Survivor’s guilt happens when someone feels guilty for living through a tragedy that hurt or killed others. They might wonder why they survived or feel like they should’ve done more to help.
Living with survivor’s guilt can bring sadness, anxiety, and even nightmares. In many cases, it overlaps with post-traumatic stress disorder (PTSD).
Talking with a therapist and learning coping strategies can help you manage survivor’s guilt in healthy ways.
A terrible car crash. A hurricane that wipes out a town. A mass shooting at work. We hear about tragedies like these almost every day. For those who make it through, the impact doesn’t always end when the danger is over. Many have survivor’s guilt and wonder why they were spared when others weren’t.
Survivor’s guilt doesn’t just happen after someone has died. It can also occur when you feel guilty for making it through a difficult situation when others didn’t. Maybe you kept your job after a mass layoff or escaped a fire while your neighbors lost everything.
This is a complicated type of grief that can last for years and even lead to other mental health conditions. But support is available. With a therapist’s guidance and healthy coping mechanisms, you can learn to manage survivor’s guilt in healthy ways or even move past it with time.
Signs you’re living with survivor’s guilt
Sometimes people don’t realize what they’re feeling is survivor’s guilt. Instead, they carry around sadness or blame themselves for things that weren’t their fault. They might not know how to process these emotions, so they keep everything bottled up.
Common signs include:
Blaming yourself: You may feel like the tragedy was your fault, even when it wasn’t. That kind of thinking, called hindsight bias, makes you believe you should’ve done something differently, even though you couldn’t have changed the outcome.
Questioning your purpose: After surviving a serious illness, like cancer, some people feel a deep shift in how they see their life and priorities. It’s common to wonder, “Why am I still here?” or, “What do I want to do with this second chance?” This questioning can feel unsettling, but it can also open the door to rediscovering values, passions, and a renewed sense of meaning.
Replaying the event in your mind: The memories of the trauma can play on a continuous loop, leaving you stuck in the moment of what happened.
Pulling away from friends and family: You may start isolating yourself, feeling like no one understands your guilt. Things you used to enjoy may no longer bring you happiness.
Trouble sleeping and frequent nightmares: Your sleep may feel restless or filled with nightmares that remind you of the trauma.
Feeling anxious, depressed, or hopeless: With unaddressed survivor’s guilt, heavy emotions can take over. These might make it hard to function.
Changes in appetite or energy levels: You might eat too much or too little, feel drained, and struggle to keep up with normal activities.
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The toll of carrying survivor’s guilt
Survivor’s guilt can make you feel like you’re carrying a heavy weight on your shoulders. Not addressing your guilt can harm your mind and body. This makes it especially important to get the support you need, whether that’s from a therapist, support group, or loved ones.
Survivor’s guilt can develop into mental health conditions, like:
Post-traumatic stress disorder (PTSD): Constantly replaying the event, nightmares, or always being on edge may be signs of post-traumatic stress disorder. If you think you might have PTSD, you can work with a mental health provider to find the right treatment for your needs.
Depression: Feelings of blame, sadness, and unworthiness can lead to depression.
Anxiety disorders: The stress and worry related to survivor’s guilt can turn into anxiety that affects daily life.
Substance use: Some people turn to substances to numb their emotional pain. This can create a cycle that may be hard to escape.
The stress of survivor’s guilt can take a physical toll too. You might experience headaches, digestive issues, muscle tension, or constant fatigue. Additionally, you may find yourself pulling away from family and friends, which can lead to isolation or loneliness.
Healthy ways to cope with survivor’s guilt
Many people with survivor’s guilt and PTSD symptoms start to feel better within the first year. But for some, the feelings can persist for years. The good news is you can heal. By talking with a therapist and learning coping strategies, you can ease the burden of survivor’s guilt.
Here are some steps that may help you start healing:
Join a support group. A support group brings together people who’ve gone through similar struggles so that no one feels alone in their struggles. You can meet in person or online to share stories and offer encouragement.
Practice self-care. Looking after yourself is an important step in healing from survivor’s guilt. Practicing mindfulness, deep breathing, journaling, and meditation can bring calm and ease guilt. Getting enough rest and remembering to eat nourishing meals can also help your body and mind recover.
Honor those lost. Many people find comfort in creating a memorial, volunteering, or dedicating their time to a meaningful cause in remembrance of those who died.
Exercise regularly. Moving your body is one of the best ways to ease stress and boost your emotional well-being. Activities like hiking in nature not only lowers stress in people with PTSD but also creates opportunities to connect with others.
Limit alcohol and drugs. Substances may numb pain temporarily but usually make things worse over time.
Stay connected. Spend time with supportive friends or loved ones instead of withdrawing. A healthy support network is often essential in the healing journey.
Some people try to suppress or outrun the guilt. Many people throw themselves into overworking, caretaking, or constant busyness, hoping to ‘earn’ their survival. But healing begins not with repayment, but with compassion. It’s important to recognize that being alive doesn’t mean you owe a debt.
Ashley Ayala, LMFT
Clinical reviewer
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If you or someone you know has survivor’s guilt, therapy can provide a safe space to talk about guilt and pain without judgment. A therapist can also teach you how to reframe negative thoughts, manage anxiety, and take steps toward healing emotionally. You don’t have to carry guilt forever.
At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best.
Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we're here to help you make progress — wherever you are on your mental health journey.
Linda Childers
Linda is an award-winning medical writer with experience writing for major media outlets, health companies, hospitals, and both consumer and trade print and digital outlets.
Her articles have appeared in the Washington Post, USA Today, WebMD, AARP, Brain+Life, HealthyWomen.org, The Rheumatologist, California Health Report, Everyday Health, HealthCentral, and many other media outlets.
While juggling the responsibilities of being part of the “sandwich generation” and caring for both her toddler son and terminally ill mother, a nurse friend encouraged her to seek therapy, which helped her to learn coping strategies and manage her depression. Linda hopes her work will help to destigmatize mental health conditions and encourage others to get the help they need.
Ashley Ayala, LMFT
Ashley is a Licensed Marriage and Family Therapist who specializes in generational healing and family dynamics. Ashley has worked in schools, clinics, and in private practice. She believes that people’s relationships, including our relationship with ourselves, greatly shape our experiences in life.
Ashley is committed to empowering others to show up authentically and deepen their self understanding. This passion stems from taking a critical lens on her own life story and doing inner healing. One of her favorite quotes is “Be yourself and the right people will love the real you.”
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