There is growing interest in how helpers working with severely traumatized individuals are affected by their work. A sample of 69 persons working with war and torture survivors across specialized centers throughout Sweden filled out questionnaires evaluating negative (i.e., compassion fatigue—composed of secondary traumatic stress [STS] and burnout—depersonalization, and impairment of functioning) and positive (posttraumatic growth [PTG], compassion satisfaction) reactions related to working with trauma survivors. We also measured attitudes toward human evil and death, demographics, history of trauma, and exposure to trauma narratives in hours per week and years of practice. Compassion satisfaction correlated negatively with most negative posttraumatic reactions. PTG was associated with STS, depersonalization, and impairment in functioning. Negative reactions to trauma work correlated with each other. Regression analyses showed that compassion satisfaction was negatively correlated with fear of death and age, whereas compassion fatigue correlated positively with fear of and resignation towards human evil (EVIL); the latter also predicted burnout and STS. STS also correlated with years in the field. Depersonalization correlated positively with EVIL and negatively with fear of death, whereas impairment of functioning correlated positively with years in the field and EVIL and negatively with fear of death. The more years in the field, the more people reported PTG. A majority of respondents stated that their attitude toward evil had changed because of their work. It is important to consider existential issues, especially human evil, when evaluating the effect of working with trauma.

Background Psychotic disorders are associated with impaired facial emotion recognition (FER) and poor functional outcome. Most studies regarding facial emotion recognition have focused on schizophrenia. The aim of this study was to explore FER in patients with different psychotic disorders at psychiatric outpatient facilities. The intention was also to examine if patients diagnosed with schizophrenia differed from patients diagnosed with other psychotic disorders in the ability to recognize facial emotions. Methods FER was examined in forty outpatients, evenly divided between schizophrenia and other psychotic disorders and 33 healthy control persons. The ability to recognize facial emotions was assessed with The Facially Expressed Emotion Labelling (FEEL). To assess the severity of psychotic symptoms in the patient group The Structured Clinical Interview for Symptoms of Remission (SCI-SR) was used. Results Patients performed significantly worse than healthy controls (p<.001, r =-.28) in recognizing facial emotions in general, including expressions of fear, disgust and sadness. Subjects with a schizophrenia diagnosis performed poorer than healthy controls when depicting fear (p<.01, r=.45) or anger (p=.026, r=.36). Compared to other psychotic disorders they were less accurate in recognizing anger (p=.036, r=-.040). We did not find any significant differences between patients with other psychotic disorders and healthy controls in FER. Furthermore, patients performed significantly slower on the FEEL test (p<.001, r=0.44), including both patients with a schizophrenia diagnosis and other psychotic disorders as compared to healthy controls. Patients diagnosed with schizophrenia showed significantly more psychotic symptoms (p= .001, r= -.53). However, there were no significant differences between patients in remission (40 %) and patients with more severe psychotic symptoms regarding the FEEL measures. Discussion In this study, patients with psychotic disorders performed less accurately and slower on the FEEL task as compared to healthy control persons. Patients diagnosed with schizophrenia tended to exhibit more difficulties. The results from this between-group comparison should however be interpreted with caution due to limited statistical power. Since no significant difference in FEEL score was demonstrated between patients in remission and patients suffering from more severe psychotic symptoms, it could be suggested that deficits in FER are independent of current psychotic symptoms. Impaired facial emotion recognition ability may negatively influence social interaction and functional outcome and the results from this study indicate that FER should be further explored in larger cohorts of outpatients with different psychotic disorders.