Survival Guilt Syndrome

By | June 10, 2022

People with surviving guilt syndrome went through an extreme situation and survived. They feel guilt towards those who have died. The variant of post-traumatic stress disorder can be observed particularly frequently in the context of wars or natural disasters.

What is surviving guilt syndrome?

Extreme stress paves the way for mental illness. Post-traumatic stress disorder is particularly well known in this context. There are different variants of this persistent personality change after extreme stress. One of them is surviving guilt syndrome. The mental illness is also known as concentration camp syndrome or Holocaust syndrome. For what is the definition of corneal ulcer, please visit

The patients have mostly experienced an accident, a natural disaster, an epidemic or war, genocide and imprisonment first hand. Precisely because those affected survived the extreme situation, they are tormented by feelings of guilt in view of the deceased. People have died around the affected person without them being able to help them.

The term Survival Guilt Syndrome or Survivor Guilt Syndrome was introduced in the 1960s by the German-American psychiatrist William G. Niederland, who used the term to describe the feelings of guilt felt by concentration camp victims. The basic context was known within psychology even before Niederland’s description. However, there was no independent term for it until his beginnings. Niederland described surviving guilt as the central link for all survivors of an extreme situation determined by dying.


The primary cause of surviving guilt syndrome is an extreme situation in which other people have died. This connection is particularly true in wars and in the context of natural disasters. However, the guilt for surviving syndrome does not necessarily have to occur on such a comprehensive scale. Smaller frames are also conceivable.

For example, the death of a loved one can trigger surviving guilt syndrome. For example, if a spouse dies of a serious illness, the spouse left behind may also develop survivor’s guilt syndrome. As a rule, however, the syndrome occurs when many people in the immediate vicinity of those affected have died under their eyes.

The patient recognizes the exceptional case of his own survival and feels his survival in this context as “undeserved”. Because of the undeserved survival among thousands, the afflicted feels a nagging guilt toward those who have died whom he was unable to help.

Those with survivor guilt have lived lives of constant threat. Especially often a faceless threat is omnipresent. In addition, public and personal suspicions and accusations related to Holocaust survivors without the possibility of recourse to legal protection contributed to the causes of the syndrome.

Symptoms, Ailments & Signs

Like any syndrome, surviving guilt syndrome is made up of different symptoms. At the heart of the syndrome is the crushing guilt patients feel for their survival. The central symptom of feelings of guilt is associated with other symptoms that can be of different types.

Many patients with surviving guilt syndrome suffer from accompanying symptoms such as depression. They are often powerless or even apathetic. The apathy can relate exclusively to the mental area, but under certain circumstances it can also relate to the physical area. Feelings of insecurity are also a common symptom. Those affected often feel insecure, especially in their dealings with the world.

This insecurity often initiates a social withdrawal that can extend to all areas of life. The psychological situation of the patients in turn favors psychosomatic illnesses. In addition, those affected often feel states of anxiety or excitement, which promote persistent insomnia. On the basis of the inner restlessness, delusional symptoms can develop.

Diagnosis & course of disease

The diagnosis of surviving guilt syndrome is usually made according to ICD-10. The stressful situation and the central symptom of guilt are the most important diagnostic criteria.


People who suffer from the guilt for surviving syndrome often develop mental illnesses and sometimes also suffer from psychosomatic complaints. For example, many sufferers become depressed or numb. Apathy can promote stress diseases of the cardiovascular system such as heart failure, high blood pressure or organ damage.

Thyroid diseases and various infectious diseases such as tuberculosis or chlamydia can also occur. Likewise diseases of the nervous system such as neuroses, depressions or myasthenia gravis. Apathy can also cause anemia with dizziness and fatigue. The guilt for surviving syndrome often causes a strong insecurity in dealing with other people, which leads to a social withdrawal.

The quality of life and well-being are greatly reduced in a diagnosed guilt for survival syndrome. Sleep disorders, anxiety and panic attacks contribute to a rather negative general prognosis. Treatment can reduce symptoms, but it also carries risks.

Drug therapy can lead to side effects and interactions and, similar to psychotherapy, can cause a temporary deterioration in mental health. In the long term, comprehensive therapy can reduce the symptoms of the syndrome and largely prevent further complications. However, relapses are always possible in the case of severe mental illness.

When should you go to the doctor?

Many people who have survived an accident or other fateful situation experience states of emotional distress and overwhelm. In principle, cooperation with a therapist or doctor should be sought for better processing of the experiences. If the zest for life falls or if feelings of guilt arise, he needs help and support.

Particularly difficult are situations in which one’s own survival takes place, but relatives or friends have died. Coping with such an event should take place with an experienced therapist. If it comes to depressive states, mood swings, withdrawal behavior or an aggressive appearance, the person concerned needs help. In the event of personality changes or unusual behavior, consultation with a doctor is necessary.

If there are vegetative disorders, diffuse pain, a feeling of illness, inner weakness or a feeling of emptiness, a doctor should be consulted. If food is refused, if there is a visual reduction in physical strength, or if there is severe weight loss, there is cause for concern. If you can no longer fulfill your daily obligations, if you no longer feel joy or if your well-being is severely reduced, you should consult a doctor.

Treatment & Therapy

The treatment of people with surviving guilt syndrome takes place within the framework of psychotherapy. Drug therapy is often used at the same time. For people with surviving guilt syndrome, remembering the events is usually extremely distressing. This poses a challenge for the psychotherapist.

Many patients are even completely unable to remember the events. As long as those affected are still in a traumatizing situation, it is not possible to treat the traumatic disorder. It is important to educate the patient. In psychoeducation, the person concerned must develop an understanding of the difficulties of their own symptoms and recognize the cause of the symptoms.

Day-care treatment is recommended for most patients initially. This is especially true when the disruption impairs important everyday functions. Inpatient treatment is indicated for particularly strong panic reactions to stabilize the person concerned. In cognitive behavioral therapy based on the behavioral model of Kozak and Foa or the cognitive-behavioural model of Clark and Ehlers, a direct confrontation with the trauma takes place.

The protected memory of the traumatic situation should relieve the patient of the guilt. In the metacognitive model, the post-traumatic thinking style and its metacognitive beliefs are altered. The patient’s beliefs are influenced through Detached Mindfulness or similar practices. Eye movement desensitization and reprocessing, on the other hand, aims at integrating the traumatic situation.

This integration is initiated through targeted remembering and a change of perspective. Psychodynamic procedures have a similar goal and, for example, provide the patient with an opportunity to retreat to an inner place of safety if their emotions become too strong. Drug therapies depend on the symptoms in the individual case. The administration of paroxetine, mirtazapine or amitriptyline is possible .


The guilt for survival syndrome can hardly be prevented in a targeted manner, since the causal situations are usually unavoidable and cannot be influenced.

You can do that yourself

Social support from friends and family can have a positive impact on surviving guilt syndrome. As a result of the syndrome, some sufferers feel they no longer deserve life. However, it can be helpful to consciously experience beautiful moments despite this feeling and to treat yourself to something.

Some people who suffer from surviving guilt syndrome find strength in meaningful pursuits, such as volunteering or an information project related to the traumatic event. However, it varies greatly from person to person as to whether such activities are perceived as distraction and fulfillment or whether they represent an additional burden. Commitment should not be viewed as repentance, since this perspective can be a hindrance to recovery. If in doubt, those affected should work with a therapist to consider what they can do themselves in addition to the therapy.

Since guilt for survival is a form of post-traumatic stress disorder (PTSD), self-help methods can be used that are promising in this disorder. A number of studies have found evidence that mindfulness can help reduce PTSD symptoms. Mindfulness is based on Buddhist meditation. During the implementation, physical sensations, thoughts and feelings are perceived without evaluating them. In order not to cause retraumatization, however, it can make sense to limit yourself to breathing meditations and other clearly defined exercises. There are numerous instructions for this in books and on the Internet.

Survival Guilt Syndrome