Burnout syndrome: causes, symptoms, treatment

Overview

Burnout syndrome is a mental illness that has become increasingly important in recent years. However, unlike many other psychiatric disorders, the burnout syndrome does not yet have a single definition or diagnostic criteria. Accordingly, the burnout is instead made as an exclusion diagnosis, if no other cause can be found for existing physical and mental complaints.

Burnout syndrome is today considered to be a state of physical, mental and emotional exhaustion characterized by the following symptoms:

  • chronic fatigue
  • performance degradation
  • prolonged exhaustion
  • physical complaints such as insomnia, pain and tension states

Burnout or depression?

A burnout does not occur suddenly, but rather creeping over months or even years in response to a prolonged stress situation. This is in most cases professional, but can also come from the family or social environment.

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In order to diagnose a burnout syndrome, many other mental and physical illnesses that can cause similar symptoms must first be ruled out. These include depression and anxiety disorders, as well as hypothyroidism and fibromyalgia. Often, however, this is difficult, since in the course of many different physicians visited and various findings from various investigations must be brought together, which can delay a diagnosis considerably and further increase the suffering.

Varied therapeutic approaches

Treatment for burnout can be either outpatient or inpatient, and usually consists of a multimodal therapy program consisting of psychological individual and group discussions as well as ergo, physiotherapy and sociotherapy. Also sports, art and music therapy can be part of the treatment.

Overall, the therapy aims to recognize why it has come to a burnout and how to avoid another serious exhaustion. For this, the respective problem behavior must be recognized and changed. Furthermore, the therapy should be an aid in the learning of active relaxation procedures and leisure activities. Because these things are important to avoid burnout, but are often completely neglected in the development of the disease.

definition

Unlike many other psychiatric disorders, there is no consistent definition for burnout syndrome. One of the first definitions came from the American scientist Christina Maslach, who defined three main features of burnout syndrome. These must all exist at the same time and create considerable suffering:

  • Emotional fatigue: Emotional exhaustion is the feeling of being unable to cope with professional, family and / or social demands. Instead of energy and zest for action emptiness and discouragement, so that even simple abandonment can be done only with great difficulty.
  • Alienation from itself (Depersonalization): Depersonalization refers to a state in which the feeling of "standing next to oneself" prevails. Formerly important things lose their importance and are viewed with distance and a growing cynicism. The symptom can go so far that everything is perceived as a kind of veil and becomes increasingly meaningless.
  • Performance loss: Triggered by the emotional exhaustion and the constant experience of overworking, it comes to a limitation of performance. Successes become less common, goals and plans become less important. Doubt and search for meaning are at the forefront of intellectual activity and leave no room for everyday thoughts.

Also physical complaints belong to it

While the Maslach model initially understood burnout syndrome only as a state of mental exhaustion, later models also increasingly recognized physical symptoms as part of burnout. Thus, Ferdinand Jaggi's burnout syndrome is defined as a physical, emotional and mental exhaustion due to occupational overload.

This definition is currently extended to other areas outside the world of work, so that the burnout syndrome often described as "state of exhaustion after a previous process of high workload, stress and / or self-excessive" (Great Dictionary Psychology, Compact, 2007) becomes.

causes

The exact causes that can lead to the development of a burnout syndrome are not yet sufficiently clarified. However, it is assumed that the disease has a multifactorial genesis, that is to say it is the result of the interaction of different stress factors, an existing vulnerability and a genetic predisposition.

External load factors

Exposure factors, which may favor the onset of burnout, usually arise from the professional, social or family context and can be very different.

While in some cases, for example, the care of a seriously ill relative as the cause of the emergence of burnout comes into question, in other cases, occupational overload or excessive demand in the workplace jointly responsible for the disease. A typical combination is also a stressful working environment in the absence of recognition for the accomplished services.

Furthermore, the following occupational factors are often stated in connection with the burnout syndrome:

  • bad climate in the workplace
  • subliminal conflicts to bullying
  • Constant stress
  • hierarchical structures
  • Fear of job loss
  • temporary employment contracts

In some occupational groups these factors can be found significantly more frequently than in others. These include the profession of teacher, manager and doctor, as well as occupational groups such as social workers, nurses and geriatric nurses.

Most of these professions have one thing in common: they follow the goal of helping other people with great idealism and commitment. In doing so, they receive too little or even no recognition for often great achievements, neither idealistic nor financial.

Vulnerability: Everyone is ticking differently

In addition to the externally applied stress factors, personality patterns also play an important role in the development of burnout. Personality traits that increase "susceptibility" to a particular disease are summarized under the term vulnerability. Vulnerable to burnout are people who are not able to listen to their own needs, who can not easily switch off and rarely give up rest periods. Performance-orientedness and excessive perfectionism also seem to promote the onset of burnout syndrome.

Genetic factors

It is unclear which genes are involved in the development of the burnout syndrome. What is certain, however, is that people with a family history of burnout are more likely to get sick than those who have no first-degree relatives who suffer from the condition.

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Questions and answers about the causes

symptoms

The burnout syndrome can be characterized by a range of symptoms that are individually very different and different types. Based on the existing symptom constellation, a clear definition of the syndrome is not possible. Rather, a burnout is a combination of physical and psychological symptoms that occur over a longer period of time and are related to a stress situation.

It is typical that no organically detectable correlates can be found for physical complaints of the burnout syndrome. Rather, the cause of the physical symptoms is the psyche, which is why psychosomatic causes are also mentioned in this context.

When the psyche is overloaded

Classically, the following symptoms occur as part of the burnout syndrome:

  • pronounced states of exhaustion: Due to persistent tiredness and extreme exhaustion, everyday tasks can not or no longer be managed satisfactorily. As a result, the feeling of being overstrained continues to grow, which in turn contributes to an increasing exhaustion situation. Although more and more breaks must be taken, relaxation and recovery phases are less and less lasting. A vicious circle of less restful relaxation moments and constant overreaching experience arises.
  • Leistungsknick: Particularly in the professional, but also in the family environment, there is a decline in performance. Even simple tasks lead to excessive demands and do not succeed properly. This results in nervousness and concentration disorders, which in turn can lead to errors. Urgently necessary success experiences come less and less often, which leads to work even more, to be more efficient and to allow less and less rest breaks.
  • inner emptiness: Due to lack of success experiences and constant experience of surprises there is a growing joylessness and inner emptiness.Much of what used to be fun is perceived as exhausting and tormenting. Enthusiasm gives way to a cool cynicism and can eventually turn into hopelessness, self-doubt and despair.
  • Social withdrawal: As a result of the many negative everyday situations, there is often a social retreat, which gradually becomes tired in complete isolation.

The body is exhausted

In addition to the psychological symptoms, physical complaints often arise, for which, as a rule, no organic cause can be found. Especially common are:

  • sleep disorders
  • a headache
  • Nausea and vomiting
  • back pain
  • Dizziness and balance disorders
  • susceptibility to infection

Fatigue as the first harbinger

For a long time it was assumed that the burnout syndrome runs in different phases, which follow each other according to the law. Thus, a great idealism develops step by step to a depression-like state. Phases that occur between the beginning and end are physical and mental fatigue, reduced capacity, indifference and cynicism.

Scientifically, however, such a course could not be proven. However, the model helps to better understand the disease and will be briefly outlined below.

At the beginning of the burnout there are often mental and physical states of exhaustion, which manifest themselves in the form of chronic fatigue. The tiredness is a sign of the overload, which can not be reduced by sufficient sleep.

Especially professional commitment gives way to stagnation and emptiness after a short period of resistance. The work is increasingly seen as an annoying obligation that is difficult to meet. The own action of stagnation and resignation is perceived as an additional burden that can easily turn into aggression towards other people.

The facade is crumbling more and more

While at the beginning of the burnout syndrome the facade can still be maintained reasonably well, there are increasing numbers of sick leave and sick leave. The job is associated with more and more negative experiences and experiences, a return to everyday life before the illness seems impossible.

Often the distancing from work commitments is the first big incision the illness brings. However, it is often followed by isolation from the social and family environment.

In the phase of social withdrawal, physical complaints such as sleep disturbances, tensions and painful conditions also increasingly occur. Since these symptoms can be alleviated quickly and comparatively easily by medications such as painkillers or sleeping pills, the misuse of various substances and the harmful use of alcohol are not uncommon.

diagnosis

The diagnosis of burnout is even today an exclusion diagnosis and not always easy to make. Since in many cases at the beginning of the illness only single physical or mental complaints are in the focus, these are first comprehensively clarified. Especially for physical symptoms, an organic cause is often sought for a long time, which delays the diagnosis and can increase the suffering enormously.

Only when every possible organic disease was excluded for the existing complaints, the psyche comes as the cause of the complaints in question. Here, too, certain diseases that could explain existing complaints must first be ruled out before the suspicion of a burnout syndrome can be expressed.

Confusingly similar

The most important physical and mental illnesses that can cause symptoms similar to burnout include:

  • Depression: The three main symptoms of depression are lack of drive, loss of interest and joylessness. A differentiation from burnout is not always easy, since the two clinical pictures often occur together or merge into each other.
  • chronic fatigue syndrome: in the foreground of this disease is a lasting for at least six months tiredness, for which no physical or mental cause can be found. In contrast to the burnout syndrome, the chronic fatigue syndrome is not related to a current congestion situation.
  • Anxiety disorders: Due to specific or unspecific fears, anxiety disorders lead to a strong avoidance behavior of certain situations as well as to social withdrawal. In contrast to burnout, the anxiety disorder does not develop as a result of a stress situation. Anxiety-triggering situations are difficult to understand by outsiders.
  • Fibromyalgia (non-inflammatory muscle pain): The clinical picture of fibromyalgia is characterized by pain in changing locations, especially in the joints and the back.Chronic pain can lead to fatigue, insomnia and poor motor performance and can easily be confused with the burnout syndrome in full screen, which presents itself in a very similar way.
  • Hypothyroidism: In hypothyroidism symptoms include fatigue, lack of drive, depression and difficulty sleeping, coldness and loss of appetite. However, in contrast to the other diagnoses mentioned above, a hypothyroidism can be easily diagnosed by a blood test and treated well with medication.

treatment

For the treatment of burnout syndrome, there are various approaches that can take place either in the outpatient or in the inpatient setting.

Often, the first step of therapy is the most severe: states of exhaustion and physical ailments must be recognized as a result of overworking and thus as part of the condition and must not be further characterized as a burnout typical of personal failure. Once this step has been taken, many different treatment options can be taken to manage a burnout.

1. Outpatient therapy offers

There are various outpatient therapy methods that can be used to treat burnout. In addition to behavioral and depth psychological procedures, there are also systemic therapies, Gestalt and talk therapies and psychoanalysis. At present, however, only the behavioral therapy, depth psychology and psychoanalysis for the treatment of burnout are reimbursed by the statutory health insurance. All other procedures have to be paid by yourself.

Behavioral therapy: to change life concretely

Behavioral therapy aims to uncover and alter pathogenic behaviors. As part of a burnout syndrome, together with your treating psychotherapist you will first find the patterns that made you sick in the first place. Subsequently, solutions are to be developed, which help you, step by step, to approach small challenges again and to achieve small success experiences.

In addition, a very important part of behavior therapy is to consciously structure one's own life in such a way that work and leisure are always in balance. The content of the leisure time activities is also discussed, as many people with burnout syndrome have to realize that hobbies and free organization of one's own time have long since played a role and once triggered the feeling of helplessness.

Furthermore, active measures to deal with stress situations are learned, such as the delegation and prioritization of tasks. Failures in behavioral therapy are not uncommon at the beginning, but can be addressed and analyzed directly in the following sessions, so that a solution can be found for each situation.

Explain what lies behind: depth psychology and psychoanalysis

While behavioral therapy aims to analyze and restructure patterns of behavior, depth-psychological procedures and psychoanalysis reveal reasons for their behavior. These reasons may lie in the unconscious or even in childhood, so that in the context of these forms of therapy your entire biography is worked up in many individual sessions.

A particular focus is on identifying conflicts that you are having with yourself and the environment, where these conflicts are coming from and what can be done to resolve them. Depth psychological approaches can be far removed from the currently existing problems in the job or in the family, but always come back there. The goal is to strengthen your self-esteem and to stop defining yourself solely about what you do in the job.

2. Inpatient therapy offers

The advantage of inpatient therapy is that you are exclusively dedicated to your illness for a certain period of time and can completely ignore everyday life during this period. Since you do not come into contact with everyday tasks, you have plenty of time to learn relaxation, to concentrate on yourself and to experience phases of rest consciously and possibly also to enjoy.

psychosomatic medicine

As part of a psychosomatic treatment, apart from individual psychotherapeutic discussions, which usually focus on behavioral therapy, other therapy offers are also provided, such as occupational therapy, art, sports and group therapy. Furthermore, relaxation techniques are learned such as the progressive muscle relaxation according to Jacobson or autogenic training and the contact with the nursing staff and the fellow patients encouraged.

The therapies offered not only have the goal of promoting physical and mental regeneration, but also providing ideas on how to shape your free time in the future, what fun you can find, and what makes shutting down after a stressful day easier.

The stay in a psychosomatic clinic is usually a 3-6 weeks spa stay, which must be applied for on an outpatient basis and is limited to a certain period of time.

psychiatry

In severe cases, the burnout syndrome can lead to a nervous breakdown, which can manifest itself through crying, despair and even suicidal thoughts at worst.If your situation is so severe, visit the emergency department of a psychiatric hospital. In the case of strong despair and danger for self-endangering behavior, the latter is obligated to take you to hospital for emergency intervention, at least for a short time.

Even though today psychiatry still has many stigmata, it is nevertheless a place in which you can fully concentrate on yourself and learn to cope in everyday life.

As in psychosomatic clinics or spa stays, psychiatric clinics offer a wide range of treatment options. In addition to individual and group therapies, there are multimodal services such as physiotherapy, ergo and sociotherapies.

3. Drug treatment

Drug treatment is not part of any burnout therapy. It is particularly useful when you suffer from severe drive disorders and depression. In these cases, antidepressants are mainly used to lighten the mood and increase the drive. Some supplements also have a sleep-inducing effect, so they can improve your nighttime sleep.

Once started, antidepressants are usually prescribed over a period of half a year and can then slowly be discontinued, with a marked improvement in your condition. If you are receiving an antidepressant medication, you should also know that onset of action is only expected after 2 weeks and full effectiveness is only expected after 4-6 weeks. Changes to the medication and discontinuation plans should always be discussed with the attending physician.

More about this topic can be found here:
Questions and answers about the treatment

prevention

The best therapy for a burnout syndrome is its prevention. You can do a great deal yourself for a balanced work-life balance and thus minimize the risk of suffering a severe state of exhaustion. The following are the most important tips for a well-balanced life in which much can still be achieved and achieved:

  • Defining realistic goals: In order to minimize overstrain situations and avoid stressful situations, it helps to define goals that can be achieved in a certain amount of time without having overtime already planned. Communicate the times that you take into account for certain work and calculate generously. Everyone works differently fast. If you are one of the slower but more accurate people, accept it and do not put too much demands on yourself.
  • Minimize work interruptions: Try to avoid work interruptions such as phone calls or interim questions. If you are kept away from your actual work by calls, you will need a lot more time than if you call back all callers at the end of an operation.
  • Addressing overdue moments: If you feel overwhelmed with a requirement, you should address this in good time. Let us show you again what is required of you, and ask questions that will help you in the independent execution of the task and give security.
  • conscious breaks: Take conscious breaks. For example, avoid eating and drinking in front of the computer. Even if you only go out in the fresh air for 15 minutes, or have a coffee with a colleague for a short break, it's better than canceling any break from your day-to-day work.
  • Change work attitude: Try to reduce your perfectionism to a necessary level. With serenity you will achieve equally good results, perhaps with minimal extra time, but without sacrificing yourself and, in the worst case, even taking work home with you.
  • Say no: Learn to say no. Especially if work is not within your area of ​​responsibility or you feel overwhelmed by an upcoming activity, you refuse. Polite, but determined. If a project fails because other employees have failed to do their part, it is annoying - but not your personal responsibility.
  • Relax in a targeted manner: Relax after work. Again, a short window of 30-45 minutes is sufficient if you consciously use it for yourself. Go for a walk, listen to your favorite music or take a bath. Targeted relaxation helps to leave the workday behind and arrive after work.
  • healthy diet: Try to eat a balanced and fresh diet. Take time to prepare your own food and eat it consciously. If you do not have a company, read a thrilling book or newspaper, or watch a good series or documentary on radio or television.
  • sufficient sleep: Be sure to sleep well. As you sleep, you process and regenerate. Only sleep well you are over the time fully efficient and vital.
  • regular exercise: most occupational activities today are performed sitting down. In the long run, this can lead to dissatisfaction, as clumsiness and sluggishness are often side effects of constant sitting. Therefore, motivate yourself to sport.Whether you choose the gym, a sports class, or the outdoors for your exercise program, overcome and crank up your circulation!
  • maintain social contacts: Even if your professional or family situation is still so stressful, you continue to try to maintain important social contacts. Above all, people who are withdrawn and isolated from the environment tend to develop diseases such as depression and burnout. Social contacts help to cast one's own worries and problems, to find solutions and to steer the focus of thinking away from stressful situations.

Further advice can be found here:
Questions and answers on prevention

Author: Lisa Wunsch

sources

C. Maslach et al .: Job Burnout, In: An Annual Review of Psychology, 2001.

Dr. M. Nelting: BURNOUT - when the mask breaks down: how to recognize overloading and how to break new ground, Mosaik Verlag, 2010.

D. Korczak et. al: Differential Diagnosis of Burnout Syndrome, German Institute for Medical Documentation and Information (DIMDI).

Burnout syndrome, https://www.burn-out-syndrom.org, last accessed on 09.03.2018.