Compassion Fatigue or Lack of Boundaries?

August 2021 Volume 11, Issue 8

TRANSCULTURAL PSYCHIATRY

It feels like one of those days when things just don’t seem right. Despite a full night’s sleep, energy levels feel depleted, motivation levels oscillate between low to negligible, and mood swings become recurrent. Have you experienced such symptoms lately, when it feels like a task to get out of the bed, feeling apathetic or irritable throughout the day, and irrespective of the effort put in, you cannot shake off the inescapable dread of seeing patients? These can be understood as stemming from compassion fatigue. Usually, those in the caregiving or healthcare industry are highly susceptible to experiencing this. It can be defined as an emotional stress reaction due to cyclical interactions with individuals who are emotionally demanding and require compassion and empathy of higher levels, i.e., dealing with individuals who are emotionally needy or have highly unrealistic expectations. Compassion fatigue is often confused with burnout, and these terms have been used synonymously. However, they are quite distinct from each other.

The concept of practicing emotional boundaries is crucial for any successful personal or professional relationship. But what happens when we are unable to set appropriate boundaries, thereby disrupting our work-life balance, or develop a possible unobjective stance with certain specifics or superiors? Boundaries, in layman terms, are the necessary cues, needs, and expectations regarding what is okay and not okay for us in a relationship—knowing when to say yes to others and when to assertively decline forms an essential component of healthy communication. Violating our own boundaries due to being in a helping profession can often result in feeling overwhelmed, resentful, avoidant, irritable, or fatigued. Behaviourally, it can take the form of over-extending oneself to help the patient(s), people-pleasing or over-working to elicit admiration from peers, patients or superiors, inability to decline to any request of a patient or superior, having high expectations from others, avoiding vulnerability, accepting mistreatment due to fear of being rejected or ridiculed by a superior or patient, feeling fearful of treating, etc. Our parental upbringing and individual personalities often determine the extent of our flexibility with our boundaries, as both extremes – being porous or too rigid is detrimental to any fruitful interaction. Consequently, possessing poor boundaries can significantly predispose health care workers to experience compassion fatigue in their work, especially in the context of the current pandemic induced uncertainties.

The following steps can be taken to ensure that we don’t overextend ourselves in our work and social interactions:

1. Learn to verbally communicate your needs or say no assertively, without the fear of rejection or confrontation.
2. Engage in hobbies or activities outside of work and maintain a healthy work-life balance.
3. Practice effective stress management by developing healthy coping strategies and engaging in a self-care routine to rejuvenate.
4. Reach out to a trained and licensed mental health professional or support group.
5. Maintain regularity in your sleep-wake cycle and physical exercise.
6. Practice any form of meditation, mindfulness, and/or other creative art forms (journaling, painting, doodling, and others).

Reference:

Sweileh, W.M. Research trends and scientific analysis of publications on burnout and compassion fatigue among healthcare providers. J Occup Med Toxicol 15, 23 (2020). https://doi.org/10.1186/s12995-020-00274-z

Further reading:

1. Set Boundaries, Find Peace: A guide to reclaiming yourself, by Nedra Glover Tawwab.

2. When the Body Says No: The Cost of Hidden Stress, by Dr. Gabor Mate.