“Preventing the Pain” When Working with Family and Sexual Violence in Primary Care

Table 1

Indicators of secondary stress [2].

Psychological	Cognitive shifts/altered world view	Relationship changes
Continuing distressing emotions, for example, sadness, anger, fear, and shame	Loss of trust and sense of safety	Overidentification with patients
Intrusive images of the patient’s experience, for example, nightmares, or flashbacks	Heightened sense of vulnerability	Detachment from patients, particularly those with traumatic experiences
Numbing or avoidance, for example, Being unable to ask about or work with family violence	Helplessness	Isolation from colleagues and peers
Somatic disorders, for example, headaches and abdominal pain	Loss of personal control	Overprotection of or detachment from family and friends
Addictive behaviours, for example, overworking, substance abuse, and compulsive eating.	Loss of sense of freedom
Chronic physiological hyperarousal	Increased dependence on others
Impaired day-to-day functioning, for example, chronic lateness, cancelling of appointments, and feeling unappreciated	Loss of confidence and job satisfaction