Burnout: symptoms, causes, prevention
Burnout describes a state of deep emotional, physical and mental exhaustion. Those affected have difficulty concentrating and make many mistakes. Some also lose energy for their private lives. Burnout is usually attributed to excessive demands and stress at work. But the causes are manifold. How to recognise burnout, how to protect yourself and how to overcome burnout, you can find out here.
Burnout: Short overview
- Symptoms: deep exhaustion, no possibility to “switch off”, psychosomatic complaints, feeling of lack of recognition, “service by the book”, aloofness, cynicism, loss of performance, finally depression
- Causes: overstraining or stress due to external circumstances, perfectionism, self-confidence based on performance, problems saying “no”, strong desire for recognition
- Prevention: perceiving one’s own needs, stress management, reducing perfectionism, defining and pursuing clear personal goals, building good self-acceptance, social contacts, healthy lifestyle
- Diagnosis: by means of special questionnaires, differentiation to fatigue and depression
- Therapy: Crisis intervention, cognitive behavioural therapy, psychotherapy based on depth psychology, group therapy, antidepressants if necessary
- Prognosis: good chances of recovery with early treatment, untreated there is a risk of permanent incapacity to work
Burnout symptoms are very diverse. They manifest themselves emotionally, psychologically and in mental performance, but can also occur in the form of psychosomatic complaints. Every 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 phase
In the early phase of a burnout, the affected person usually puts an extreme amount of energy into their tasks. This may be voluntary, out of idealism or ambition, but it may also be born out of necessity – for example, due to multiple burdens, relatives to care for or fear of losing their job.
A characteristic early sign of burnout is when people can no longer switch off. You can no longer recover properly, you are less efficient and then you have to expend even more energy to accomplish your tasks. This is the beginning of a vicious circle. Other burnout symptoms in the initial phase include
- Sense of urgency
- Denial of personal needs
- Displacement of failures and disappointments
- Restriction of social contacts to clients, patients, business partners etc.
Soon the first burnout signs of exhaustion become apparent. These include:
- Energy shortage
- Sleep deprivation
- increased accident risk
- increased susceptibility to infections
2. Phase: Reduced commitment
The over-commitment typical of the entry phase increasingly tips over into an attitude of entitlement at some point. Those affected expect something in return for their great commitment. If they are disappointed, they slide into a deep frustration. The following symptoms will help you recognize an impending burnout:
Domestic notice: Those affected take longer breaks than usual, come to work late and leave too early. They increasingly enter a state of “inner denunciation”. The strong reluctance to work leads to the fact that they only do what is absolutely necessary, if at all.
Depersonalization and cynicism: Especially in helping professions a “depersonalization” of relationships is a typical burnout symptom. The ability to empathize with and care for others (empathy) decreases. Emotional coldness and cynicism are common in our dealings with each other. Nursing staff, for example, then strongly devalue their patients.
Effects on the family: Such signs of burnout often affect family life. Those affected make ever greater demands on their partner, without giving anything in return. They no longer have the strength and patience to spend time with their children.
Typical burnout symptoms at this stage are:
- fading idealism
- Shutting down the exposure
- Sense of unappreciatedness
- Sensation of being exploited
- Blossoming out in leisure
- increasing distance to 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, blame
Burnout symptoms also manifest themselves in emotional reactions. When excessive commitment slowly spills over into frustration, disillusionment often sets in. The persons realize that reality does not correspond to their own wishes. They blame either the environment or themselves. The former tends to lead to aggression. The latter contributes to a depressive mood (“I’m a failure!”).
Depressive symptoms of burnout are:
- Feelings of powerlessness and helplessness
- Sense of emptiness
- crumbling self-esteem
- Loss of drive
Aggressive symptoms of burnout are:
- Blame to the outside world, to colleagues, superiors or “the system”
- Moodiness, irritability, impatience
- frequent conflicts with others, intolerance
4. Degradation, dwindling performance
The declining motivation and the strong emotional strain are also reflected in a worse performance after some time. The drunk people make more frequent careless mistakes or forget appointments. Other signs of cognitive decline are:
- dwindling creativity
- Inability to cope with complex tasks
- Problems making decisions
- undifferentiated black-and-white thinking
- Rejecting changes
On closer examination, the last two burnout symptoms are also based on decreasing 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 are reacting increasingly indifferently. They often feel bored, give up hobbies, withdraw from friends and family. Burnout is lonely.
6. Psychosomatic reactions
The enormous psychological strain is also reflected in physical complaints. Such psychosomatic signs already appear in the early stages of burnout. Physical symptoms are among others:
- Insomnia and nightmares
- Muscle tension, back pain, headaches
- increased blood pressure, palpitations and tightness in the chest
- Nausea and digestive problems (vomiting or diarrhoea)
- sexual problems
- significant weight gain or loss due to changes in eating habits
- increased consumption of nicotine, alcohol or caffeine
- increased susceptibility to infections
7. Last stage: Desperation
In the last burnout stage the feeling of helplessness intensifies to a general hopelessness. Life seems pointless at this stage and suicidal thoughts arise. Nothing then gives more pleasure and everything becomes indifferent. Those affected sink into a severe burnout depression.
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 a burnout require?
The term “burnout”, used worldwide, even in non English speaking countries, is clearly understood as a “total exhaustion”. Such a state can affect anyone. Teachers suffer as much as managers, nurses or single parents. But also pensioners, people who do not have a job, and housewives can empty their energy batteries.
First, the disease was described in volunteers and people working in the healing and nursing professions. Often people who bring a high degree of idealism to these professions work beyond the limits of physical and emotional stress without receiving much recognition for their efforts.
A question of resilience
Every person reacts differently to stress. Some are barely able to withstand even moderate pressure. With them, little is already 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 few people survive them without burning out. Experts also refer to the latter as “Ware Out”, “attrition” or “passive burnout”.
Even very resistant persons are therefore not protected from burnout. You are particularly at risk when a series of frustrating episodes occur and the resources to deal with them are exhausted.
Short-term stress is a normal physical reaction, improves performance 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. It can make you sick. Take care of yourself and try to incorporate small changes in your daily life that will reduce stress.
Signal interest and willingness for an open conversation, listen! Those affected often withdraw from their environment for fear of becoming a burden or not being understood. Don’t apply pressure. At the same time, it is important not to take all things from patients. A daily structure or simple tasks that they can continue to manage themselves are important positive reinforcers.
Causes for burnout
The causes of burnout are as varied individually as the people affected. The needs and goals of each person are unique in their particular constellation. The environment in which they live is just as varied.
Risk factors for burnout
Basically there seem to be two types of people who have an increased risk of burnout:
- People with a weak self-confidence, who as a result are oversensitive, more adapted and passive and particularly in need of love.
- Likewise, among 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 they have some things in common. Both types have difficulty expressing their feelings and a strong desire for recognition by their environment.
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)
- Doubt about the sense of one’s own actions
- unrealistically ambitious targets that cannot be achieved or can only be achieved with disproportionate energy input
- Goals that do not meet one’s own needs, but the expectations of others.
- high expectations of the reward that follows the achievement of a specific goal
- Difficulties in admitting personal weakness and helplessness
- Difficulty in saying “no” – either to others or to one’s own “inner driving force” that drives ambitious people to perfection and peak performance
External causes that increase the risk of burnout
Many burnout processes start when the life situation changes fundamentally. This can be the start of studies, career entry, job change or a new supervisor. In such burnout phases, one’s own self-image is sometimes severely shaken, expectations are disappointed or even goals in life are destroyed.
On the other hand, the absence of a hoped-for change can also contribute to frustration and burnout, for example when the longed-for job is given to another applicant or the promotion is not forthcoming.
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 barriers
- Conflict between own values and convictions and the requirements
- lack of social support in private life
- unresolved conflicts with superiors or employees
Even people who are normally good at dealing with problems can develop burnout when under great stress. The good news is that you are not helplessly at the mercy of this process and can contribute to burnout prevention yourself. The following strategies can help you:
Perceive your own needs: Try to perceive your wishes and needs. What is really important to you? Social recognition, opportunities for advancement, freedom in the design of work processes or opportunities for influence? Admit to yourself that your needs are as important as those of your fellow human beings.
Reveal basic needs: Burnout arises out of frustration. Look for tasks that satisfy your individual basic needs. Creativity for example, reputation, diverse social contact or movement for example. Therefore, it is important for the choice of a job that you know the everyday life in the desired profession.
Stress management and relaxation: Stress is a burnout driver. Take active countermeasures! Helpful for burnout prophylaxis are stress management and relaxation techniques such as autogenic training or progressive muscle relaxation.
Self attention: Burnout usually goes unnoticed. Ask yourself regularly how much stress you have and how satisfied you are with your life.
Stress diary: A stress diary helps to reveal in which situations and contexts stress occurs and whether it is continuously increasing. If you don’t want to rely solely on your self-perception, you can also ask friends and family for help. They could reflect directly to you if you seem more irritable or less motivated than usual.
Social contacts: The social network is an important factor in burnout prevention. Take time for your friends and family. Contact with people close to you offers you the necessary balance to your working life.
Disempower the internal boosters: People who are susceptible to burnout have inner drivers that whip them into excessive demands. They can be maxims like “Be perfect” or “please everybody.” Only those who know their personal inner drivers can disempower them. Make yourself aware that nobody can always be perfect and that mistakes are part of life.
Define clear goals in life: Find out what goals are really important to them in life. In this way you can use your energy in a targeted manner. Also try to say goodbye to ideas that others have inoculated in you. This is the only way to avoid getting bogged down in exhausting projects that ultimately do not satisfy you.
Strengthening of self-acceptance: People are particularly susceptible to burnout who derive their self-confidence predominantly from a role in their professional or private life: 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 danger 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 sport and plenty of exercise – this helps to reduce stress. Restrict the consumption of stimulants (e.g. nicotine, caffeine) or stimulants (e.g. alcohol, sugar) This not only makes you feel fitter, but without the chemical stimulants you may also go less beyond your personal limits.
Seek help: It is often not so easy to put good intentions 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 a burnout is detected, the better the chances of recovery.
Preventing burnout – what you can do at work
Since burnout syndrome often arises with dissatisfaction at work, it is important to apply the above strategies at the workplace. The following points can help you with burnout prevention and improve the working atmosphere:
Aspire to autonomy: Those who can flexibly organize their tasks and working hours are much less at risk for 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 and worn out in a demanding job, you should acquire strategies for proper time management.
Saying no: The ability to be able to turn down a task once in a while is an important burnout prophylaxis. Otherwise you’ll get too much on your chest. 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 unrealistically hopes for recognition and personal satisfaction from their tasks will be disappointed. This applies to the nurse who expects gratitude from his patients, as well as the secretary who takes over unloved errands and hopes for praise and recognition.
Life and work in balance: The term “work-life balance” – the balance between work and leisure – contains an essential basic human need. Those who do not manage to allow themselves adequate time off and time off, will most likely fall into the burnout trap.
Career planning: Even the best job can lead to monotonous boredom after years. If you have a career goal in mind, you run less of a risk of getting stuck in everyday life. Further training is also a good method for burnout prevention and for finding inspiration for everyday work.
To prevent burnout, you can also turn to coaches who specialize in burnout and help you implement strategies at work.
When the first symptoms such as persistent tiredness, exhaustion or sleep disturbances occur, those affected usually consult their family doctor first. In an anamnesis interview, the doctor will ask the patient about his or her complaints and particular strains. The following questions could be asked by the family doctor if burnout is suspected:
- Do you have the feeling that you never rest?
- Do you feel that there are many tasks that only you can perform?
- Have you been working more than usual lately?
- Do you sleep well at night?
- Do you often feel tired during the day?
- Do you feel valued in your job?
- Do you feel exploited?
- Are you feeling lethargic?
- Do you have any other physical complaints?
By means of further examinations the doctor can exclude a physical cause of the complaints. For example, inexplicable tiredness and exhaustion can also indicate a malfunction of the thyroid gland or another serious physical illness. This can be determined, among other things, by a blood test.
However, if the suspicion of burnout is confirmed, the family doctor will refer you to a specialist. In this case it is a psychological or medical psychotherapist.
In a clinical interview, the psychotherapist will use questions to clarify whether your symptoms actually indicate a burnout syndrome.
Maslach Burnout Inventory (MBI)
The burnout test most frequently used by experts is the Maslach Burnout Inventory (MBI). It measures burnout on the basis of 22 questions on the three scales:
- emotional exhaustion
- Depersonalisation/cynicism (impersonal/cynical attitude towards clients, colleagues and superiors)
- personal fulfilment / satisfaction with performance
Typical statements are, for example: “I feel emotionally exhausted by my work”, “I have become more indifferent to people since I have been doing this work”; “I have the feeling of being at the end of my wisdom”.
However, some burnout symptoms are not considered in this burnout test. For example, the initially extremely high level of commitment, which gradually flattens out into complete disinterest.
Tedium Measure (Burnout Measure)
The Tedium Measure, also called Burnout Measure, consists of 21 questions. On a scale of one to seven, those concerned can indicate the extent to which the respective question applies to them (1= never applies; 7 = always applies).
In this questionnaire, the physical (“Are you physically exhausted?”), emotional (“Are you emotionally exhausted?”) and mental exhaustion (“Do you feel worn out?”) are questioned. Depersonalisation and performance satisfaction do not play a role in this burnout test, unlike in MBI.
Burnout tests on the Internet: Not recommended
You can find numerous free burnout tests on the Internet. However, such a burnout self-test can never replace medical or psychological diagnosis. However, the online check can help you to become aware of your own level of stress and personal work frustration. If there is evidence of burnout, you should consult a doctor or psychologist.
Differential diagnosis burnout
Although the term “burnout” appears frequently in the media and everyday language, there is still no generally accepted 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 point “Problems related 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. Above all, however, there is an overlap with depression. This makes the diagnosis difficult.
Burnout or depression?
Some experts even fundamentally doubt that burnout is an independent disease. They assume that people with the disease basically suffer from depression.
In fact, it is conceivable that many may accept the diagnosis of burnout better than that of depression. Because burnout is generally attributed to people who have done a lot before. Depression, on the other hand, is still wrongly associated with weakness.
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 characteristics of depression.
However, some major symptoms of burnout and depression do not match. Depersonalisation and dissatisfaction with performance are therefore untypical of depression. The generally low self-esteem that weighs on many depressive people is not typical for people with burnout.
Some experts also see burnout more as a risk factor for psychological problems rather than as an illness in its own right. Others describe the disease as a process which, if it is not stopped, leads to exhaustion depression. The line between burnout and depression thus remains blurred. The therapist has to check very carefully whether there is not actually – or also – a depression that needs to be treated accordingly.
Burnout is a serious disease that should be treated professionally as soon as possible. If a burnout is discovered and treated too late, the chances of recovery deteriorate. That is why you should seek professional help with burnout in good time.
A burnout therapy consists of many different components. They are individually adapted to the problems and personality of the patient. In addition to psychotherapeutic support, medication can also help with burnout – especially when more severe depressive symptoms occur.
In the beginning is the insight into the disease
The prerequisite for any therapy is the insight that a burnout problem exists at all. To this end, those affected should clarify the following four questions with therapeutic support:
- To what extent do I myself contribute to the difficult situation?
- Where do I exceed my limits?
- Which environmental factors are involved?
- Which ones can be changed, which ones cannot?
People with burnout who do not admit their own share of the situation cannot get to the root of the problem themselves. 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 its early stages, a crisis intervention or a short-term therapy of a few hours is often sufficient as first burnout aid. The aim is to develop improved skills for conflict and problem solving and to get a finer sense of 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 burnout treatment.
If the burnout has already progressed further, psychotherapy is usually necessary for burnout treatment. Since the reasons that lead to burnout are very different, the focus of therapy and the method are also individually different. The following therapeutic procedures can help.
With the help of cognitive behavioural therapy, false ideas and behavioural patterns that burnout patients have often internalised can be resolved. For example: “I have to do everything perfectly or I’m worthless.” Questioning such patterns and world views (paradigms) makes it possible to free oneself from the “inner drivers” that cause illness. One aim of burnout therapy is therefore to recognise the problematic patterns and to change them step by step.
Depth psychological methods
For many burnout sufferers, the focus is on building a more stable self-esteem. As their self-esteem grows, their dependence on external recognition decreases. It is often the secret engine behind the overexploitation of one’s own forces.
In such cases, profound psychological restructuring is necessary, which can be better achieved through depth psychological procedures such as psychoanalysis. Such processes can be lengthy and sometimes painful at first, but in some cases they are essential for effective burnout 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 communicate with other people who are also affected.
Body therapy and sports
Many patients with burnout 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 tensions caused by fears and stress. If the physical tension is specifically released, the psyche also relaxes.
Physical activity also supports the recovery process, various studies show. It has a positive effect on body sensation and self-confidence.
Therapy offer in burnout clinics
In cases of severe burnout, a stay in a special clinic may be advisable. Burnout clinics offer patients a wide range of therapies. In addition to depth psychological approaches, cognitive behavioural therapy, systemic therapy and group therapy, this often includes body therapy, art therapy or occupational therapy.
The exact therapy plan is tailored to the individual patient. The inpatient setting allows patients to deal with their problems intensively and without distraction, to uncover causes and practice new patterns of behaviour and thinking. Such a “burnout cure” helps them to better manage their resources in the long term.
Medication for burnout
There are no special burnout medications. 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 have a boosting effect.
Burnout: course of disease and prognosis
According to a burnout statistic of the Robert Koch Institute, 4.2 percent of Germans in Germany suffer from burnout. The idea is still widespread that the burnout syndrome is always preceded by a phase of idealistic over-commitment and the so-called “burning”. But this is 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 out of necessity.
A common warning signal is that the person concerned cannot switch off after work and cannot 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, permanently falls short of expectations, or the strength is no longer sufficient, does the burn-out phase begin – the burnout syndrome.
The (self)-overstrain is followed by exhaustion, irritation and frustration. The enormous psychological strain does not leave the body unaffected. Therefore, psychosomatic complaints such as headaches, stomach aches or sleep disturbances can be signs of a burnout syndrome.
The same applies to burnout as to many other diseases and disorders: The earlier the problem is identified and addressed, the better it can be resolved.
If a severe burnout syndrome is not detected and treated over a longer period of time, it usually leaves permanent traces. Even the normal professional and social stress is for many affected people still months and years after the therapy an excessive demand. Partial or total disability as a result of burnout is not uncommon. Therefore, an impending burnout should be taken seriously and treated quickly.