Burnout: immense fatigue induced by psychosocial stress

Burnout is a syndrome, not an officially recognized disease, that is caused by chronic stress at the workplace. How do you know when you have a burnout, and what is its link with stress? Important questions to answer, considering that absenteeism costs can to a large extent be attributed to burnout.

The definition of burnout

The World Health Organization has recognized the fact that chronic psychosocial stress at work leads to health problems, with burnout being one of them. However, burnout is not (yet) recognized as a medical condition. Rather, the WHO describes burnout as an “occupational phenomenon”, defined as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed”.

While it is laudable that the WHO shows interest in burnout, the classification of burnout as a phenomenon, exclusively found in exercising professional activities (i.e. work), may be a disappointment for the millions of people suffering from it worldwide. A recent survey from Indeed has shown that as many as 52% of employees in the study are feeling burned out, an increase of 9% in comparison with a survey before the COVID-19 pandemic has started.

The characteristics of burnout

It is in general not very difficult to recognize a burnout once the symptoms have well developed over time. This is one of the problems with burnout: you don’t realize that you are on your way to one, until it is already there. It is therefore important to know the symptoms of burnout, according to the WHO:

1. Feelings of energy depletion or exhaustion
2. Increased mental distance from your job, or having negative or cynical feelings about things related to your job
3. Reduced efficiency while doing your work

Practically speaking, you may experience the following when having burnout:

• Physical and mental exhaustion
• Concentration and memory problems
• Headaches or stomach aches or muscle aches
• Cynicism
• The feeling of having failed
• Sleep problems
• Brooding
• Being tense

Some research organizations analyze whether you have burnout according your responses to the following five statements:

• I feel emotionally exhausted by my work.
• At the end of a working day I feel empty.
• I feel tired when I get up in the morning and am confronted with my work.
• It takes a lot out of me to work with people all day.
• I feel completely exhausted by my work.

The response options here are: never, several times a year, monthly, several times a month, weekly, several times a week or every day. Those who experience all five items on average a few times per month for at least a few months may have burnout.

Burnout symptoms overlap with those of depression. Scientists are still looking for indicators in the body (unique biological features) that appear only in burnout, and not in depression.

The link between burnout and stress

A superficial view of stress and burnout quickly leads to the conclusion that the two are opposites. This is because acute, short-term stress results in enhanced activity and productivity. Energy levels go up to deal with the stressful event: a deadline, too high a workload, a nasty boss or bullying colleagues. Burnout is rather characterized by reduced activity and productivity and very low energy levels.

However, if your acute stress responses through the sympathetic nervous system and the hypothalamus-pituitary-adrenal axis have not helped you to solve your problems caused by stressful events, the stress becomes chronic. Initially, you will try to fight off your nasty boss and colleagues, but eventually you give up. The stress will then have taken its toll on your body. As stress consumes a lot of energy, at some point your energy reserves will be depleted. Even a good night’s sleep, if at all possible during stress, is not sufficient to revitalize you. You will feel more and more tired, up to a point when working is no longer possible.

There is a lot of scientific research on the activity of the brain in case of burnout as a result of work stress. The problem with this is that burnout can develop over years and that no direct connection can be made with certain stressful circumstances of a few years ago, before the burnout was diagnosed.

Nevertheless, there are indications that parts of the cortex show less activity during burnout. This explains why a person develops memory and concentration problems. A correlative relationship has also been found between the amount of stress a person experiences and the activity of the prefrontal cortex. Among other things, the prefrontal cortex controls stress responses and emotion.

Concentrations of the stress hormone cortisol are lower in burnout patients than in healthy individuals. As cortisol is the end product of the hypothalamus-pituitary-adrenal (HPA) axis, this suggests that this axis is no longer able to function properly. This means that when you have burnout, you can no longer evoke a good stress response when a new stressful event presents itself. This is problematic, because the HPA axis helps to deal with a stressful event. After all, acute stress is something good, as you can read here. For one, it makes energy resources from your body available to actively deal with the problem that stresses you out. When this doesn't work, your ability to cope with stress is reduced. Thus, on the one hand, people with burnout have almost no energy reserves left in the body, and on the other hand, they have too little cortisol to tap into this bit of energy when they need it to deal with a stressor.

This is what sets burnout apart from depression, another mental problem that is often caused by stress. In people with depression, cortisol levels in the blood are typically higher than in healthy persons. It is thought that depression is caused by an overactive HPA axis, and burnout by an HPA axis with blunted activity, reflecting exhaustion. Blood plasma cortisol levels may thus be a marker to differentiate between burnout and depression. This is currently being investigated further. If low cortisol can serve as a biological marker of burnout, and when still others will be found, the chances that WHO recognizes burnout as a medical condition (a disease) increase. If you have burnout, then this would make your position a lot stronger. You would then be diagnosed with a disease, so that you will be declared sick. This makes it easier to deal with your employer and your health insurance company.

Treatment of burnout

Treatment of burnout usually takes many months. This is why burnout is so costly to employers and health systems.

The first thing to do to get over burnout is to take a lot of rest. You will have to disconnect from your professional life. In addition, you will have to seek professional help from a psychologist or psychiatrist. Together with him or her, you will seek to identify the causes of the stress that led to burnout. These causes will have to be eliminated before you can return to work. If this is not possible, you may have to change your place of work once you feel sufficiently re-energized and recovered.

You also may have to examine your own behavior and change it where necessary. For example, you can learn to say "no" more often, be less of a perfectionist to meet your deadlines easier, how to deal with conflicts or bullying, or how to relax better. You can learn these and other stress management techniques in our course "Surmounting Stress", but it is also often necessary to ask for professional hep from a psychologist or a psychiatrist.