Cumulative Compassion Fatigue Induced by Prolonged Exposure to War Imagery: A Multi-Case Qualitative Investigation Among Non-Professional Observers in Lebanon

Abstract

A descriptive, multiple case-study design was employed. Five Lebanese female participants (aged 18–58 years), identified as manifesting CCF symptoms through purposive social media observation, were recruited. Data were collected across three structured sessions per participant using: (1) semi-structured diagnostic interviews across eight thematic domains; (2) the Impact of Event Scale–Revised (IES-R), validated on a Lebanese sample (α = 0.895, split-half r = 0.934); and (3) a projective photographic battery of 12 wartime images. Triangulation was achieved through concurrent behavioural observation. Three of five participants demonstrated high CCF (IES-R mean scores: 3.36, 3.04, 3.08), one moderate (2.74), and one low (0.70). Symptoms consistently span intrusion, avoidance, and hyperarousal domains. Cross-case analysis identified six symptom clusters: affective dysregulation (grief, guilt, rage), cognitive impairment (attentional deficits, intrusive recollections), physiological reactivity (somatic pain, cardiac acceleration), behavioural disruption (sleep and appetite disturbances, social withdrawal), relational deterioration, and existential perturbation (loss of future orientation). Absence of self-care practices and low emotional regulation capacity emerged as significant amplifiers. Visual content, particularly footage involving child victims, produced more severe distress than written media. Digital media exposure to ongoing armed conflict constitutes a legitimate pathway to CCF in non-professional populations. The collective and morally infused nature of empathic engagement with Palestinian suffering introduces a distinct psychosocial dynamic not captured by occupational fatigue models. Targeted psychological interventions and media-literacy programmes are warranted for this population.