burnout

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Burnout describes a state of deep emotional, physical and mental exhaustion. Those affected have difficulty concentrating and make a lot of mistakes. Some also lose the energy for their private life. Burnout is mostly attributed to excessive demands and stress at work. The causes are diverse, however. You can find out here how to recognize burnout, how to protect yourself and how to overcome burnout.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. Z73

Burnout is often announced by early warning signs. If you pay attention to your needs and allow yourself enough relaxation, you can take countermeasures in good time.

Marian Grosser, doctor

Burnout: Brief overview

Symptoms: deep exhaustion, no possibility of "switching off", psychosomatic complaints, feeling of lack of recognition, "following the rules", aloofness, cynicism, loss of performance, finally depression
Causes: Overstrained oneself or stress from external circumstances, perfectionism, self-confidence that feeds on performance, problems with saying “no”, strong desire for recognition
Prevention: Perceiving your own needs, stress management, reducing perfectionism, defining and pursuing clear personal goals, building good self-acceptance, social contacts, healthy lifestyle
Diagnostics: by means of special questionnaires, differentiation from fatigue and depression
Therapy: crisis intervention, cognitive behavioral therapy, psychotherapy based on depth psychology, group therapy, possibly antidepressants
Prognosis: good chances of recovery with early treatment; if left untreated, there is a risk of permanent incapacity for work

Burnout: symptoms

Burnout symptoms are very diverse. They express themselves emotionally, psychologically and in mental performance, but can also occur in the form of psychosomatic complaints. Each affected person shows an individual pattern of symptoms and complaints. These change depending on the phase of the disease. However, the main symptom of burnout is a feeling of deep exhaustion.

Burnout symptoms in the initial stages

In the early phase of burnout, the person affected usually puts a lot of energy into their tasks. This can happen voluntarily out of idealism or ambition, but it can also be born out of necessity - for example, due to multiple burdens, relatives requiring care or fear of losing a job.

A characteristic early sign of burnout is when people can no longer switch off.You can no longer recover properly, are less productive and then have to use even more strength to cope with your tasks. This starts a vicious circle. Other symptoms of burnout in the initial phase include:

Feeling indispensable
Feeling of never having enough time
Denial of own needs
Suppression of failures and disappointments
Restriction of social contacts to customers, patients, clients, etc.

Soon the first signs of burnout become noticeable. This includes:

restlessness
Lack of energy
lack of sleep
increased risk of accidents
increased susceptibility to infection

2nd phase: Reduced engagement

The over-commitment that is typical for the entry-level phase will at some point increasingly turn into a demanding attitude. Those affected expect that something will be given back to them for their great dedication. If they are disappointed, they slide into severe frustration. The following symptoms will help you to recognize an impending burnout:

Internal dismissal: those affected take longer breaks than usual, come to work late and leave too early. You are increasingly entering a state of "inner resignation". The strong reluctance to work means that they - if at all - only do what is absolutely necessary.

Depersonalization and cynicism: A "depersonalization" of relationships is a typical symptom of burnout, especially in helping professions. The ability to empathize with others (empathy) decreases. Emotional coldness and cynicism spread in dealings. Nursing staff then severely devalue their patients, for example.

Family Impact: Such signs of burnout often have an impact on family life as well. Those affected place increasing 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
Shutdown the engagement
Feeling of lack of appreciation
Feeling of being exploited
Blooming in your free time
increasing distancing from clients, patients, business partners
decreasing ability to empathize with others
emotional coldness and cynicism
negative feelings towards colleagues, customers or superiors

3. Emotional reactions - depression, aggression, finger pointing

Burnout symptoms are also expressed in emotional reactions. When the excessive commitment slowly turns into frustration, disillusionment often spreads. People realize that reality is not what they want. You blame either the environment or yourself. The former is more likely to lead to aggression. The latter contributes to a depressed mood (“I'm a failure!”).

Depressive symptoms of burnout are:

Feeling powerless and helpless
Feeling of inner emptiness
crumbling self-esteem
pessimism
Anxiety
Dejection
Listlessness

Aggressive symptoms of burnout are:

Assignment of blame to the outside world, to colleagues, superiors or "the system"
Moodiness, irritability, impatience
frequent conflicts with others, intolerance
anger

4. Degradation, dwindling efficiency

The declining motivation and the strong emotional stress are reflected in poorer performance after a while. Those affected are more likely to make careless mistakes or forget appointments. Other signs of cognitive decline are:

dwindling creativity
Inability to handle complex tasks
Problems making decisions
"Call of duty"
undifferentiated black and white thinking
Rejecting Change

On closer inspection, the last two burnout symptoms are also based on declining performance. Because differentiated thinking and changes require strength that burnout candidates can no longer muster.

5. Flattening, disinterest

The lack of energy also leads to an emotional withdrawal. Those affected react increasingly indifferently. They often feel bored, give up hobbies, withdraw from friends and family. Burnout makes you lonely.

6. Psychosomatic reactions

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

Sleep disorders and nightmares
Muscle tension, back pain, headache
increased blood pressure, palpitations and tightness in the chest
Nausea and indigestion (vomiting or diarrhea)
sexual problems
severe weight gain or loss due to changes in eating habits
increased consumption of nicotine, alcohol or caffeine
increased susceptibility to infection

7. Final stage: despair

In the last burnout stage, the feeling of helplessness increases to a general hopelessness. Life seems pointless in this phase and thoughts of suicide arise. Then nothing brings more joy and everything becomes indifferent. Those affected sink into a severe burnout depression.

The 7 burnout phases according to Prof. Burisch

The phase model according to Prof. Matthias Burisch: Not everyone affected experiences each of these phases.

Burnout causes and risk factors

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 term burnout comes from English and stands for "burned out, total exhaustion". Such a state can affect anyone. The widespread use is typical of burnout. Teachers suffer as well as managers, nurses and single parents. But pensioners, people who do not have a job and housewives can also empty their energy batteries.

The disease was first described in the case of voluntary helpers and people who work in the healing and nursing professions. Often people work in these professions who have a high degree of idealism, who exert themselves beyond their physical and emotional limits without receiving much recognition.

A question of resilience

Everyone reacts differently to stress. Some are barely able to cope with moderate pressure. For them, little is enough to set the fatal burnout spiral in motion.

Others cope well even with very difficult situations. But there are also situations that are objectively so stressful and hopeless that only a few people survive them without being burned out. Experts also refer to the latter as "goods out", "attrition" or "passive burnout".

Even very resilient people are therefore not protected from burnout. One is particularly at risk when a number of frustrating episodes occur and the resources to deal with them are exhausted.

Burnout: "Listen to those affected!"

Three questions for

Dr. med. Robert Doerr,
Specialist in psychiatry, psychotherapy
1
When does stress become unhealthy?

Dr. med. Robert Doerr
Short-term stress is a normal physical reaction, has a performance-enhancing effect and helps to cope well with challenging situations. If, on the other hand, stress persists over a longer period of time, the body lacks the urgently needed recovery phases. He's on constant alert. That can make you sick. Take care of yourself and try to make small changes in everyday life that will reduce stress.
2
Can everyone get burnout?

Dr. med. Robert Doerr
In principle, it can affect anyone, regardless of whether they are managers, teachers or salespeople. Yet everyone reacts differently to stress. Burnout often occurs when a life situation changes fundamentally. In particular, people with a high motivation to achieve, a lot of commitment and pronounced ambition are at risk. But also those who are very self-critical or insecure or who are difficult to say “no”.
3
How can I, as a relative, support those affected?

Dr. med. Robert Doerr
Show interest and readiness for an open conversation - listen! Affected people often withdraw from their surroundings for fear of being a burden or not being understood. Do not apply pressure. At the same time, it is important not to lose all things from patients. A daily structure or simple tasks that you can still manage yourself are important positive reinforcers.
Dr. med. Robert Doerr,
Specialist in psychiatry, psychotherapy
Dr. med. Robert Doerr is chief physician at the Schön Klinik Berchtesgadener Land in the field of psychosomatic medicine.

Causes of Burnout

The causes of burnout are as individual as those affected themselves. The needs and goals of each person 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:

People with low self-esteem who are, as a result, over-sensitive, more adapted and passive and especially in need of love.
Likewise, among the burnout candidates one often 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 something in common. Both types have difficulty expressing their feelings and a strong desire to be recognized by those around them.

Internal risk factors for burnout are also:

Dependence of self-image on the successful performance of a single role (e.g. the self-sacrificing nurse, the successful manager)
Doubts about the meaning of one's own actions
unrealistically ambitious goals that cannot be achieved or can only be achieved with disproportionate use of energy
Goals that do not meet your own needs, but the expectations of others.
high expectations of the reward that follows the achievement of a certain goal
Difficulty admitting personal weakness and helplessness
Difficulty saying "no" - either to others or to your own "inner driver" who spurs ambitious people to perfection and top performance

External causes that increase the risk of burnout

Many burnout processes start when the life situation changes fundamentally. This can be the beginning of your studies, a career start, a change of job or a new supervisor. In such burnout phases, one's own self-image is sometimes severely shaken, expectations are disappointed or even life goals are destroyed.

Conversely, the lack of a hoped-for change can also contribute to frustration and burnout, for example if the longed-for job is given to another applicant or if the promotion fails to materialize.

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 one's own values and beliefs and the requirements
lack of social support in private life
unresolved conflicts with superiors or employees

Factors that can lead to burnout

There are numerous factors that can trigger burnout.

Burnout: prevention

Even people who are usually good at coping with problems can develop burnout when they are under a lot of stress. The good news is that you are not at the mercy of this process and can contribute to burnout prevention yourself. The following strategies can help you:

Perceiving your own needs: Try to perceive your wishes and needs. What is really important to you? Social recognition, opportunities for advancement, freedom in structuring work processes or opportunities to influence? Admit to yourself that your needs are as important as those of those around you.

Uncover basic needs: Burnout arises out of frustration. Find tasks that meet your individual basic needs. Creativity, for example, reputation, diverse social contact or movement, for example. When choosing a job, it is therefore important that you have a thorough understanding of everyday life in the job you are aiming for.

Stress management and relaxation: Stress is a burnout driver. Take active countermeasures! Stress management and relaxation techniques such as autogenic training or progressive muscle relaxation are helpful for burnout prophylaxis.

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

Stress diary: A stress diary helps to uncover in which situations and contexts stress occurs and whether it is continuously increasing. If you don't just want to rely on your self-perception, you can also ask friends and family for help. They might reflect right back to you if you seem more irritable or less motivated than usual.

Social contacts: The social network is an important factor in burnout prevention. Make time for your friends and family. The contact with people close to you offers you the necessary balance to your working life.

Disempower internal drivers: People who are prone to burnout have internal drivers that whip them into excessive demands. These can be maxims like "Be perfect!" Or "Do it all right!". Only those who know their personal inner drivers can disempower them. Realize that no one can always be perfect and that mistakes are a part of life.

Define clear goals in life: Find out which goals are really important to you in life. So you can use your energy in a targeted manner. Also, try to get rid of ideas that others have instilled in you. This is the only way to avoid getting bogged down in exhausting projects that ultimately do not satisfy you.

Strengthening self-acceptance: People who predominantly draw their self-confidence from a role in their work or private life are particularly susceptible to burnout: the perfect mother or the successful manager. People with a strong self-acceptance also have a self-confidence that is independent of success. This reduces the risk of over-commitment and the feeling of being exploited.

Healthy lifestyle: A healthy lifestyle can also prevent burnout. This includes a balanced diet, but above all regular exercise and plenty of exercise - this helps reduce stress. Limit the consumption of stimulants (e.g. nicotine, caffeine) or luxury foods (e.g. alcohol, sugar). This not only makes you feel fitter, but you may also go less beyond your personal limits without the chemical drivers.

Seeking help: It is often not so easy to put good resolutions into practice. If you notice an increased stress level or typical symptoms of burnout over a longer period of time, you should definitely consult a doctor, psychotherapist or psychiatrist. The earlier burnout is recognized, the better the chances of recovery.

Preventing Burnout - What You Can Do at Work

Since burnout syndrome often arises from dissatisfaction at work, it is important to apply the above strategies at work as well. The following points can help you prevent burnout and improve the working atmosphere:

Strive for autonomy: Those who can flexibly organize their tasks and working hours are far less at risk of burnout. Try to negotiate as flexible a working time model as possible with your employer.

Time management: If you don't want to get bogged down in a demanding job, you should acquire strategies for correct time management.

Saying no: The ability to turn down a given task is an important prophylactic against burnout. Otherwise you will quickly become too much on yourself. This applies to tasks that are brought to you from outside, but also to those that you have imposed on yourself.

Reduce unrealistic expectations: Anyone who hopes for an unrealistic amount of recognition and personal satisfaction from their tasks will be disappointed. This applies to the nurse, who expects his patients to be grateful, as well as to the secretary, who takes on unpopular errands and hopes for praise and recognition.

Living and working in balance: The term "work-life balance" - the balance between work and leisure - includes an essential basic human need. Those who do not manage to allow themselves adequate freedom and time out are very likely to fall into the burnout trap.

Career planning: Even the most beautiful job can lead to monotonous boredom after years. If you have a career goal in mind, you run less risk of getting stuck in everyday life. Further training is also a good method for burnout prevention and to find inspiration for everyday professional life.

To prevent burnout, you can also turn to coaches who specialize in burnout, who will help you implement strategies in your work.

When the first symptoms such as persistent tiredness, exhaustion or sleep disorders appear, those affected usually first consult their family doctor.In an anamnesis interview, he will ask the patient about his complaints and particular burdens. The family doctor could ask the following questions if burnout is suspected:

Do you feel like you are never resting?
Do you feel that there are many tasks that only you can do?
Have you been working harder than usual lately?
Can you sleep well at night?
Do you often feel tired 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?

Through further examinations, the doctor can rule out a physical cause of the symptoms. Inexplicable tiredness and exhaustion can also indicate a malfunction of the thyroid gland or another serious physical illness, for example. This can be determined, among other things, in the context of a blood test.

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

In a clinical interview, the psychotherapist will answer questions as to whether your symptoms actually point to a burnout syndrome.

Maslach Burnout Inventory (MBI)

The burnout test most frequently used by experts is the Maslach Burnout Inventory (MBI). It measures burnout using 22 questions on the three scales:

emotional exhaustion
Depersonalization / cynicism (impersonal / cynical attitude towards clients, colleagues and superiors)
personal fulfillment / satisfaction with performance

Typical statements are, for example: "I feel emotionally exhausted from my work", "I have become more numb towards people since I did this job"; "I have the feeling that I am at the end of my wisdom".

However, some burnout symptoms are not taken into account in this burnout test. For example, the initially extremely high level of commitment that gradually flattens into complete disinterest.

Tedium Measure (Burnout Measure)

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

In this questionnaire, physical (“Are you physically exhausted?”), Emotional (“Are you emotionally exhausted?”) And mental exhaustion (“Do you feel exhausted?”) Are asked. In contrast to the MBI, depersonalization and performance satisfaction do not play a role in this burnout test.

Burnout tests on the internet

Numerous free burnout tests can be found on the Internet. However, such a burnout self-test can never replace medical or psychological diagnostics. However, the online check can help you to become aware of your own stress level and personal frustration at work. If there are indications of burnout, you should consult a doctor or psychologist.

Differential diagnosis of burnout

Although the term “burnout” appears frequently in the media and everyday language, there is still no generally applicable clinical definition of burnout.

Burnout is therefore not listed as an independent disorder in the classification systems for mental disorders (ICD-10; DSM-V). “Being burnt out” is only listed under the diagnosis item “Problems with regard to difficulties in coping with life” as an additional diagnosis in the sense of burnout in ICD 10.

The symptoms of burnout overlap with those of other disorders such as chronic fatigue syndrome. Most of all, there is an overlap with depression. That makes diagnosis difficult.

Burnout or Depression?

Some experts even fundamentally doubt that burnout is a disease in its own right. They assume that people with the disease are basically suffering from depression.

In fact, it is conceivable that many people are better able to accept the diagnosis of burnout than that of depression. Because burnout is generally attributed to people who have previously achieved a lot. Depression, on the other hand, is still mistakenly associated with weakness.

Indeed, many of the symptoms of burnout, particularly deep emotional exhaustion, are also characteristic of depression. Signs such as a loss of interest and motivation are also characteristics of depression.

However, some key symptoms of burnout and depression do not match. Depersonalization and dissatisfaction with performance are atypical for depression. The generally battered self-esteem that is a burden for many depressed people is again not typical for people with burnout.

Some experts also see burnout as a risk factor for mental health problems rather than as a disease in itself. Others describe the disease as a process that, if not stopped, leads to depression of exhaustion. The line between burnout and depression remains blurred. The therapist must check very carefully whether there is actually - or also - a depression that needs to be treated accordingly.

Burnout: treatment

Burnout is a serious condition that should be treated professionally as quickly as possible. If burnout is discovered and treated too late, the chances of recovery worsen. That is why you should seek professional help with burnout in good time.

Burnout therapy consists of many different components. They are individually tailored to the patient's problems and personality. In addition to psychotherapeutic support, medication can also help with burnout - especially if more severe depressive symptoms occur.

In the beginning there is the insight into the disease

The prerequisite for any therapy is the understanding that a burnout problem exists at all. For this purpose, those affected should clarify the following four questions with therapeutic support:

How do I contribute to the difficult situation myself?
Where do I exceed my limits?
Which environmental factors are involved?
Which can be changed and which cannot?

People with burnout who do not admit their own share in the situation cannot tackle the problem themselves at the root. Dealing with other burnout sufferers, for example in self-help groups or through experience reports, can help to find ways out of burnout.

Rapid crisis intervention

If the burnout process is still in the initial phase, crisis intervention or short-term therapy of a few hours is often sufficient as first aid to burnout. The aim is to develop improved skills for conflict and problem solving and to get a finer feel for the limits of one's own resilience.

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

psychotherapy

If burnout has progressed further, psychotherapy is usually necessary to treat burnout. Since the reasons that lead to burnout are very different, the focus of therapy and the method are individually different. The following therapeutic procedures can help.

Behavior therapy

With the help of cognitive behavioral therapy, misconceptions and behavior patterns that burnout patients have often internalized can be resolved. An example: "I have to do everything perfectly, otherwise I am worthless." The questioning of such patterns and world views (paradigms) makes it possible to free oneself from the pathogenic "inner drivers". One of the goals of burnout therapy is to recognize the problematic patterns and to change them step by step.

Depth psychological procedures

For many burnout sufferers, the focus is on building a more stable self-esteem. As their self-esteem increases, their dependence on external recognition decreases. It is often the secret engine behind the overexploitation of one's own strength.

In such cases, profound mental restructuring is necessary, which can be better brought about by depth psychological methods such as psychoanalysis. Such processes can be tedious and sometimes painful at first, but in some cases they are unavoidable for effective burnout therapy.

Group therapy

Group therapy can also provide important support for burnout. For many patients it is initially unfamiliar to share their own problems with a group of initially strangers. However, it usually has a relieving effect to talk to other people who are also affected.

Body therapy and sports

Many burnout patients have forgotten how to perceive their own needs. In such cases, so-called body therapies can help in addition to psychotherapy. The patient learns to perceive physical tension caused by fear and stress. If the physical tension is released in a targeted manner, the psyche also relaxes.

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

Therapy offered in burnout clinics

In the case of severe burnout, a stay in a special clinic can make sense. Burnout clinics offer patients a wide range of therapies. In addition to depth psychological approaches, cognitive behavioral therapy, systemic therapy and group therapy, this often also includes body therapy, art therapy or occupational therapy.

The exact therapy plan is tailored to the individual patient. Thanks to the inpatient setting, patients can deal intensively and without distraction with their problems, uncover causes and practice new behavior and thought patterns. Such a "burnout cure" will help you to manage your resources better in the long term.

Medication for burnout

There are no special burnout drugs. However, if a patient suffers from pronounced depressive symptoms such as listlessness, inner emptiness and loss of interest, antidepressants can be a good option in addition to psychotherapy. Serotonin reuptake inhibitors (SSRIs), for example, raise the serotonin level in the brain and thus increase drive.

Burnout: disease course and prognosis

According to burnout statistics from the Robert Koch Institute, 4.2 percent of Germans in Germany suffer from burnout. Above all, the idea is still widespread that the burnout syndrome is always preceded by a phase of idealistic over-engagement and the so-called “burning”. That's not the case.

However, those affected invest more energy in their tasks than they can cope with in the long run. This can have its origin in idealism, but it can also arise from an emergency.

A common warning signal is that those affected can no longer switch off after work and can no longer recover. In this phase, however, an impending burnout is rarely recognized.

Only when the hoped-for reward, for example in the form of professional advancement or recognition, falls short of expectations or the strength is no longer sufficient, does the burnout phase begin - the burnout syndrome.

Exhaustion, irritation and frustration then follow the (self) overstrain. The enormous emotional strain does not leave the body without a trace. Therefore, psychosomatic complaints such as headache and stomach ache or sleep disorders can be signs of burnout syndrome.

The same applies to burnout as to many other illnesses and disorders: the earlier the problem is recognized and addressed, the easier it is to fix it.

Impending disability

If a severe burnout syndrome is not recognized and treated over a longer period of time, it usually leaves permanent traces. Even the normal professional and social stress is overwhelming for many sufferers months and years after the therapy. Partial disability or complete disability as a result of burnout are not uncommon. Therefore, an impending burnout should be taken seriously and treated quickly.

Additional information

Books

Thomas Bergner Burnout Prevention: Preventing Exhaustion - Building Energy - Self-Help in 12 Steps Paperback - October 14, 2015
Sabine Gapp-Bauß: Overcoming depression and burnout: Your red thread from the crisis: The most effective self-help strategies VAk - February 15, 2016
Mirriam Prieß: Find your way back to yourself !: Effective ways out of burnout Southwest, April 29, 2014

Guideline

HTA report "Therapy of Burnout Syndrome" from the German Institute for Medical Documentation and Information

Self help

Burnout self-help: https://www.burnout-selbsthilfe.de/
National contact and information point for the suggestion and support of self-help groups (NAKOS): https://www.nakos.de/

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