Survivor’s guilt

Survivor’s guilt was first written about in detail in survivors of the Holocaust and of the Hiroshima bombing. One psychiatrist called it “survivor syndrome”.

It was later studied in Vietnam War veterans, many of whom carried high levels of survivor’s guilt. Since then, it has been described in refugees, survivors of terrorist attacks, mass-casualty accidents and many other groups.

Researchers describe one type of survivor’s guilt as linked to something the survivor did, or didn’t do. For example: “If I hadn’t swapped shifts, he would still be here.”

Looking carefully at what you actually knew and could control at the time often shows that you did your best in an impossible situation. Hindsight makes things look far more predictable than they were.

Another type is guilt about surviving itself. Many survivors know there was nothing they could have done, yet still feel guilty. Researchers call this existential survivor’s guilt.

Survival is very often a matter of chance, like which seat someone sat in. In most tragedies, one person’s death did not spare another person’s life.

Survivor’s guilt is more likely when many people died and the chances of surviving seemed small. It can last for years: in one study of a maritime disaster, 61% still felt it 30 months later.

Guilt can also push people to help. After huge bushfires in Australia, survivors shared their homes with people who had lost theirs.

Survivor’s guilt is common in veterans, especially after combat. Studies found it in 38% to 46% of soldiers and veterans in different groups.

In studies of moral injury, a question about survivor’s guilt is one of the most commonly endorsed by veterans.

Survivor’s guilt has been found in 55% of lung cancer survivors in one study. It has also been described in people who survived HIV when friends did not.

In a study of 195 people one month after leaving hospital with COVID-19, those with more survivor’s guilt had more low mood, trauma symptoms and sleep problems.

It can be especially strong when you were “in the same boat” as those who died, for example on the same hospital ward.

After a suicide, many people are consumed by guilt, replaying “what if” and “if only” and wondering if they could have prevented it. Confusion and feelings of rejection are common too.

You might always wonder why it happened. Over time, the raw intensity usually fades.

Researchers have also used the term survivor’s guilt for non-life-threatening events. Examples include keeping a job when coworkers were laid off, and first-generation college students from low-income homes who have gone further in school than their family.

The feeling of having benefited more than others is similar, even though no one has died. It can make it hard to enjoy what you have worked for.

Survivor’s guilt has been reported in refugee groups. The American Psychological Association also lists worry for family back home among the stresses people face after moving to a new country.

You may feel guilty for being safe, for having more, or for not being there when someone needed you. Holding both gratitude and grief is part of many immigrant stories.

The VA’s National Center for PTSD notes that during a health care crisis, health care workers may feel guilty about surviving when others are dying, or about not being able to save a patient.

First responders and law enforcement officers can also face events that leave lasting guilt.

Survivor’s guilt can come with nightmares, flashbacks, irritability and pulling away from others.

Some survivors feel they don’t deserve to enjoy life. Birthdays, holidays and happy moments can bring a sting of guilt.

Guilt says “I did something bad.” Shame says “I am bad.” Survivor’s guilt often brings both.

Many people hold a deep belief that the world is fair. When someone good dies and you live, that belief is shaken, and guilt can rush in to fill the gap.

Survivor’s guilt is more likely when someone was close to the person who died, saw them suffer, or when many people died. The bigger the sense of unfairness, the stronger the guilt can feel.

It is also more likely after impossible choices, like whether to escape or stay to help, and after surviving more than one event where others died.

Common patterns

• Asking “Why them and not me?” over and over
• Believing feeling guilty is a way to remember them
• Feeling you must “earn” your survival, and it’s never enough
• Replaying images of the person or the event

These patterns usually come from love and loyalty. But they tend to keep guilt going rather than ease it.

Researchers describe survivor’s guilt as reflecting the empathy a survivor feels for others. One study after an earthquake found that survivors with more guilt also had more social support, which was linked with growth over time.

Many survivors are also grieving, especially when they knew the people who died. Guilt can make grief harder, for example by making it painful to talk about the person or face reminders of them.

After a traumatic event, some people blame themselves for bad things that happened, or for surviving when others didn’t. The VA notes that we all tend to be our own worst critics.

Survivor’s guilt has been linked with more severe PTSD symptoms.

Moral injury can follow events where a person did something, failed to prevent something, or witnessed something that goes against their moral beliefs. Guilt, shame, betrayal and anger are hallmark reactions, along with trouble forgiving yourself.

Survivor’s guilt is often considered one type of moral injury. Surviving can feel like a break in how a fair world is supposed to work.

Moral injury has been studied most in veterans, and also in health care workers, first responders, law enforcement and civilians affected by community violence.

Research has linked survivor’s guilt with suicidal thoughts and attempts, for example in veterans after their service. This is a reason to take heavy guilt seriously and reach out early.

The three parts

• Self-kindness: notice harsh, guilty thoughts and resist judging yourself
• Common humanity: remember you are not alone, and let others show you compassion
• Mindful awareness: notice your pain without ignoring it or drowning in it

Being kind to yourself is often harder than being kind to others. It gets easier with practice.

Therapists working with survivor’s guilt often ask: would you judge other survivors the same way? If you had died and they had lived, would you want them to feel guilty?

Most people answer no. That answer can be a first step toward offering yourself the same mercy.

Looking closely at the facts of what happened often shows that the survivor did their best. As one expert put it, it was the circumstances, not the survivor, that were irrational or bad.

Questions to ask

• Could anyone have known then what I know now?
• How much time did I have to decide?
• What else was going on around me?
• Who or what else played a part?

Try this

1. Breathe in through your nose and out through your mouth three times
2. Remember a moment you felt loved and accepted for who you are
3. Imagine that moment is happening now. Notice the sights, sounds and warmth
4. Notice how it feels in your body
5. Let the picture fade, and rest in the feeling

If you feel overwhelmed, stop and come back to it another time, or try it with a counselor.

Gratitude practice may help loosen unfair thoughts. Being grateful for being alive is not betraying those who died.

Small steps

• Do one thing they enjoyed, in their honor
• Let yourself laugh without explaining it
• Notice one good moment a day
• Say yes to one invitation

In one example from therapy, a man who lost his brother wrote him a letter about how much he loved him and how much the loss had hurt, and left it at his grave.

Your letter can hold thanks, apologies, memories, news, or anything else. No one else needs to read it.

The same family agreed to spend the brother’s birthday together every year, telling stories so he would never be forgotten.

Ideas

• Cook their favorite meal on a special day
• Keep a photo or object somewhere you see it
• Plant a tree or garden
• Share stories about them with people who knew them

Many survivors feel an urge to repair or make amends for surviving. Some set up funds or charities in a loved one’s name.

Researchers suggest that trying to “earn” survival may never feel like enough. Instead, ask what is meaningful to you, and what your loved one would want for you, then put your time there.

Anniversaries, holidays and special occasions can be painful reminders. It’s okay to change or pause traditions that feel too painful for now.

News of similar events can also stir up memories and guilt.

The VA notes that moral injury can affect spirituality. Some people find it hard to see how their beliefs can still be true after what they lived through.

Researchers note that spiritual or religious beliefs may be brought into question after surviving. Talking with an understanding, supportive faith leader can help.

In a study of a Muslim community after a 2019 attack on two mosques in New Zealand, people reported that their faith was very important to them. Researchers highlighted social connection and faith as helping recovery.

Ideas

• Ask a faith leader about prayers, rituals or services of remembrance
• Find comfort in sacred texts, music or prayer
• Join a faith-based grief or support group
• Light a candle or visit a place of worship

Logotherapy, developed by Viktor Frankl, a Holocaust survivor, focuses on finding meaning in suffering. It has been used to help veterans and first-generation college students with survivor’s guilt, though it has not been formally tested for it.

Meaning can come from relationships, values, faith, creativity or helping others. There is no single right answer.

Some VA programs for moral injury are led or co-led by chaplains. One group program focuses on a person’s relationship with a Higher Power and on challenges with forgiveness.

If you have a faith leader you trust, they can be a good person to talk with too, alongside a counselor or therapist.

Therapy, especially CBT, can help with the harsh thoughts, shame and beliefs about fairness that keep guilt going. Trauma-focused CBT and EMDR have shown promising results.

A therapist may help you find a personally meaningful explanation for your survival, and test beliefs like “Feeling guilty keeps them remembered.”

A small early study found that imagery rescripting, where a person changes painful images in their imagination with a therapist’s guidance, reduced distress linked to survivor’s guilt. Larger studies are still needed.

Some people imagine a conversation with the person who died, hearing them say they want the survivor to be happy.

The VA describes several therapies for trauma-related guilt and moral injury. One short therapy that focuses on guilt helped reduce guilt, PTSD and depression symptoms more than supportive therapy in a trial.

Some approaches include self-compassion, making amends, and making a plan to live by your values going forward.

Sharing your story with others going through the same kind of loss may help you find purpose or strength. If a group keeps you stuck going over the death, other support may suit you better.

The American Foundation for Suicide Prevention lists suicide loss support groups and offers Healing Conversations, where you can talk with a volunteer who has also lost someone to suicide.

Places to look

• Disaster survivor or community groups
• Faith-based grief groups
• Hospital, hospice or cancer center programs
• Veterans groups and Vet Centers

Try

• “I’m so glad you’re here.”
• “It makes sense you feel this way, and it wasn’t your fault.”
• “Would you like to tell me about them?”
• “You don’t have to go through this alone.”

Avoid

• Arguing with every guilty thought
• “Everything happens for a reason.”
• “It’s time to move on.”
• “You should just be grateful.”

Ideas

• Encourage support from a counselor or survivor group
• Invite them gently to things they used to enjoy
• Listen without rushing to fix it
• Remember hard dates and check in
• Say the name of the person who died

Many people find it hard to talk about loss, so survivors can end up feeling isolated. Your steady presence matters.

Signs to take seriously

• Drinking or using drugs to cope
• Giving things away or saying goodbye
• Pulling away from everyone
• Talking about not deserving to live, or wanting to die

Children who lose a brother or sister can feel survivor’s guilt, or pressure to make up for the loss. They may not have words for it.

Ideas

• Answer questions honestly, at their level
• Let them know it wasn’t their fault, more than once
• Notice changes in sleep, play or schoolwork
• Remind them they don’t have to replace anyone

You can reach

• 988 Suicide & Crisis Lifeline: call or text 988, or chat at 988lifeline.org
• Crisis Text Line: text HOME to 741741
• Veterans Crisis Line: dial 988 then press 1, or text 838255

You can contact 988 for yourself or if you are worried about someone else.

SAMHSA’s Disaster Distress Helpline offers free, 24/7 crisis counseling to anyone in the U.S. and its territories feeling distress after a natural or human-caused disaster. Survivors, loved ones of victims, responders and relief workers can all call. Call or text 1-800-985-5990 (press 2 for Spanish).

Find A Helpline (findahelpline.com) is a global directory of free, confidential helplines, shared by the International Association for Suicide Prevention. The Helplines section of this app lists support by country too.

In an emergency, call your local emergency number.