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How to Manage Survivor’s Guilt

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Survivor’s guilt is very common for those who have gone through a traumatic experience or are diagnosed with post-traumatic stress disorder (PTSD). This type of guilt often manifests in situations where others passed away, but you are still alive. Guilt can stem from multiple reasons, and you might be wondering why you survived, and they didn’t.

On top of that, you might be using substances to help cope with these feelings as they can be difficult to manage. We will discuss how common this is, along with ways to treat survivor’s guilt and PTSD in general.


What Is Survivor’s Guilt?

Survivor’s guilt is a specific type of guilt that you feel for surviving a situation that others didn’t. The classic example would be a soldier who survived an attack while his or her friends and comrades were killed. While this is a classic example, it’s not the only one.

You might have been through a traumatic situation where people were murdered. This could include mass shootings or other crimes. You may have also been involved in an accident where others died, but you somehow survived. The accident could be caused by another human, or it could be natural or random.

Death from illness can also cause survivor’s guilt. You might feel survivor’s guilt from others who passed away from an illness. This can be especially true if you contracted the same illness or if you got sick before them and you’re worried you infected them.

Just as there are many causes of death, there are just as many causes of survivor’s guilt. You might be wondering why you were able to survive. You might wonder if this leaves you with a special purpose, or you might also think that you should have joined those who passed away. Many people have trouble moving beyond the guilt and develop PTSD as a reaction to the trauma and stress.


Physical and Psychological Symptoms of Survivor’s Guilt

Describing survivor’s guilt is fairly simple. It’s about feeling guilty that you survived. The truth is that this becomes far more complex in your mind and body. Many people suffer from a range of physical and psychological symptoms. The symptoms are largely the same as PTSD, and it is possible to receive a PTSD diagnosis if you are suffering from survivor’s guilt.

Typical psychological symptoms include:

  • Helplessness
  • Distressing flashbacks
  • Irritability and/or hostility
  • Lack of motivation
  • Unpredictable mood swings
  • Obsessions and intrusive thoughts
  • Suicidal thoughts and/or ideation

This also causes physical symptoms, and these typically are:

  • Changes in appetite
  • Insomnia/difficulty sleeping
  • Headaches and physical tension
  • Racing heart rate
  • Stomach pains and nausea

These are just the common symptoms of the survivor’s guilt itself. Many people go on to develop anxiety and depressive disorders if they do not receive treatment, which can result in more symptoms. It is also common to use substances in order to cope with the feelings, which will result in other concerns as well.

If you are feeling guilt from surviving and having distressing memories, then reach out before the symptoms get worse. There are treatments available to help.


Comorbid Substance Use

Many people turn to substances to help cope with their feelings. Sometimes this is due to a pre-existing mental illness, or it might just be overall discomfort. If you are suffering from survivor’s guilt, then there is a high chance that you might either be using or tempted to use substances in order to numb the pain and distressing thoughts.

According to the National Institute of Health, about 30% of the overall population will suffer from substance use disorder at some point in their lives. The figure is higher for those diagnosed with PTSD. About 40% of those with PTSD will develop substance use disorder.

There is no shame if you are using, but there are better coping skills available. Not only that, but this causes a range of other symptoms and concerns that you will have to manage on top of your survivor’s guilt. Substances may feel like they are helping the situation, but they are simply hiding the problem away.


Additional Factors

The truth is that not everyone involved in a survivor situation will develop survivor’s guilt or PTSD. Some people will heal on their own without any intervention. This isn’t specifically a sign of weakness or strength, but rather it’s about resiliency. There are some factors that may make you more prone to feeling survivor’s guilt. You might find that some, all, or none of these factors play a part in your life.

Having a previous history of trauma greatly increases the likelihood of experiencing survivor’s guilt. This is especially true with childhood trauma. The same goes for having a history of depression and low self-esteem. These make it easier to look down on yourself and to wonder why you survived when others died.

Social support helps many people pull out of survivor’s guilt and other life difficulties. Having a lack of social support can increase the odds of developing a lasting trauma response. You don’t need a specific number of people in your life. It’s more about your ability to reach out and your social support being receptive to your needs. Even having one good friend can be enough to help.

The last contributing factor would be coping skills. You may not think that you have coping skills, but the truth is that everyone does. This refers to how you cope with a situation. Some people avoid stress, disengage from behaviors, experience wishful thinking, or turn to substances. All of these help you cope with stress, but this coping style may lead to survivor’s guilt and other mental health concerns. Those who are more active with their coping skills tend to fare stress and trauma better, but there’s no guarantee, of course.


Common Treatment Options

Treatment options will depend largely on your presentation, preferences, and the combination of concerns that you have when you contact us. There are many different treatment modalities and theories that assist with survivor’s guilt and PTSD. It is typically best to seek out evidence-based treatments as these have been studied to ensure they actually work with clients.

According to the U.S. Department of Veterans Affairs, two evidence-based treatments are prolonged exposure, or PE, and cognitive processing therapy, or CPT. Both of these have been proven to help treat trauma along with comorbid substance use if that is also a concern.

Survivor’s guilt and trauma, in general, will create feelings of avoidance. It starts by making you want to avoid the subject itself, but it quickly turns into avoiding anything that slightly reminds you of the event. For example, let’s say that your survivor’s guilt manifested from being in a major car accident where other people passed away. You may start by not wanting to approach the memories. This may then turn into avoiding driving, anywhere with cars, the sounds of cars, and anything else associated with the memory.

Both PE and CPT will help you address these feelings and combat the avoidance. Your therapist will help you address the memories and to talk more openly about the experience. You will also learn grounding techniques and new perspectives so that you can move beyond the survivor’s guilt.


Medical Detox for Substance Use

If you are engaged in substance use in an effort to help with the survivor’s guilt, then you may want to seek out a medical detox program to help treat the biological side of your addiction. Granite Recovery Centers provides medical detoxification for people who do not need immediate medical intervention, are not a danger to themselves, and are capable of self-evacuation in the event of an emergency.

While detox may not be necessary for everyone, it can help if you are experiencing cravings, facing withdrawal symptoms, or otherwise having difficulty discontinuing use. In fact, you might be wondering what medical detox really is. It is a process where one of our doctors monitors your health and symptoms as you discontinue the substance. Many substances, such as opioids or alcohol, cause withdrawal symptoms that range from extremely uncomfortable to fatal. Our doctors will know how to help you proceed through the process in the safest and most comfortable way possible.

This commonly involves tapering the substance. That means that you will be given smaller and smaller doses until your body no longer relies on the substance. You may also be given supplemental medications in order to help with pain, nausea, and other withdrawal symptoms.

Some people may also benefit from medication-assisted treatment, or MAT. This is especially popular with opioids and heroin. This type of treatment uses medications to help wean you off the opioids while avoiding withdrawal symptoms.


Inpatient and Outpatient Care

If you are suffering from survivor’s guilt without any substance use, then outpatient treatment would be most appropriate. Most evidence-based trauma treatments, such as CPT and PE, are performed on an outpatient basis. This is most commonly done through individual sessions where you meet one-on-one with your therapist. While some treatments will only require a weekly session, CPT is best suited for twice-weekly visits.

Group therapy can also be helpful. There are specific trauma groups along with intensive outpatient, or IOP, if you are suffering from co-occurring substance use disorder. The benefit of group therapy is that you can speak openly with other peers who are seeking to recover from their trauma. This gives you an opportunity to learn from others who are further along in the process, and you can support others who are struggling through similar concerns.

Inpatient treatment may be required if you are suffering from substance use and have significant difficulty controlling use and cravings. Inpatient treatment allows you to live at the facility while you focus on recovery. Not only does this allow you to get away from your daily stressors, but you will also have 24-hour access to doctors, therapists, and other medical staff to assist you.

Deciding on the proper treatment can be difficult without a professional helping you. Be sure to tell us about your concerns when you contact us so that we can generate an effective treatment plan for your needs. The more we know, the better we can treat you. We also like when our clients are engaged in their recovery, so tell us what you need, and we will accommodate your situation as much as possible.



Survivor’s guilt can be a difficult situation that may make you question why you survived when others passed away. While this is difficult, it’s possible to recover and live a fulfilling life after this trauma. Be sure to tell us about your concerns so that we can assist you in this troubling time. We at Granite Recovery Centers have been helping people with substance use, mental illness, and other concerns for over 10 years. Let us know what you need so that we can help you.