Burnout: Symptoms, Treatment, Prevention

Brief overview

  • Symptoms: Deep exhaustion, no possibility to “switch off”, psychosomatic complaints, feeling of lack of recognition, “duty by the book”, aloofness, cynicism, loss of performance, depression if necessary.
  • Treatment: Various methods, psychotherapy, behavioral therapy, body therapy, learning of relaxation techniques, if necessary medication against depression
  • Course of the disease and prognosis: Good chances of recovery with early treatment, permanent incapacity to work threatens if left untreated.
  • Causes: Self-exertion or stress due to external circumstances, perfectionism, self-confidence fed by performance and recognition, problems saying “no” or setting limits

What is burnout?

Burnout is a state of emotional and physical exhaustion. Burnout is not listed as a separate disease term in the catalog of international classifications for diagnoses (ICD-10). There, burnout is described with the code “problems related to difficulties in coping with life”.

Burnout is a risk factor for various mental and physical illnesses. The disorder is not infrequently accompanied by depression, but this does not necessarily have to be present.

Burnout can be found more frequently in people in helping, social professions. However, it also occurs in many people in other professions.

What are the symptoms of burnout?

However, the main symptom of burnout is a feeling of deep exhaustion.

Burnout symptoms in the early phase

In the early phase of burnout, the person affected usually puts an extreme amount of energy into his or her tasks. This sometimes happens voluntarily out of idealism or ambition, but sometimes also out of necessity – for example, due to multiple burdens, such as caring for relatives or fear of losing their job.

Other burnout symptoms in the early stages include:

  • Feeling of being indispensable
  • Feeling of never having enough time
  • Denial of own needs
  • Repression of failures and disappointments
  • Restricting social contacts to customers, patients, clients, etc.

Soon the first burnout signs of exhaustion become apparent. These include:

  • Restlessness
  • Lack of energy
  • Lack of sleep
  • Increased risk of accidents
  • Increased susceptibility to infections

2nd phase: Reduced engagement

Internal resignation: Those affected take longer breaks than usual, come to work late and leave too early. They increasingly enter a state of “inner resignation”. The strong reluctance to work leads them to do only what is necessary – if at all.

Effects on the family: Such signs of burnout often affect family life. Those affected make ever greater demands on their partner without giving anything back. They no longer have the strength or patience to spend time with their children.

Typical burnout symptoms in this phase are:

  • Dwindling idealism
  • Lowering of commitment
  • Feeling of lack of appreciation
  • Feeling of being exploited
  • Flourishing in leisure time
  • Decreasing ability to empathize with others
  • Emotional coldness and cynicism
  • Negative feelings towards colleagues, customers or superiors

3. emotional reactions – depression, aggression, blaming others

Burnout symptoms also manifest themselves in emotional reactions. As over-commitment slowly tips over into frustration, disillusionment often sets in. The persons realize that reality does not correspond to their own wishes.

Depressive symptoms of burnout are:

  • Feeling of powerlessness and helplessness
  • Feeling of inner emptiness
  • Crumbling self-esteem
  • Pessimism
  • Anxiety
  • Dejection
  • Listlessness

Aggressive symptoms of burnout are:

  • blaming others, colleagues, superiors or “the system
  • moodiness, irritability, impatience
  • Frequent conflicts with others, intolerance
  • Anger

4. degradation, diminishing efficiency

  • Dwindling creativity
  • Inability to cope with complex tasks
  • Problems making decisions
  • “Service by the book”
  • Undifferentiated black-and-white thinking
  • Rejection of change

On closer inspection, the last two burnout symptoms are also based on a decline in performance. This is because differentiated thinking and change require strength, but burnout sufferers are no longer able to muster it.

5. flattening, disinterest

6. psychosomatic reactions

The enormous psychological stress is also reflected in physical complaints. Such psychosomatic signs already appear in the initial phase of burnout. Physical symptoms include:

  • Sleep disturbances and nightmares
  • Muscle tension, back pain, headaches
  • Increased blood pressure, palpitations and chest tightness
  • Nausea and digestive problems (vomiting or diarrhea)
  • Sexual problems
  • Increased consumption of nicotine, alcohol or caffeine
  • Increased susceptibility to infection

7th and last stage: Despair

In the last burnout stage, the feeling of helplessness intensifies into a general hopelessness. Life seems meaningless in this stage, and suicidal thoughts emerge. Nothing gives pleasure anymore and everything becomes indifferent. Those affected sink into a severe burnout depression.

What is the treatment for burnout?

What to do against burnout?

Burnout therapy is made up of many different components that are individually tailored to the patient’s problems and personality. In addition to stress medicine and psychotherapeutic support, medication can help with burnout – especially if depressive symptoms appear.

Ways out of burnout – in the beginning there is insight into the illness

  • To what extent do I myself contribute to the difficult situation?
  • Where am I overstepping my boundaries?
  • Which environmental factors are involved?
  • Which ones can be changed, which ones can’t?

People with burnout who do not admit their own contribution to the situation do not succeed in getting to the root of the problem themselves. Talking to other burnout sufferers, for example in self-help groups or through experience reports, is helpful in finding ways out of burnout.

If the burnout process is still in its initial phase, a crisis intervention or a short-term therapy of a few hours is often sufficient as a first burnout help. The goal is to develop improved skills for conflict and problem solving and to gain a finer sense of the limits of one’s own resilience.

Relaxation techniques such as autogenic training or progressive muscle relaxation according to Jacobson are also sometimes helpful in supporting burnout treatment.

Stress medicine is a relatively new field within psychosomatics. With a holistic approach, it includes the personality, the individual environment and genetic aspects in the diagnosis and therapy. Stress-related hormonal changes are also examined with the help of laboratory values.

Stress medicine incorporates aspects of psychology, immunology, neurology and the hormonal system. Acupuncture (especially NADA ear acupuncture), which intervenes in the autonomic nervous system, also sometimes brings success.

Psychotherapy

Behavioral therapy

With the help of cognitive behavioral therapy, misconceptions and behavioral patterns that burnout patients have often internalized can be dissolved.

Depth psychological methods

For many burnout sufferers, the focus is on building a more stable sense of self-worth. As their self-esteem grows, their dependence on external recognition diminishes. It is often the secret motor behind the depletion of one’s own strengths.

Group therapy

Group therapy also provides important support for burnout, if necessary. For many patients, it is initially unfamiliar to share their own problems with a group of strangers. However, it usually has a relieving effect to exchange ideas with other sufferers.

Body therapy and sports

Physical activity also supports the recovery process, various studies show. It has a positive effect on how the body feels and on self-confidence.

Therapy offered in burnout clinics

The therapy plan is individually tailored to the patient. The inpatient setting enables patients to deal intensively with their problems, uncover causes and practice new behavioral and thought patterns. Patients also learn to manage their resources better in the long term.

Medication for burnout

Burnout prevention

Even for people who normally cope well with problems, there is a risk of burnout when they are under severe stress. The good news is that you are not helpless against this process. You can prevent “burnout” by using the following burnout prevention strategies:

Uncover basic needs: Burnout stems from frustration. Find tasks where your individual basic needs are satisfied. Creativity, for example, reputation, diverse social contact or exercise. Therefore, it is important for the choice of a job that you know exactly the daily routine in the desired profession.

Self-awareness: Burnout usually comes unnoticed. Regularly ask yourself how much stress you have and how satisfied you are with your life.

Social contacts: Social networking is an important factor in burnout prevention. Make time for your friends and family. Contact with people close to you provide you with the necessary balance to your working life.

Define clear life goals: Find out which goals are really important to you in life. In this way, you will use your energy in a targeted manner. Also try to say goodbye to ideas that others have instilled in you. This way, you won’t get bogged down in energy-sapping projects that ultimately don’t satisfy you.

Healthy lifestyle: A healthy lifestyle also helps prevent burnout. This includes a balanced diet, but above all regular sport and plenty of exercise – this helps to reduce stress. Limit the consumption of stimulants (for example, nicotine, caffeine) or stimulants (for example, alcohol, sugar). This will not only make you feel fitter, but you are more likely to avoid pushing yourself beyond personal limits.

Prevent burnout – what to do at work?

Since burnout syndrome often develops together with dissatisfaction at work, it is important to apply the above strategies at work as well. The following points will help you prevent burnout and improve the work climate:

Aim for autonomy: People who flexibly schedule their tasks and work time are far less at risk for burnout. Try to negotiate a working time model with your employer that is as flexible as possible.

Saying no: The ability to refuse a task is an important prophylaxis against burnout. Otherwise you will quickly take on too much. This applies to tasks that are assigned to you from outside, but also to those that you have imposed on yourself.

Life and work in balance: The term “work-life balance” – the equilibrium between work and leisure – includes an essential human basic need. Those who fail to allow themselves adequate time off are more likely to fall into the burnout trap.

To prevent burnout, coaches who specialize in burnout can also help you implement strategies at work.

What is the prognosis and what are the late effects of burnout?

The study also showed an increase in the average time lost due to burnout: while in 2005 burnout diagnoses accounted for 13.9 days of incapacity to work out of 1,000 members, in 2019 the figure was 129.9 days lost due to illness.

However, it is not possible to make a blanket statement about how long one is ill due to burnout. As a rule, the earlier treatment is received, the shorter the period of absence.

However, the people concerned invest more energy in their tasks than they can cope with in the long term. This sometimes has its origins in idealism, but sometimes also arises from distress.

A frequent warning signal is that those affected can no longer switch off after work and that there is no longer any sense of recovery. In this phase, however, the threat of burnout is rarely recognized.

Exhaustion, irritation and frustration then follow the (self-)excessive demands. The enormous mental strain does not leave its mark on the body. This is why psychosomatic complaints, such as headaches, stomach aches or sleep disorders, are signs of a burnout syndrome.

The same applies to burnout as to many other diseases and disorders: The earlier the problem is recognized and addressed, the better it can be remedied.

Threat of disability

Partial or even total disability as a result of burnout is not uncommon. Therefore, an impending burnout should be taken seriously and treated quickly.

Burnout: What are the known causes?

The causes of burnout are manifold. Internal (personality) and external factors (environment) are always involved in the development of the burnout syndrome.

Who does burnout affect?

The disease was first described in volunteers and people working in the healing and nursing professions. People who work in these professions often bring a high degree of idealism to the table, exerting themselves beyond their physical and emotional limits without receiving much recognition in return.

A question of resilience

Others cope well even with very difficult situations. But there are also situations that are objectively so stressful and hopeless that few people survive them without burning out. Experts also refer to the latter as “ware out”, “attrition” or “passive burnout”.

Causes of burnout

The causes of burnout are as individually different as the people affected themselves. Each person’s needs and goals are unique in their particular constellation. The environment in which they live is just as different.

Risk factors for burnout

Basically, there seem to be two types of people who have an increased risk of burnout:

  1. Likewise, among burnout candidates one finds dynamic, very determined people who want to achieve a high goal with a lot of ambition, idealism and commitment.

These two types are very opposite and yet have things in common. Both types have difficulties in expressing their feelings and a strong desire for recognition by their environment.

Internal risk factors for burnout are also:

  • Doubts about the sense of one’s own actions
  • Unrealistically high goals that cannot be achieved or can only be achieved with a disproportionate amount of energy.
  • Goals that do not meet one’s own needs, but rather the expectations of others
  • High expectations of the reward that follows the achievement of a particular goal
  • Difficulty admitting personal weakness and helplessness

External causes that increase the risk of burnout

Many burnout processes start when the life situation changes fundamentally. That is for example the beginning of studies, career start, job change or a new superior. In such burnout phases, one’s own self-image is sometimes severely shaken, expectations are disappointed or even life goals are destroyed.

External factors that increase the risk of burnout are:

  • Work overload
  • Lack of control
  • Lack of autonomy
  • Lack of recognition
  • Lack of justice
  • Insufficient rewards
  • Bureaucratic obstacles
  • Conflict between own values and beliefs and requirements
  • Lack of social support in private life
  • Unresolved conflicts with superiors or co-workers

How does the doctor diagnose “burnout”?

Possible questions to ask when burnout is suspected include:

  • Do you feel like you never get any rest?
  • Do you feel like there are many tasks that only you can do?
  • Have you been working more than usual lately?
  • Do you sleep well at night?
  • Do you often feel a sense of fatigue during the day?
  • Do you feel valued at your job?
  • Do you feel like you are being exploited?
  • Do you feel listless?
  • Do you have any other physical complaints?

Which doctor is the right contact for burnout?

However, if the suspicion of burnout is confirmed, the family doctor will refer you to a specialist. In this case, this is a psychological or medical psychotherapist.

Burnout tests

The psychotherapist will use questions in a clinical interview to clarify whether your symptoms actually point to a burnout syndrome.

Maslach Burnout Inventory (MBI)

  • Professional emotional exhaustion
  • Depersonalization/cynicism (impersonal/cynical attitude toward clients, colleagues, and supervisors)
  • Personal fulfillment/performance satisfaction

Typical statements include, “I feel emotionally exhausted by my work,” “I have become more indifferent to people since doing this work,” “I feel like I am at my wit’s end.”

Tedium Measure (Burnout Measure)

The Tedium Measure, also known as the Burnout Measure, consists of 21 questions. On a scale of one to seven, those affected indicate the extent to which each question applies to them (1= never applies; 7 = always applies).

Burnout tests on the Internet

Numerous free burnout tests can be found on the Internet. However, such a burnout self-test never replaces a medical or psychological diagnosis. However, the online check may help to become aware of one’s own level of stress and work frustration.

If there are indications of burnout, it is advisable to consult a doctor or psychologist.

Differential diagnosis burnout

The symptoms of burnout overlap with those of other disorders, for example chronic fatigue syndrome (fatigue). Above all, however, there are overlaps with depression, which makes the diagnosis more difficult.

Burnout or depression?

Some experts even doubt in principle that burnout is an independent disease. They assume that people with this illness are basically suffering from depression.

Many of the symptoms of burnout, especially deep emotional exhaustion, are in fact also characteristic of depression. Signs such as loss of interest and motivation are also equally characteristics of depression.

Some experts also see burnout as a risk factor for mental health problems rather than a disease in its own right. Others describe the illness as a process that, if not stopped, leads to exhaustion depression. Thus, the line between burnout and depression remains blurred.

Self-help

Some people with burnout find support and exchange of experiences in self-help groups, for example here:

  • National Contact and Information Center for the Initiation and Support of Self-Help Groups (NAKOS): https://www.nakos.de