Burnout: Symptoms, Causes, and Ways to Overcome Burnout Syndrome

The term “burnout” first appeared in the 1970s. The German-American psychologist Herbert Freudenberger coined the term “staff burnout.” He used it to describe a condition he observed in people working in the social services.

In 1996, C. Maslach described the symptoms as follows:

• extreme exhaustion (“overwhelming exhaustion”),
• a cynical, detached attitude toward one’s job (“detachment”), and
• a feeling of being unable to make a difference or of having too little impact (“inefficacy”).

Since then, the description of the burnout phenomenon has expanded to include other occupational groups. Reports on burnout syndrome appear regularly in the media. Athletes such as Sven Hannawald and TV chef Tim Mälzer have spoken openly about experiencing burnout.

In the medical field, burnout syndrome is a subject of controversy. Some doctors and psychologists view the syndrome as a distinct disorder. Others see cases of burnout as meeting the criteria

• of depression,
• an adjustment disorder, or
• exhaustion syndrome

.

Currently, burnout is not recognized as a distinct mental disorder. In the World Health Organization’s (WHO) ICD-10 diagnostic classification, it is assigned to code Z.73, “Problems related to difficulties in coping with life.” It does not appear in Chapter V of the ICD-10, “Mental and Behavioral Disorders,” which covers mental illnesses. This has not changed in the new, completely revised ICD-11, which entered the pilot phase in 2018.

Modern therapeutic approaches are tailored to the individual needs of each patient. Therefore, those affected still receive appropriate treatment.

Burnout syndrome usually develops slowly and in stages. It typically begins with an excessive commitment to a cause and ends in complete exhaustion. The symptoms initially relate to the work environment. There is a high risk that they will spread to all areas of life.

People who are prone to burnout usually exhibit the following characteristics:

• very high expectations of themselves,
• a strong commitment to their work, and
• a tendency toward idealism.
• Sometimes, people also try to boost their low self-esteem through work.

Factors that increase the risk of burnout include

• unfavorable working conditions,
• high effort combined with low pay,
• significant responsibility with little control, and
• job insecurity.

There are two models that describe the development of burnout.

Freudenberger’s 12-phase model

1. Ambition and work effort: There is an excessive desire to prove oneself to others and to assert oneself.
2. Increased work effort: Because recognition and success are not achieved to the desired extent, work effort is intensified even further.
3. Denial of one’s own needs: To manage the workload, one’s own needs are suppressed. The imbalance is felt but also denied.
4. Suppression of conflicts: There is barely enough energy left to manage the work; conflicts are not addressed and resolved, but rather pushed aside.
5. Shift in priorities: Only work matters anymore. Family, friends, and former hobbies seem to have lost all value.
6. Denial of problems: Any problems are blamed on work and time pressure; the actual problems go unrecognized.
7. Social withdrawal: Relationships and conversations are avoided, and contact with others is kept to a minimum.
8. Behavioral changes: A lack of drive and motivation sets in.
9. Functional status: The sole focus is on simply functioning.
10. Inner emptiness: People with burnout feel empty and perceive their actions—and possibly their entire lives—as meaningless.
11. Hopelessness and depression: In this phase, the symptoms spread to all aspects of life. It is difficult to distinguish whether this is burnout or already depression.
12. Full-blown burnout syndrome: People are at the end of their rope and literally break down both physically and mentally.

Headaches and exhaustion are among the many symptoms of burnout © zinkevych | AdobeStock

Burisch’s 7-Phase Model

1. Chronic stress caused by excessive dedication to a task. The number of working hours increases, while hours spent sleeping and resting decrease. The nervous system reacts with initial signs of overstimulation, such as diarrhea, dizziness, sweating, and trembling.
2. Exhaustion (burnout), reduced commitment, and an increasingly negative attitude. The previously positive attitude toward the task turns negative. The person merely tries to keep up with the workload somehow. There is no longer any real interest or even joy in the work.
3. Development of depressive symptoms such as lack of drive and joy, and a depressed mood. In addition, there is a feeling of being constantly overwhelmed. Hopelessness and resignation set in.
4. Difficulties with concentration, attention, and thinking. These difficulties make it nearly impossible to continue managing tasks, leading to mistakes.
5. Neglect of social life and general disinterest. Interest in family and friends wanes. Activities are reduced to a minimum.
6. Tension headaches, sleep and eating disorders. Physical symptoms increase. Often, there are numerous visits to the doctor, during which no physical illnesses are usually found.
7. Despair and depression. Mood is persistently low, leading to rumination and questioning the meaning of life itself. Suicidal thoughts may occasionally arise.

Burnout syndrome usually develops over a prolonged period of time. A course lasting several years is entirely possible.

A diagnosis helps the patient because it gives a name to their symptoms. They then know that they are ill and can take active steps to address it. The doctor needs a diagnosis to initiate the appropriate treatment. At the same time, diagnoses play a central role for evaluators, for example, in cases of early retirement. For those affected, the most important thing to remember is this: A diagnosis is a medical term. For this reason, you should view the diagnosis as a guide for dealing with your symptoms. You do not have to identify with it.

Especially when it comes to mental illnesses, patients have long feared being labeled for life. This concern is unfounded. Mental disorders are—just like physical illnesses—an unpleasant but normal part of life. And just like most physical ailments, mental illnesses are highly treatable. Burnout is not yet classified as a distinct disorder. It overlaps with depression, chronic fatigue syndrome, and adjustment disorder. As such, burnout is not clearly defined.

Patients experiencing exhaustion typically consult their primary care physician first. They complain of

• sleep disturbances,
• fatigue, or
• malaise.

The general practitioner will refer the patient to specialists to rule out any physical causes for the symptoms. For example, an underactive thyroid can also lead to fatigue.

Burnout syndrome is usually diagnosed by a specialist in neurology, psychiatry, or psychosomatic medicine. Psychotherapists can also make the diagnosis. You can find a test on the website of the Technical University of Dresden. This test allows you to assess your personal risk of burnout: Click here for the self-test. Note: While the test helps you better assess your situation, it is not a substitute for a medical examination.

Various factors can contribute to the development of burnout syndrome:

• unrealistic expectations of oneself and one’s job, as well as
• difficult external circumstances.

People with excessively high standards set very ambitious goals for themselves. The risk of failure—and thus of experiencing disappointment—increases accordingly. At the same time, those affected tend to have a hard time coping with their mistakes or even failure. They want to be successful and well-liked.

However, monotony and a lack of mental stimulation can also lead to exhaustion. In the media, such examples are often referred to as “bore-out.”

Burnout syndrome can be effectively treated today. Whether outpatient therapy is sufficient depends on the individual case. In some cases, admission to a day clinic or inpatient facility is more helpful. In some cases, it can also be helpful to involve the employer in the process. Then, solutions can be sought together with the employer. Alternatively, employers and employees can reflect on the work situation through supervision or mediation. This allows them to manage the situation more consciously and influence it positively.

In any case, it is important to reduce stress. In some cases, the affected person should leave their stressful environment for a certain period of time. Strategies for better stress management help improve the acute condition. At the same time, these methods serve as relapse prevention. Here are a few examples:

• Mindfulness training: for example, MBSR (mindfulness-based stress reduction),
• Relaxation techniques: such as progressive muscle relaxation according to Jacobsen or autogenic training,
• Behavioral training: nonviolent communication.

In cases of severe sleep disturbances, it may be necessary to take measures to promote sleep. This may also involve the short-term use of medication.

The measures described are primarily aimed at alleviating symptoms. Through psychotherapy, those affected learn, among other things,

• to perceive and express their feelings more clearly,
• stand up to external pressure, and
• develop conflict and stress management strategies.

The goal of therapy is to change behaviors that have contributed to burnout and feeling overwhelmed.

Hobbies and maintaining social connections are an important part of burnout therapy © elnariz | AdobeStock

It is just as important to reflect on one’s priorities in life and to structure daily life accordingly. It can be helpful to reconnect with neglected relationships and hobbies. Exploring new areas of interest can also make life worth living again.

Self-Help: Behavioral Tips for Burnout

• Make sure to eat a balanced diet, get regular exercise, and get enough sleep.
• Schedule regular breaks to recharge.
• Make time for enjoyable activities.
• Try to reduce stress through relaxation techniques.
• Reevaluate your expectations of yourself.
• Set achievable goals and let go of unattainable ones.
• Reflect on your motivation and values.
• Make time for family and friends.

Those who know and respect their own needs are better protected against burnout. Ignoring personal boundaries increases the risk of burnout. Employers should ensure

• adequate compensation for work,
• sufficient feedback,
• transparency,
• time and space

. Clear, unambiguous structures foster a sense of calm. Employees know what is expected of them and who to turn to with specific questions.

For years, digital technology and global markets have been driving acceleration and, in some cases, rapid change. Against this backdrop, burnout prevention is of central importance. At the same time, it poses a particular challenge for companies and individual employees.

Prevention for Every Individual

• Are you pursuing a career that matches your abilities, or are you trying to prove something to yourself and others?
• How confident do you feel? Can you accept yourself as you are, or are you trying to compensate for a lack of self-confidence through your career?
• Do you set your goals too high and want to “make the world a better place” instead of just focusing on your own sphere of influence and doing your best there?
• Do you give your hobbies enough space and time?
• Is there a balance between work and leisure? And do you plan your free time so that it doesn’t become a source of stress as well?
• Do you know your needs and make sure they’re being met to a sufficient degree?
• Do you nurture your relationships and make enough time for family and friends?
• Do you know your stressors and have coping strategies in place?

Prevention in the Workplace

• Are employees assigned tasks that match their skills?
• Are the hierarchies and structures in the workplace clear? Does every employee know who has the authority to give instructions and from whom they can receive support?
• Are there regular team meetings where employees have a chance to speak?
• Do employees have enough time to complete their tasks?
• Is there a positive culture of feedback and error management within the company?
• Is there appropriate compensation for the work performed?
• Is there a point of contact in case of bullying?
• Are the workspaces set up in a way that makes employees feel comfortable?
• What about appreciation and recognition?

At the beginning of the 20th century, the writer Edmund von Hórvath observed that every era has “its own plague.” Alongside obesity, exhaustion in its various forms is one of the typical ailments of the modern world.

The good news: Never before have people had so much knowledge and so many resources at their disposal to combat illness. An optimistic yet realistic attitude toward burnout syndrome is appropriate and, at the same time, strengthens resilience.

What is burnout?

The term “burnout” describes a state of emotional and mental exhaustion caused by chronic, persistent stress. Burnout syndrome was first described by Herbert Freudenberger. Those affected often feel drained, overwhelmed, and increasingly lose their motivation and ability to perform. This condition occurs particularly frequently in social professions and in a demanding work environment.

What are the symptoms of burnout?

Typical symptoms of burnout include physical symptoms such as sleep disturbances, tinnitus, lack of energy, and physical discomfort. Additionally, feelings of depression, hopelessness, difficulty concentrating, and psychological distress may occur. The symptoms of burnout often develop gradually and are initially underestimated by many of those affected.

What is the difference between burnout and depression?

Burnout and depression share similar symptoms but differ in several ways. While burnout often begins with work-related overload and excessive demands, depression typically affects multiple areas of life. Nevertheless, untreated burnout syndrome can progress into depression. For this reason, burnout and depression should be carefully distinguished diagnostically.

How is burnout treated?

The treatment of burnout is based on several components. These include psychotherapy, psychotherapy-supported interventions, stress management, and changes in daily life. Depending on the severity, treatment can take place on an outpatient basis or as an inpatient at a clinic specializing in psychosomatics, psychiatry, or psychotherapy and neurology. The goal is to sustainably reduce the psychological and physical stress experienced by the patient.

How can burnout be prevented?

To prevent burnout, it is important to maintain social connections and not to consistently neglect one’s own needs. A healthy balance between work and rest, regular breaks, and effective stress management help prevent burnout. Especially when the first signs of burnout appear or when the workload increases, it is important to seek professional help early on from a primary care physician, psychotherapist, or specialized professionals.