Survivor’s guilt, also known as bereavement guilt, is a psychological phenomenon characterized by feelings of remorse that are experienced by individuals who have lost someone to suicide. This feeling often emerges due to a belief, whether rational or not, that they could have done something to prevent the suicide. Often rooted in a combination of self-blame, responsibility, and a sense of failure, it can lead to significant amounts of emotional distress that are so intense that it interferes with one’s daily life.

This article aims to provide insight about self-reproach; exploring its causes, symptoms, and potential interventions that affect individuals who struggle to cope with the aftermath of suicide.

Several Emotional Factors Include

According to psychologist Hannah Murray, to better understand this complex emotional response, recognizing the factors that may lead to and intensify survivor’s guilt include:

  • Perceived responsibility: Survivors may feel responsible for their loved one’s decision to die by suicide, perceiving that their actions or inactions directly influenced the tragedy.
  • Perceived failure: Survivors may also feel that they failed to prevent their loved one’s suicide, even if there was nothing they could have done differently.
  • Shame: Survivors may experience shame because of their association with suicide, which is often stigmatized in society.
  • Unresolved grief: Survivors may have unresolved grief from a previous loss, such as the death of a parent or sibling. This unresolved grief can make it more difficult for them to cope with their loved one’s suicide.
  • Lack of support: Survivors who do not receive support from family members, friends, or professionals are more likely to experience survivor guilt than those who do receive support.
  • Unresolved conflicts: Unresolved conflicts or relationship difficulties before the suicide can compound survivor guilt, as individuals may feel that their actions contributed to the loss.
  • Unrealistic expectations: Unrealistically high standards or expectations, such as assuming the role of a caregiver or protector, may contribute to feelings of guilt when those expectations cannot be met.

What can Survivor’s Guilt Symptoms Look Like?

As you can see, survivor’s guilt can manifest from various aspects that impact an individual’s mental, emotional, cognitive, and even physical well-being. While the presentation of emotional symptoms can show up as sadness, anger, and shame, these feelings may be directed at oneself or others, such as the person who died or those who survived with them.

Understanding the potential indications of survivor’s guilt is essential for mental health counselors to effectively be able to identify and address their client’s needs. Commonly, physical symptoms like headaches, stomachaches, and irregular sleep patterns may begin to plague the bereaved. Cognitive symptoms could include feelings of inadequacy and intrusive thoughts about the deceased and the traumatic event that leads to negative self-perception and self-destructive thoughts.

Survivors may also experience nightmares about the event or feel compelled to avoid situations that remind them of their loved ones. They may feel numb or detached from their emotions and have trouble concentrating on various tasks as well.

As a result, unmanaged guilt can develop into extended periods of emotional and physical distress symptoms like depression and anxiety. Depression, being another common symptom, robs individuals of their joy and ultimately leaves them with feelings of hopeless unworthiness.

survivor's guilt

Post-Traumatic Stress Disorder

It is essential to recognize that survivor’s guilt and post-traumatic stress disorder (PTSD) are also often intertwined by their shared origins of trauma that create a complex and challenging experience for those affected. PTSD is a mental health condition that occurs in response to a particular event and includes symptoms such as flashbacks, nightmares, and severe anxiety.

Individuals who experience survivor’s guilt may be more vulnerable to developing PTSD, as the guilt and self-blame associated with survivor’s guilt can intensify and prolong the psychological impact of the traumatic event (Smith, 2021). Moreover, the symptoms of survivor’s guilt can often overlap with PTSD symptoms, such as intrusive thoughts, emotional numbing, and heightened arousal. These further complicate the recovery process (Murray, 2021), but understanding this interplay is vital for mental health professionals who provide practical support and interventions to individuals grappling with both guilt and PTSD (Freeman et al., 2016).

survivor's remorse
Seeking Professional Help

While every individual’s experience is unique, counselors and other mental health providers, including psychiatrists, endeavor to provide appropriate support and interventions to those who experience survivor’s guilt. Various therapeutic approaches can be effective in helping individuals cope with and lessen the intensity of their remorse. Given the connection between guilt and post-traumatic stress disorder (PTSD), obtaining a professional evaluation becomes essential (Stanley et al, 2019). While there is no singular “magical” solution or specific therapy that can eliminate emotional distress, adopting coping strategies is an important first step in managing survivor’s remorse (Morrell, 2021).

In some cases, the use of antidepressants or other pharmacological interventions may be necessary, particularly when symptoms of anxiety or depression are present (VA, 2022). Moreover, individuals with a history of suicidal thoughts or attempts may require specialized clinical care to address their unique needs (Bryan et al., 2017).

Another method such as individual counseling provides a safe and supportive space for survivors to explore their emotions. Two popular evidence-based therapeutic modalities include cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT) which help challenge self-blaming thoughts and begin the development of proper coping strategies.

Cognitive and Dialectical Behavioral Therapy

CBT is a highly effective form of psychotherapy that targets negative thought patterns contributing to distress. Most therapists find techniques like journaling or role-play to be most effective when guiding individuals through their sessions. Focusing on the relationship between thoughts, feelings, and behaviors empowers survivors to challenge and overcome negative thinking, paving the way for a more fulfilling life.

DBT is a form of cognitive-behavioral therapy that focuses on the same relationship between thoughts and behaviors but through techniques like mindful meditation. It is an evidence-based treatment for borderline personality disorder (BPD) that has been adapted to be implemented with those who have experienced sexual and physical abuse. It helps individuals identify and challenge the negative thoughts that contribute to their distress and teaches them how to productively show up in their interpersonal relationships.

To learn more about this stigma of shame, read “Discussing the Intersection of Sexual Shame and Suicidehere.

Group Therapy

Therapy can offer survivors who struggle with feelings of isolation and shame a sense of community and shared understanding. It allows them to connect with others who have experienced similar loss and provides an opportunity for emotional validation and mutual support. Individuals get to practice new coping strategies like mindfulness and emotional regulation in real-life situations, which can help them feel more confident about using these skills outside of therapy.

It is important for those grappling with survivor’s remorse and their loved ones to understand that seeking help is neither wrong nor a cause for shame. Delaying this necessary assistance can further complicate the healing process and increase the risk of potential future setbacks (O’Connor et al., 2020).

survivor's guilt

Conclusion

Survivor’s guilt resulting from suicide is a profound and complex emotional response that must be addressed with sensitivity and empathy. With professional help to better understand the causes, symptoms, and potential interventions of remorse, individuals can receive the necessary support they need to combat this challenging aspect of bereavement.

Providing these survivors with education about suicide helps them challenge misconceptions, alleviate self-blame, and develop healthier coping mechanisms. Psychoeducation sessions like counseling and group therapy can also equip them with the necessary tools to understand their emotions and navigate the grieving process to promote healing, resilience, and growth for the journey ahead.

For years, Kiss & Tell has been more than just a sex-positive platform for those who want to better understand the world around them, our focus is your mental health and overall wellness too.

If you or anyone you know has been affected by survivor’s guilt, we encourage you to call Centerstone’s hotline today at 1-877-HOPE123 (877-467-3123) to receive the support you need.

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References

Bryan, C. J., Mintz, J., Clemans, T. A., Leeson, B., Burch, T. S., Williams, S. R., … & Rudd, M. D. (2017). Effect of crisis response planning vs. contracts for safety on suicide risk in US Army soldiers: A randomized clinical trial. JAMA Psychiatry, 74(3), 259-266. https://pubmed.ncbi.nlm.nih.gov/28142085/

Leonard, J. (2019).  What is survivor’s guilt?  Medical news today. www.medicalnewstoday.com/articles/325578

Morrell, K. (Ed.). (2021, March 12). Survivor guilt: Symptoms, causes, coping tips, and more. Healthline.https://www.healthline.com/health/mental-health/survivors-guilt#takeaway

Murray, H., Pethania, Y., & Medin, E. (2021). Survivor guilt: a cognitive approach. The Cognitive Behaviour Therapist, 14, e28. doi:10.1017/S1754470X21000246 https://www.cambridge.org/core/journals/the-cognitive-behaviour-therapist/article/survivor-guilt-a-cognitive-approach/19F993611E0BDE9C219F16BE0E6BD622

O’Connor, R. C., Pirkis, J., & Cox, G. R. (2020). The international COVID-19 suicide prevention research collaboration. World Psychiatry, 19(3), 333-345. https://pubmed.ncbi.nlm.nih.gov/32716205/

Smith, K. V., & Ehlers, A. (2021). Prolonged grief and posttraumatic stress disorder following the loss of a significant other: An investigation of cognitive and behavioural differences. PLoS ONE, 16(4). https://doi.org/10.1371/journal.pone.0248852   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016232/

Stanley, I. H., Rogers, M. L., Hanson, J. E., Gutierrez, P. M., & Joiner, T. E. (2019). PTSD symptom clusters and suicide attempts among high-risk military service members: A three-month prospective investigation. Journal of consulting and clinical psychology, 87(1), 67–78. https://doi.org/10.1037/ccp0000350

VA/DoD Clinical Practice Guideline. (2022). The Management of Major Depressive Disorder. Washington, DC: U.S. Government Printing Office. https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFinal508.pdf