Burnout refers to a feeling or state of excessive tiredness caused by long-term stress. It may often occur due to working too hard and can negatively impact our mental and emotional wellbeing. When left untreated, this may adversely affect our personal and professional life.
What Is Burnout?
Burnout is a mental and emotional state that arises due to prolonged, unresolved frustration and stress in the workplace that has not been effectively managed. The condition consists of emotional exhaustion, depersonalization & reduced personal accomplishment. It negatively affects our motivation, enthusiasm and energy. Also known as Burnout syndrome, this can make the sufferer feel there is no meaning to their work or life and even cause depression. It often occurs due to high levels of occupational stress which leaves the person feeling empty, exhausted and inadequate. The syndrome can be associated with different physical and mental health symptoms as well. When left untreated, the condition can adversely affect the sufferer’s ability to function in everyday life.
It was classified as a type of non-medical life-management difficulty in the ICD-10 edition. In the 11th Revision of the International Classification of Diseases (ICD-11), burnout was categorized as a non-medical condition and an occupational phenomenon. The condition is often identified as a form of adjustment disorder 1, and in some cases as and Unspecified Trauma- and Stressor-Related Disorder. According to a research paper published in the International Encyclopedia of the Social & Behavioral Sciences, 2001, “Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job. It is defined by the three dimensions of exhaustion, cynicism, and inefficacy.” As the condition can affect personal, occupational and social functioning, it can decrease the quality of their relationships and work performance. According to the World Health Organization (WHO), burnout is characterized by 3 major elements:
- Feelings of exhaustion or energy depletion
- Feelings of negativism or mental distance from their job
- Decline in professional efficacy
Although not classified as a medical condition, the syndrome is classified as an occupational phenomenon in the 11th Revision of the International Classification of Diseases (ICD-11). It is regarded as a factor which is not categorized as a health condition or illness but may affect a person’s health and may make them reach out to healthcare professionals.
Understanding Burnout Syndrome
The term “burnout” was initially coined by the American psychologist Herbert Freudenberger in 1974. He used the term in his book ‘Burnout: The High Cost of High Achievement’ to explain the consequences of high stress levels and ideals associated with “helping” professions, such as doctors and nurses. At present, the term is used to describe anyone who feels listless, exhausted & unable to cope due to pressures of their job or even to explain the negative aspect of self-sacrifice. Anyone can be affected by the syndrome, from career-driven professionals, overworked employees, celebrities to stressed-out housewives. In fact, one study 2 found that parents in the United States, Canada, Switzerland, Belgium and Poland feel highly drained.
The syndrome is usually considered as a coping failure that can make a person feel they are unable to deal with the demands of life and work. Severe job-related stress can cause a “breakdown of the psychological defences” and make the person engage in different types of job withdrawal, such as absenteeism, thinking about leaving their job and resigning. In case the person affected by the condition continues to be burdened by chronic workplace stress, they will have lower effectiveness and productivity at work. It also results in a decreased commitment to their organization and lower job satisfaction. However, most experts do not agree on a clear-cut definition of burnout and how it should be diagnosed. A 2000 study 3 explains “According to the most common description at present, burnout syndrome is characterized by exhaustion, depersonalization and reduced satisfaction in performance.”
Moreover, it is also difficult to determine an accurate prevalence as most cases remain unreported. Although burnout is mostly caused by unresolved chronic stress, whether at work or overall lifestyle, the syndrome can also be triggered by certain mindsets, like pessimism & perfectionism, as well as the person’s personality traits.
Prevalence Of Burnout
According to a systematic review 4 of 182 studies across 45 countries, the prevalence of burnout is reported between 0%-80.5% in general, with 0%-86.2% for emotional exhaustion, 0%-89.9% for depersonalization and 0%-87.1% for low personal accomplishment. Research 5 reveals that 2.46% of people experience burnout in all three aspects of emotional exhaustion, depersonalization, and personal accomplishment. However, 24.83% of people experience high levels of emotional exhaustion, 6.21% are high on depersonalization and 33.99% have a high risk of personal accomplishment.
However, a 2018 study on the prevalence of burnout among people in “helping” professions, like physicians, states that “Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment.”
Stress And Burnout
Burnout is mainly caused by excessive and prolonged stress, however, stress and burnout are not the same. People experiencing stress can feel pressured but typically feel better when they manage their stress. People who are burned out feel mental exhaustion, are pessimistic and unable to improve their situation. Most people under stress are generally aware of their mental and emotional state, but people with burnout syndrome fail to identify the development of the condition.
Extreme work pressures, being permanently under-challenged or overworked, repeated conflicts with coworkers or a chronic stressful lifestyle can make someone empty, exhausted, burned out. Problems caused by stress can make the person ignore their own needs or avoid responsibilities altogether. Moreover, the stress of caring for an ill loved one can also lead to this condition. With appropriate support, one can improve their situation.
Burnout vs Depression
“Whether burnout is a form of depression or a distinct phenomenon is an object of controversy,” states a 2015 study 6. Burnout shares some similarities with depression. Depressed people have negative thoughts and emotions and may feel hopeless, and lose interest in things. However, unlike in burnout, depression affects all aspects of life not just work. Depression can also include physical and cognitive symptoms along with suicidal thoughts. According to a 2018 study 7, historically, “burnout has been difficult to separate from depression. Work-related risk factors for burnout are predictors of depression. Individual risk factors for depression are also predictors of burnout.” Although it is easy to confuse burnout syndrome with depression, both are different conditions. However, both the conditions have certain similar symptoms, such as:
- Unhappiness or feeling down
- Extreme exhaustion
- Decline in performance
A recent 2019 study 8 found that there is a significant association between burnout, anxiety and depression, however, these are different constructs even if they share some common features. The research authors state “Our findings revealed no conclusive overlap between burnout and depression and burnout and anxiety, indicating that they are different and robust constructs.” Although burnout symptoms like hopelessness, low self-esteem and suicidal ideation are common in people with depression as well, people with burnout aren’t necessarily depressed. However, this syndrome can increase a person’s chances of having depression.
Due to the similarity of most symptoms, some sufferers may get diagnosed with burnout, when in reality they are experiencing depression. Hence, a diagnosis should be made only after proper evaluation by a medical professional as it could result in an inaccurate diagnosis and wrong treatment otherwise.
Signs And Symptoms Of Burnout Syndrome
As burnout is a gradual process, the sufferer may not experience it specifically in the beginning as the signs and symptoms tend to be subtle at first. However, the symptoms may become increasingly intense and severe with time, especially when not addressed early. By paying attention to early warning signs and focusing on reducing stress, a major breakdown can be avoided.
Even though this syndrome is not considered a diagnosable mental condition, anyone suffering from burnout should seek immediate medical help. Some of the most common signs of this condition may include the following:
1. Alienation from work-related activities
People suffering from this syndrome tend to find their jobs highly frustrating, stressful, emotionally crippling and burdensome. They may develop a pessimistic and cynical attitude towards their work, work culture, office environment and their coworkers. The sufferer may also become increasingly mentally and emotionally distant and feel a sense of numbness regarding their work and workplace.
Chronic and long-term unresolved stress can lead to mental, emotional and physical exhaustion affecting their efficacy, productivity and general functioning. A recent scientific study explains “People affected feel drained and emotionally exhausted, unable to cope, tired and down, and don’t have enough energy. Physical symptoms include things like pain and gastrointestinal (stomach or bowel) problems.”
3. Reduced performance
This condition can significantly affect a person’s ability to cope with daily stressors and the demands of life. It can also affect their performance in important aspects of functioning like, education, career, relationships etc. The scientific study 9 adds “Burnout mainly affects everyday tasks at work, at home or when caring for family members. People with burnout are very negative about their tasks, find it hard to concentrate, are listless and lack creativity.”
Here are some additional physical, emotional and behavioral symptoms of burnout:
A. Physical symptoms
- Feeling extremely drained, tired and exhausted throughout the day
- Falling frequently sick or ill due to reduced immunity
- Sudden change in appetite
- Weight loss or weight gain
- Changes in sleeping patterns or habits or sleep disturbances like insomnia
- Frequent muscle pain or muscle tension
- General aches or headaches
- Gastrointestinal disorders
- Increased vulnerability to colds & flu
- Other health problems
B. Emotional symptoms
- Low mood
- Lack of creativity
- Loss of purpose
- Emotional numbness
- Being increasingly self-critical
- Having a strong pessimistic, negative and cynical outlook in life
- Low self-esteem and sense of self-worth
- Constant self-doubt and low confidence
- Hopelessness, helplessness and sense of failure
- Loss of motivation and enthusiasm
- Feeling empty, lost, defeated or trapped
- Emotional detachment or loneliness
- Low sense of personal accomplishment and satisfaction
- Interpersonal problems in personal and professional relationships
C. Behavioral symptoms
- Social withdrawal or isolation
- Avoidance of responsibilities
- Reduced performance and productivity
- Low commitment to work
- Listlessness, being slow or procrastinating
- Lack of concentration or focus and cognitive problems
- Higher tendency to make mistakes
- Intolerant attitudes towards others
- Anger outbursts or difficulty with emotional regulation
- Withdrawal from work, like absenteeism, being late etc
- Abusing food, alcohol, stimulants or substances, like drugs, to cope
- Lack of self-care
- Suicidal tendencies
Types Of Burnout
Although there may be some common signs of this syndrome, each and every person may experience it in their own unique way. According to research 10, burnout caused by chronic work-related stress can be categorized into 3 major types – frenetic, underchallenged and worn-out.
1. Frenetic burnout
The frenetic subtype is associated with over-involvement with work, especially those who work increasingly more to cope with frustration. When a person, driven by anxiety, invests excessive energy into work, their rewards tend to appear negatively disproportionate to their effort over time. However, when they work intensely by avoiding work/life balance to channel the greatest amount of their energy into work, burnout occurs. The researchers explain “The frenetic type can be seen as a category of subjects who are highly applied and committed to their work, and who are greatly characterized by the investment of an enormous amount of time and effort in his or her dedication to work.” This type type of sufferers share the following common traits:
- Involvement – Increasing effort to face work challenges
- Ambition – Need for achievements and external approval
- Rejection of failure – An inability to acknowledge own limitations
- Overload – Risking health & personal life for work
2. Underchallenged burnout
When an individual feels stuck in an unstimulating and monotonous work environment, engaged in a role which offers no job satisfaction, then they may experience this variant of burnout. This not only affects their performance, but lowers their mood as well. The underchallenged type involves people who have lost interest in their jobs, perform perfunctorily and find their role unchallenging. The researchers add “This is a group of subjects who cope with problems at work without too much involvement, seeing as they have lost their motivation along the way. In short, they are empty of challenges, motivation or desire for engagement.” The underchallenged type typically involves the following elements:
- Indifference – Performing work in a detached & superficial manner
- Lack of development – Dissatisfaction with unacknowledgement of their talents & performance in unchallenging tasks
- Contemplating another job – Pondering about the suitability of current employment & checking other job options
- Boredom – Perfunctory performance in routine & monotonous tasks
- Absence of overload-induced stress – Performing a job without much stress due to the absence of major demands
3. Worn-out burnout
A person may become worn-out when they surrender or drop out after experiencing intense and consistent stress in their work environment. This can also occur when their performance and effort offers negligible rewards. These people respond to stress and frustration by giving up. They are typically dispassionate individuals who have lowered their involvement and neglect or avoid their responsibilities. The authors of the research paper explain “These are workers with a degree of pessimism that has led them to lose all enthusiasm for their job, and have chosen to give up any effort in the face of the setbacks experienced.” This subtype may include the following elements:
- Neglect – Absence of personal involvement in tasks & responding to work-related challenges by giving up
- Lack of control – Strong feelings of desperation triggered by the absence of control over outcomes
- Lack of acknowledgement – Feeling effort, talents and dedication not being acknowledged
- Difficulties – Feeling oppressed & abused due to difficulties & lack of resources
- Depression – Presence of symptoms of depression
These different subtypes of burnout can help experts and therapists to develop specialized intervention strategies to help individuals suffering from each subtype.
Causes Of Burnout Syndrome
Burnout is mostly caused by work pressures, being overworked or being under-challenged and undervalued. “Burnout is the result of long-term, unresolvable work-related stress,” states a 2018 study 11. However, there can be many other factors contributing to the development of this syndrome, such as personality and lifestyle. Here are some of the most common contributing factors that can make someone burned out:
1. Job-related factors
- Having little or no control over work or decision making
- Overly demanding and ambiguous job expectations
- Engaged in unchallenging or monotonous work
- Working a high-pressure or chaotic environment
- Lack of recognition or reward for performing well
2. Personality factors
- Being a perfectionist
- The desperate need to control and micromanage tasks
- Having a high-achieving, Type A personality
- Having a pessimistic and negative attitude
3. Lifestyle factors
- Not socializing or spending enough time with friends and family
- Not having any personal or supportive relationships
- Being engaged with multiple responsibilities without any help
- Not getting adequate rest and relaxation
According to a recent 2020 scientific analysis 12, the following additional factors may also contribute to the onset of burnout:
- Increased working hours
- Increased screen time
- Lack of meaningful work
- A stronger focus on productivity
- Administrative or bureaucratic or work
- Lack of flexibility/work control
- Lack of cooperation, companionship or collegiality at work
- Lack of leadership support
- Lack of value alignment between the individual & organization
- Inability to accomplish work-life integration
Read more: Causes Of Burnout Syndrome
Diagnosis Of Burnout Syndrome
Although not considered as a medical diagnosis in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are some research-backed ways to diagnose the condition. The ICD‐10 outlines that to be diagnosed as burnout, the person must experience “a difficulty in life management characterized by vital exhaustion.” According to a 2016 study 13, vital exhaustion must include experiencing low energy, emotional instability, sleep difficulties, dizziness, irritability and trouble concentrating for at least two weeks. Moreover, such symptoms must also negatively affect the sufferer’s ability to perform their tasks, duties and responsibilities. “Researchers recommended that a burnout diagnosis should be connected with very negative scores on exhaustion accompanied by negative scores on one of the other two subscales (cynicism and inefficacy),” states the study. However, mental, emotional and physical exhaustion is considered as one of the single most important dimensions for diagnosing the syndrome.
A doctor may conduct certain tests and assessments to diagnose the condition in a person. Moreover, the person can also utilize various self-assessment questionnaires as well. Experts are continuously developing work-specific assessment systems. “But because there’s no generally accepted definition of burnout, it isn’t clear whether questionnaires can actually measure burnout and distinguish it from other illnesses,” explains a recent scientific review 9. Some of the most common assessment tools used for diagnosing burnout and job dissatisfaction include –
- The Maslach Burnout Inventory (MBI) 14
- The Job Diagnostic Scale (JDS)
- The Utrecht Work Engagement Scale (UWES)
The review adds “The most common questionnaire is the Maslach Burnout Inventory (MBI), which is available for different professional groups. But this questionnaire was originally developed for research purposes, not for use by doctors.” As symptoms of this syndrome can often be caused by other psychiatric or psychosomatic conditions, like chronic fatigue syndrome, anxiety disorders or depression, online questionnaires are not considered suitable for diagnosing symptoms of burnout. Hence, it is crucial to consult a doctor or a mental health professional for accurate diagnosis and treatment.
Consequences Of Burnout
The syndrome can have severe consequences, when left untreated. Not only can it make the sufferer feel exhausted and lose passion for work, it can seriously affect both their physical and mental health as well. With over 23%-54% of individuals 15 experiencing burnout, the syndrome can become a serious health issue, if treatment is not sought. According to a study 16, “Long term consequences of burnout can be mental problems such as depression or psychosomatic disorders. Affected employees are less productive and sick more often. They may even quit their jobs or need early retirement.”
Although the condition primarily affects professionals like physicians, nurses, teachers and social workers, it can affect anyone working a mundane, unchallenging and unrewarding job. “In order to prevent burnout, awareness of the problem must be promoted,” suggest the researchers. Here are some of the most common and severe consequences of burnout syndrome:
- Intense stress and anxiety
- Exhaustion and fatigue
- Insomnia or sleep disturbances
- Irritability, anger or sadness
- High blood pressure
- Heart disease
- Type 2 diabetes
- Vulnerability to diseases
- Alcohol & substance abuse
Treatment Of Burnout Syndrome
As it is not recognized as a medical or psychological condition, there is no specific treatment for this syndrome. However, according to a 2016 research paper 17, certain intervention strategies can help a sufferer deal with this condition. The researchers state “Some try to treat burnout after it has occurred, while others focus on how to prevent burnout by promoting engagement. Intervention may occur on the level of the individual, workgroup, or an entire organization.” Experts tend to believe that individual strategies tend to be more effective than organizational or social interventions.
Here are some treatment and prevention options available for burnout syndrome:
Psychotherapy strategies, such as cognitive‐behavioural training (CBT) 18 can significantly help in reducing job-related stress that often leads to this syndrome in the long run. CBT is a type of psychotherapeutic intervention that believes maladaptive cognitive factors lead to psychological distress and mental disorders. By using therapeutic strategies, therapists can improve these maladaptive cognitions to overcome problematic behaviors and emotional distress. According to a 2015 study 19, cognitive‐behavioral training (CBT), combined with mental and physical relaxation, can reduce stress symptoms. The study also found that changing work schedules can also help in relieving work-related stress. Another 2017 study 20 showed that CBT can greatly reduce work related stress and increase efficiency of individuals.
Research 21 also shows that cognitive group therapy (CGT) and focused psychodynamic group therapy (FGT) have also proven to be effective in relieving symptoms of work-related depression.
2. Physical and mental relaxation
Researchers from the 2015 study found that physical relaxation techniques, like massages or yoga, proved to be more effective than no intervention at all in relieving stress. Moreover taking additional breaks can also lead to stress reduction. Mental relaxation strategies, like deep breathing and meditation, were also found to lower stress over a period of six months. One 2014 study 22 has found that mindfulness meditation can significantly reduce stress and anxiety and improve mental health-related quality of life.
3. Organizational interventions
Interventions such as organisational support and care, changes in working conditions, changes in work schedules and improved communication skills can help a person in coping with burnout and improve their efficiency.
4. Coping strategies
The 2016 research paper outlines the following recommendations to prevent stress 23 and burnout –
- Modify your work patterns, such as work-life balance, taking enough breaks, avoiding working overtime
- Develop crucial coping skills, like time management, cognitive restructuring and conflict resolution
- Seek social support from family, friends and coworkers or healthcare professionals
- Use relaxation strategies like deep breathing, meditation, progressive muscle relaxation etc
- Follow a healthy lifestyle such as exercising regularly and eating a balanced diet
- Gain better self-awareness and self‐understanding with the help of therapy, counselling or self‐analytic techniques
“Initiatives to moderate workload demands complemented by improvements in recovery strategies through better sleep, exercise, and nutrition have direct relevance to the exhaustion component of burnout,” add researchers of the 2016 study. Apart from the strategies mentioned above, the following self-help strategies can also be helpful when dealing with burnout syndrome:
- Set aside sometime every day to tune out and stay away from technology, like your smartphone, laptop etc
- Develop problem-solving skills that can help you better deal with difficult situations
- Set strong personal boundaries to protect your mental and emotional well being
- Develop better communication with coworkers, friends and family and share your thoughts and feelings openly
- Set realistic goals, focus on the bigger picture and re-evaluate your priorities
- Develop a diverse and rich personal life by investing time in hobbies and things you are passionate about
- Plan and structure your day properly to maintain work-life balance
- Make self-care practices a priority
- Seek professional help if needed
How To Help Someone Feeling Burned Out
If a friend, family member or colleague is experiencing burnout, then you need to understand that the best thing you can do is provide emotional support. Here are a few ways you can help them:
- Educate yourself about this condition and work-related stress
- Listen to them without making any judgments or criticizing them
- Do not try to solve their problem, simply listen to them with your undivided attention
- Provide reassurance and validate their concerns and feelings
- Lend a helping hand and help them out with minor tasks and chores
- Be compassionate and empathetic. Show some kindness and gestures to appreciate their hard work
- Take them on a vacation
- Encourage them to seek professional help if needed
Recovery Is Possible
If you think you are stuck in an unchallenging, unrewarding or demanding job that is causing burnout syndrome, then start by pausing and taking a break from your busy schedule. Try to identify the signs and symptoms of the condition and seek professional treatment if you are having difficulty overcoming with it. With appropriate treatment and coping strategies, you can recover fully and live a healthier, more productive and stress-free life.References:
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Volume 7, Issue 1,