience at least one trauma in their lives. PTSD can happen to anyone. It is not a sign of weakness.
3.8%
About 6 out of every 100 people (or 6% of the population) will have PTSD at some point in their lives.
Source: NIMH
12 million
About 12 million adults in the U.S. have PTSD during a given year. This is only a small portion of those who have gone through trauma.
Source: NIMH
8%
About 8 of every 100 women (or 8%) develop PTSD sometime in their lives compared with about 4 of every 100 men (or 4%).
Source: NIMH
PTSD Facts
PTSD and DSM-5
In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5; 1). PTSD is included in a new category in DSM-5, Trauma- and Stressor-Related Disorders. All of the conditions included in this classification require exposure to a traumatic or stressful event as a diagnostic criterion.
DSM-5 Criteria for PTSD
The following text summarizes the diagnostic criteria:
Criterion A (one required): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):
- Direct exposure
- Witnessing the trauma
- Learning that a relative or close friend was exposed to a trauma
- Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)
Criterion B (one required): The traumatic event is persistently re-experienced, in the following way(s):
- Unwanted upsetting memories
- Nightmares
- Flashbacks
- Emotional distress after exposure to traumatic reminders
- Physical reactivity after exposure to traumatic reminders
Criterion C (one required): Avoidance of trauma-related stimuli after the trauma, in the following way(s):
- Trauma-related thoughts or feelings
- Trauma-related reminders
Criterion D (two required): Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):
- Inability to recall key features of the trauma
- Overly negative thoughts and assumptions about oneself or the world
- Exaggerated blame of self or others for causing the trauma
- Negative affect
- Decreased interest in activities
- Feeling isolated
- Difficulty experiencing positive affect
Criterion E (two required): Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):
- Irritability or aggression
- Risky or destructive behavior
- Hypervigilance
- Heightened startle reaction
- Difficulty concentrating
- Difficulty sleeping
Criterion F (required): Symptoms last for more than 1 month.
Criterion G (required): Symptoms create distress or functional impairment (e.g., social, occupational).
Criterion H (required): Symptoms are not due to medication, substance use, or other illness.
Two specifications:
- Dissociative Specification. In addition to meeting the criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
- Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).
- Derealization. Experience of unreality, distance, or distortion (e.g., “things are not real”).
- Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although the onset of symptoms may occur immediately.
Survivors Guilt Causes
Although anyone can experience survivor guilt, many people heal from trauma without ever experiencing guilt. People with survivor’s guilt may feel that they did not deserve to survive, or that they could have done something to prevent the tragic outcome. They may also feel a sense of responsibility to those who did not survive and may struggle with feelings of grief and loss.
Symptoms of survivor’s guilt can include feelings of sadness, hopelessness, and depression, as well as difficulty concentrating and making decisions. It can also lead to physical symptoms of survivor guilt, such as insomnia, loss of appetite, and fatigue. How do we define survivor’s guilt? There’s no definitive formula explaining why some people go on to feel guilty and others don’t, but experts believe the following factors can play a role.
Previous experience with trauma
If you’ve experienced trauma, in childhood or at any other point in life, you could have a greater chance of experiencing survivor guilt.
Existing mental health symptoms
According to the DSM-5, underlying mental health concerns, including depression and anxiety conditions, can increase the risk of guilt and other PTSD symptoms after trauma.
Personality factors
Personality factors suggest a link between survivor guilt and submissive behavior. Researchers believe this could have an evolutionary component. [2]
In other words, you might behave more submissively in social situations if you:
- Fear putdowns, threats, or other negative responses from peers
- Believe your success or well-being keeps others from experiencing the same
- Believe you’re better off than others
Submissive behavior, then, effectively helps promote well-being for your social group as a whole. This could help explain why more socially submissive people often go on to develop survivor guilt when a traumatic event affects group well-being.
Self-esteem can also play a part. Since low self-esteem often involves fixed ideas about your own abilities or sense of worth, it might fuel thoughts like:
- Why did I survive?
- I don’t deserve to be here.
- If I had done something differently, that wouldn’t have happened.
- I couldn’t stop it, so it’s all my fault.

Less social support
The DSM-5 notes that social support, both before and after trauma, can help protect against PTSD.
Loneliness can make any type of emotional distress worse since feelings you can’t share or otherwise express can easily become overwhelming.
When you don’t have support from others, you might find yourself fixating on false beliefs about the trauma, including your own sense of responsibility. You might even assume others blame you, just as you blame yourself.
Unhelpful coping skills
People cope with the effects of trauma in various ways. Some of these strategies have less benefit than others.
It’s not uncommon to try to suppress or avoid memories of the trauma in order to escape unwanted emotions like guilt and sadness. You might also try to deny feelings of guilt entirely, or alternatively, give in to them by assigning and accepting blame you don’t deserve.
In the absence of social support and other helpful strategies in dealing with survivors guilt, you could also use alcohol or other substances to numb emotional distress and keep feelings of anxiety or depression at bay.

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Hotline (855) 940-6125Is Survivors Guilt a Disorder?
In the current version of the diagnostic manual, the DSM-5, survivor’s guilt is a symptom of post-traumatic stress disorder (PTSD). It may be viewed as one of the cognitive and mood-related symptoms of PTSD, which include having distorted feelings of guilt and negative thoughts about oneself. It is important to note, however, that people can experience survivor’s guilt without having PTSD. They can also have PTSD without feeling survivor’s guilt.
Despite its previous diagnostic importance, the experience has been rarely studied systematically. Existing theoretical accounts are primarily psychoanalytic, derived from observational studies, and not empirically tested. Very few survivor’s guilt treatment studies have ever been published.
Although PTSD models are relevant, not everyone who experiences survivor guilt will meet the diagnostic criteria for PTSD. For example, they may ruminate about a death of a loved one but not intrusively re-experience it. Also, the event may not meet Criterion A for a PTSD diagnosis (which, according to DSM-5 must involve either witnessing the death or, if indirectly experienced or learned about, the death must have been violent or accidental).
Survivor guilt stories examples include, survivors of the COVID-19 pandemic (which, at the time of writing, has infected hundreds of millions of people worldwide, and killed over four million), may not develop PTSD but feel survivor guilt nonetheless. A model for survivor guilt should, therefore, be applicable to those with or without PTSD.
If you are experiencing survivor’s guilt, it is important to remember that you are not to blame for the traumatic event and that you did not have control over the outcome. Seeking support from friends, family, or a mental health professional can be helpful in managing these feelings and moving forward.
Despite the high prevalence of survivor guilt in traumatized groups, few theoretical models have been developed to guide treatment.

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How to Deal with Survivors Guilt?
Although feelings of guilt associated with surviving a life-threatening event can be painful and difficult to overcome, it is possible to address and cope with such feelings. It may be helpful to first acknowledge those feelings and recognize that they are both common and a natural part of the process of healing from grief.
How to cope with survivor’s guilt? A self-care routine is also considered to be an important part of emotional healing. Self-care typically involves regular physical movement, soothing or relaxing activities, a nutritious diet, and plenty of rest. Support is also a crucial component of coping with survivor guilt. Speaking with others who shared the experience; attending a support group; or seeking help from a trusted mentor, adviser, or spiritual counselor can help an individual feel understood. Some may also find it helpful to find a way to memorialize or honor the deceased.
How to deal with survivor’s guilt? When survivor guilt is so severe that it impacts a person’s ability to function in daily life, the support of a therapist or counselor may be recommended. A therapist can help individuals manage and process painful emotions and challenge distorted patterns of thinking that may contribute to guilt.

After a traumatic event, acceptance can feel incredibly difficult. You have to accept the event itself, which might include acknowledging and coming to terms with the loss of loved ones or your way of life. But you also have to acknowledge and accept guilt, grief, and any other emotions born from that trauma.
How to get over survivor’s guilt? Emotional support from loved ones can make a big difference after a trauma. Friends and family can offer support by listening to your distress and reminding you that you weren’t to blame.
If time doesn’t make much of a difference in feelings of survivor guilt, or any other emotional distress, talking to a therapist or other mental health professional is a good next step.
A therapist can offer guidance with:
- Exploring underlying factors contributing to guilt, such as feelings of personal responsibility
- Working through depression, fear, anxiety, and other distress
- Reframe and challenge negative thoughts around not just guilt, but also the trauma itself
- Identifying helpful coping skills and putting them into practice
It’s important to recognize that survivor’s guilt is a normal response to a traumatic event. However, if negative feelings persist or interfere with daily life, it may be helpful to seek support from a mental health professional. Therapy, support groups, and self-care practices such as mindfulness and self-compassion can be helpful in managing and coping with survivor’s guilt.
When trauma happens, individuals can react in a few different ways. Some might adopt avoidance techniques so they do not need to face the effects that the trauma has produced, while others simply cannot stop ruminating about their traumatic experience. There is no wrong way to react to trauma, however, continuing to live with its negative effects of it can be damaging and lead to even more trauma.
Typical signs and survivor guilt examples include feelings of guilt or responsibility for not being able to stop a traumatic event, self-blame, difficulty moving on or letting go of the event, and a sense of unfairness or injustice. These feelings can be accompanied by other signs of despair, such as depression, anxiety, and difficulty sleeping or concentrating.
Within the United States, approximately 70 percent of adults have experienced one form of trauma in their lives. From that 70 percent, 20 percent end up developing posttraumatic stress disorder or PTSD. It is reported that over 13 million American adults are currently struggling with PTSD. [3]
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What is Cancer Survivor Guilt?
Survivor guilt has also been recorded in medical populations, for example in 55% of lung cancer survivors. Some cancer survivors may experience this guilt if they survive a diagnosis but others don’t. Approximately 402,326 Americans living today have been diagnosed with lung cancer at some point in their lives. Despite recent advances in treatment and screening for early detection, lung cancer remains the leading cause of cancer death in the United States, killing an average of 433 people per day and 168,000 people per year.
With such high mortality and poor prognosis, estimated as an overall 5-year survival rate of only 18.0%, lung cancer survivorship has historically been a rare occurrence. It is often assumed that someone diagnosed and successfully treated for lung cancer should simply be “grateful to be alive.” However, extensive experience working with survivors of lung cancer led to the realization that many survivors expressed feelings about the burden of guilt (survivors guilt cancer). This led to the hypothesis that survivor guilt may be an undescribed psychosocial challenge in lung cancer survivorship.
PTSD and Survivor Guilt
Is survivor’s guilt a form of PTSD? Survivor’s guilt is a common symptom of Post-Traumatic Stress Disorder (PTSD). It is a common reaction to traumatic events and includes strong feelings of guilt related to surviving a life-threatening situation when others around them did not. Survivors may wonder why they deserved to survive, while others perished. Survivors may also blame themselves for not doing more to save others or help remedy the situation.
Survivor’s guilt PTSD can have an overall negative effect on one’s mental health, quality of life, and ability to function properly in society. There are many modalities of therapy available that can assist in treating this condition. Cognitive Behavioral Therapy (CBT) is a modality of therapy intervention that can be helpful in the treatment of “survivors guilt PTSD”. Rumination is often a common characteristic of survivor’s guilt and CBT interventions that are designed to target rumination guilt can be successful. CBT is designed to help one break down problems into smaller parts, making an overwhelming situation easier.
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What is Suicide Survivor Guilt?
Losing a loved one to suicide is one of life’s most painful experiences. The feelings of loss, sadness, and loneliness experienced after the death of a loved one are often magnified in suicide survivors by feelings of guilt, confusion, rejection, shame, anger, and the effects of stigma and trauma. Furthermore, survivors of suicide loss are at higher risk of developing major depression, post-traumatic stress disorder (survivors guilt suicide), and suicidal behaviors, as well as a prolonged form of grief called complicated grief. Thus, survivors may require unique supportive measures and targeted treatment to cope with their loss.
It is estimated that 85% of people in the United States will know someone personally who has completed suicide. For each suicide completed, at least 6 loved ones are directly affected by the death. While not everyone exposed to suicide will be acutely affected by the death, this is likely an underestimation as reported figures may not account for the emergency responders, health care providers, coworkers, and acquaintances also affected by the suicide. That said, individuals most closely related to the deceased are usually those most adversely affected by the death.
One of the most common feelings that suicide loss survivors have is guilt. It is so common for people to feel like they did not do enough or that they did too much and it led to their loved ones’ death. It is so easy to find fault with your own actions. Many people will fault themselves for missing clues or for not understanding what was going on inside someone else’s head.
If you or your loved one suffer from trauma symptoms and survivors guilt, professional trauma disorder treatment can become necessary. To learn more, contact us today at the We Level Up FL Treatment Facility, we provide the utmost care with doctors and medical staff available 24/7 for life-changing and lasting recovery. We can help provide an enhanced opportunity to return to a fulfilling and productive life.

Search We Level Up FL “Survivor’s Guilt Definition, Symptoms, Traits, Causes, Treatment” Topics & Resources
Sources:
[1] Survivor Guilt: A Cognitive Approach – PMC (nih.gov)
[2] NIMH » Post-Traumatic Stress Disorder (nih.gov)
[3] PTSD Treatment for Incarcerated Men and Women: NIMH – Full Text View – ClinicalTrials.gov
[4] Posttraumatic Stress Disorder – StatPearls – NCBI Bookshelf (nih.gov)
[5] Sex and gender differences in post-traumatic stress disorder: an update – PMC (nih.gov)
[6] NIMH » Coping With Traumatic Events (nih.gov)
[7] Coping with a Traumatic Event – coping.doc (cdc.gov)
[9] Major Depressive Disorder – StatPearls – NCBI Bookshelf (nih.gov)