The 'Double-Edge Sword' of Human Empathy: A Unifying Neurobehavioral Theory of Compassion Stress Injury

An integrative neurobehavioral model for “compassion stress injury” is offered to explain the “double-edge sword” of empathy and inherent vulnerability of helping professionals and care-givers. One of the most strikingly robust, yet largely invisible scientific findings to emerge over the past decade is identifying the neurophysiological mechanisms enabling human beings to understand and feel what another is feeling. The compelling convergence of evidence from multi-disciplinary lines of primary research and studies of paired-deficits has revealed that the phenomenon of human beings witnessing the pain and suffering of others is clearly associated with activation of neural structures used during first-hand experience. Moreover, it is now evident that a large part of the neural activation shared between self- and other-related experiences occurs automatically, outside the observer’s conscious awareness or control. However, it is also well established that full blown human empathic capacity and altruistic behavior is regulated by neural pathways responsible for flexible consciously controlled actions of the observer. We review the history, prevalence, and etiological models of “compassion stress injury” such as burnout, secondary traumatic stress, vicarious traumatization, compassion fatigue, and empathic distress fatigue, along with implications of the neurobehavioral approach in future research.