Burnout Syndrome

Burnout Syndrome. Introduction

The term “burnout syndrome” refers to a condition where people are under constant stress at work, which causes physical and emotional exhaustion as well as significantly decreased their performance.

Burnout originated as a term to characterize the impact of extreme stress and high standards among those in the “helping professions,” such as social workers and doctors, who started to feel helpless, weary, and unable to handle their jobs.

According to various surveys, in today’s fast-paced world, up to one-third of the working population meets criteria of burnout syndrome. These numbers highlight the growing work and life pressure when people feel chronically overwhelmed, trapped in frustrating circumstances, or torn between work and private stress.

The burnout discussion is filled with confusion and potential misconceptions tied to the term “burnout.” Contrary to popular belief, burnout is not a recognized scientific diagnosis in the internationally accepted classification system of mental disorders. Although burnout often occurs alongside a mental illness.

Burnout Syndrome: History

Since roughly 1900, the phrase “nervous breakdown” has been used historically. The 1950s saw the peak of this label’s use. Even now, the general public still uses this well-known phrase to characterize an exhaustion.

The term’s appeal is because it is ambiguous and protects privacy by not disclosing too much. It emphasizes the premise that nerves, not the mind, are the problem and that nerves can be fixed. The truth is that a “nervous breakdown” was never a legitimate diagnosis in psychology.

Herbert J. Freudenberger, an American psychotherapist, first described the burnout phenomenon in 1974. It was initially considered a problem of people working in social professions. Today, the term is used for people from various professions who experience job-related psychological exhaustion.

Burnout Syndrome: Symptoms

Burnout symptoms can be very diverse. The first signs usually include sleep disturbances: affected individuals wake up too early or can’t fall asleep at night. They can’t properly recover, feel less productive, and need more effort for normal tasks. Personal needs are denied, and social contacts are reduced.

After an initial phase of increased work engagement, expectations change, leading to disappointment and frustration. Those affected feel unappreciated, develop cynicism, and show declining empathy.

Over time, depressive symptoms often emerge, such as feeling empty, powerless, or unmotivated. Aggressive symptoms may also appear. Psychosomatic complaints like digestive issues, stomach pain, backaches, headaches, frequent infections, or sexual problems are common.

Burnout symptoms often cluster around three areas: emotional exhaustion, cynicism/detachment, and reduced work performance, although symptoms vary.

Burnout symptoms at one glance:

• Exhaustion, low energy, sleep disorders

• Concentration and memory problems, feelings of inadequacy, indecisiveness

• Reduced initiative and creativity, indifference, boredom, disillusionment, crying tendency, weakness, restlessness, despair

• Blaming others, loss of empathy, cynicism, loss of idealism, bitterness, “dehumanization,” more distance from clients, use of jargon

• Relationship or family problems

• Feeling of lack of recognition

• Physical symptoms like chest tightness, breathing difficulties, back pain, nausea, increased smoking

NCBC Burnout Categories

National Center for Biotechnology Information (NCBI), (2017), distinguish three primary categories of burnout symptoms:

• Exhaustion: Affected individuals have a lack of energy. They feel emotionally and physically exhausted. Pain and gastrointestinal or intestinal issues are examples of physical symptoms.
• Alienation from (work-related) activities: Burnout patients experience an increase in stress and frustration at work. They could become pessimistic about their coworkers and the environment they work in. Simultaneously, people could become more emotionally detached and begin to feel detached from their profession.
• Decreased performance: Daily responsibilities at work, home, or when taking care of family members are primarily impacted by burnout. Burnout affects a person’s attitude towards their work, makes it difficult for them to focus, makes them listless, and saps their creativity.

Classification of Burnout Syndrome According to ICD-11

Burnout syndrome is defined in the ICD-11 as a work-related phenomenon, not a medical condition. It is described as a result of chronic workplace stress that has not been successfully managed. Burnout is classified under section QD8 – “Problems associated with employment or unemployment” and is characterized by three dimensions:

• A feeling of exhaustion
• Increasing mental distance from work or feelings of negativity or cynicism toward one’s job
• Reduced professional effectiveness

Outside the work context, burnout syndrome is listed under category ICD 11: QF27 – “Difficulties or need for support in managing household and no other household member available to provide care.” Burnout in caregiving relatives is described as “caregiver burnout.”

Experiencing Burnout Syndrome

The experience of burnout can manifest differently in each individual, with severe exhaustion and/or various psychological and physical symptoms. Herbert Freudenberger emphasized that burnout can vary from person to person, making it impossible to define the phenomenon solely based on symptoms. This is why burnout is still not a recognized medical diagnosis or “disease” but rather a term that aptly reflects the situation and feelings of many people. These individuals experience mental or psychosomatic pressure from unmanageable or distressing work-related stress. As a result, the World Health Organization (WHO) lists burnout as an (undefined) additional code, but not as a formal diagnosis.

Burnout Syndrome: Causes

Burnout never has just one cause. The large number of people feeling burned out today reflects current work and societal conditions. Workplace stressors are often structured in a way that many people struggle to handle long-term. Pressure to perform, fear of job loss, emotional hurt, equating job success and income with self-worth, the need for flexibility, and the loss of social security and bonds—all these factors create a difficult environment. This list of burdens could easily be extended.

Still, some people manage well, even in tough situations, like teachers who retire with energy, while others feel burned out from the start. Burnout results from a perceived, ongoing mismatch between personal demands and abilities, like handling conflict and situational challenges. Some people burn out without obvious external pressure, while others find high demands stimulating and stay healthy. There are also jobs where vulnerable individuals feel supported and creative, while others face so much conflict and insecurity that even confident people risk burning out.

The hypothesis that only highly engaged individuals are affected has not been proven. Similarly, models that describe burnout as a process with 2 to 12 stages lack scientific support. These studies show that people differ in their patterns and strategies for coping with stress at work and in their personal lives. Some strategies are better than others. Without effort to improve stress management, coping methods remain relatively stable over time.

People who feel overwhelmed early in their careers are more likely to experience burnout years later.

Burnout Syndrome: Risk Factors

How you handle stress and yourself significantly impacts whether you burn out. Studies show that the following personality traits are linked to a higher risk of burnout:

• Perfectionism (“I must do everything perfectly, I can’t make mistakes, I’m responsible for everything, I must meet all expectations…”)

• Low self-efficacy (“I won’t make it, I don’t stand a chance…”)

• Strong need for harmony (“Everyone must be happy, I must not upset anyone…”)

• External locus of control (“I’m just a small cog in the machine, the ministry, my boss… control my life, I’m just a puppet…”)

Effects of Burnout Syndrome

The quality of life for those feeling burned out is drastically reduced. Depressed mood, various physical or emotional symptoms, reduced work performance, inner resignation, and growing conflicts can create a vicious cycle. Often, the individual cannot end this cycle by themselves.

Supportive and de-escalating measures at work may be necessary, along with psychotherapy. If no severe depression or other mental illness is present, sick leave may seem relieving at first, but it often worsens underlying work conflicts in the long run.

Treatment for Burnout Syndrome

Treatment of Burnout Syndrome encompasses various approaches with a multimodal therapy recommended. The prerequisites for burnout therapy involve recognizing and accepting the need for treatment. It also requires reducing stressors, incorporating relaxation and exercise, and adjusting personal needs according to the situation. This includes letting go of perfectionism and setting boundaries to protect yourself from excessive demands.

The goal is to improve the match between individual abilities, expectations, and external conditions. Commonly suggested burnout treatments, such as learning relaxation techniques, healthy lifestyle choices, reducing stress, reflecting on and adjusting personal expectations, and improving work-life balance, should be tailored to the individual’s situation. For work-related burnout, a causal approach would be to consider a change of position or employer.

Cognitive Behavioural Therapy (CBT)

CBT is frequently applied for burnout. Problematic personality traits are identified, and social skills, emotion regulation, and stress management are trained. Journals are often kept. The standard model works to shift the patient’s negative worldview and self-image so they can relearn specific behavioural patterns. Typically, 15 to 20 sessions over 3 to 4 months are planned.

Use of Medication

Symptomatic treatment may temporarily include various psychopharmaceuticals as adjunctive therapy. Antidepressants, sleep-inducing medications, and in rare cases, benzodiazepines are used. Medications typical for the specific physical symptoms are also applied. In case of pain, non-steroidal pain medications like ibuprofen or diclofenac can be used.

In cases of co-occurring mental disorders (usually depression or anxiety), the treatment follows standard therapeutic or medication-based methods.

Physiotherapy and Relaxation Techniques

Physiotherapy may include massages, Shiatsu, aromatherapy, therapeutic baths, hot mud packs, and moderate endurance training.

Diagnosis of Burnout

There is no diagnostic algorithm or clear criteria to diagnose burnout syndrome. Some authors use the Maslach Burnout Inventory (MBI). Burnout is often “diagnosed” based on the total scores of its three dimensions: “Emotional Exhaustion,” “Depersonalization,” and “Personal Accomplishment.” However, the MBI is not clinically validated.

Some psychiatrists identify burnout when unusual work demands result in stress symptoms that persist for weeks or months and don’t resolve with short recovery periods. Burnout can be seen as a risk state, from which conditions like depression, anxiety disorders, or tinnitus may develop.

Burnout Syndrome: Differentiation from Depression

A common mistake is misdiagnosing burnout with depression. Depression symptoms mainly include low mood, lack of motivation, and loss of interest or pleasure. These symptoms have various causes. Workplace problems may contribute, but other causes, according to the biopsychosocial model, include genetic factors, biological causes, loss experiences, trauma, stress, or conflict.

The feeling of burnout may only arise secondarily as a result of depression. Therefore, it is important to clarify individually what is a trigger and what is a consequence of the sense of overload.

Burnout is associated with three areas: emotional exhaustion, cynicism, detachment, depersonalization, and reduced work performance, though the symptoms are not uniform. This is also why burnout is still not a recognized medical diagnosis or “disease.” Instead, it is a term that clearly reflects the situation and feelings of many people experiencing psychological or psychosomatic stress due to unmanageable or distressing work-related pressures.

Similarities between burnout and depression

• Abrupt fatigue
• Lack of sleep
• I’m depressed
• Decreased output

Symptoms not appearing in burnout

• Low regard for oneself
• Despondency
• Suicidal thoughts

The feeling of overload—the sense of being burned out—can also appear as a secondary result of depression. It’s important to individually assess what the trigger and what the consequence of feeling overwhelmed is.

Differentiation from depression can be based on:

• Burnout can spontaneously resolve after reducing the stress level, while depression continues.
• Typical for Burnout are anxiety combined with anger, while in depression dominate symptoms of sadness and melancholy.
• Individuals with burnout usually overestimate their abilities, which leads to exhaustion. Depressed people don’t believe in themselves and underestimate their abilities.

Burnout Syndrome: Prevention

When it comes to optimizing personal strategies for dealing with work-related stress, prevention and treatment of burnout are quite similar. Besides appropriate relaxation and recovery measures, regular reflection on personal goals and values within the context of one’s professional situation and life (work-life balance) is recommended, possibly with therapeutic support. In social professions, participation in supervision and self-experience groups is important. Additionally, professional development and coaching may be helpful.

Burnout Syndrome. Summary

Burnout syndrome refers to a state of complete physical, emotional, and mental exhaustion with reduced performance ability.

The term burnout was introduced in 1974 by psychoanalyst Herbert Freudenberger in New York. He initially associated it with people in social professions, such as caregivers, who overextend themselves in their work without considering their limits and without engaging in pleasurable activities for themselves.

Burnout is not an independent illness but a risk situation that can lead to psychological or psychosomatic disorders. Possible consequences include depression, anxiety disorders, or physical issues like high blood pressure, heart problems, stomach issues, or headaches.

It is believed that highly motivated, idealistic, and perfectionistic personalities were especially at risk for exhaustion syndromes, particularly if they experienced repeated frustration.

Other perspectives attribute burnout primarily to external workplace stress factors, such as bullying, under- or overwork, or low appreciation and pay. Even when external factors are seen as the cause, individual responses to stress remain crucial.

The burnout therapy follows the multimodal concept, combining distinct methods such as mindfulness, healthy lifestyle choices, reducing stress, reflecting on and adjusting personal expectations, psychotherapy, and less frequent use of medication.