Survivors Guilt Defined, Symptoms, Causes & How To Cope
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. 
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.
Survivor’s Guilt Symptoms
The extent and severity of a survivor’s guilt vary between people. Symptoms of survivor’s guilt can be both psychological and physical and often mimic those of PTSD.
The most common psychological symptoms include:
Common physical symptoms can include:
- Appetite changes
- Difficulty sleeping
- Nausea or stomachache
- Racing heart
Survivor guilt 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.
Survivors Guilt Causes
Although anyone can experience survivor guilt, many people heal from trauma without ever experiencing 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. 
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 coping strategies, you could also use alcohol or other substances to numb emotional distress and keep feelings of anxiety or depression at bay.
Is Survivors Guilt a Disorder?
Survivor guilt was once considered a symptom of Post-Traumatic Stress Disorder, according to DSM-III (Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, American Psychiatric Association, 1980), reflecting the influence at the time of research focused on Vietnam war veterans, who reported high levels of survivor guilt. It was listed as an associated symptom of PTSD in DSM-IV-TR (APA, 2000), then removed in the most recent diagnostic criteria, DSM-5 (APA, 2013).
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 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).
For example, 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.
Despite the high prevalence of survivor guilt in traumatized groups, few theoretical models have been developed to guide treatment.
How To Cope
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.
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.
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.
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
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 the negative effects of it can be damaging and lead to even more trauma.
Within the United States, approximately 70 percent of adults have experienced one form of trauma within 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. 
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 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.
 How to Cope with Survivor Guilt, Because Survival Is No Reason to Feel Guilty – https://www.healthline.com/health/mental-health/survivors-guilt#takeaway