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What is "nurse burnout?"

By Oretha Johnson posted 09-06-2013 11:28

  

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What is burnout syndrome?

Created: December 5, 2012; Last Update: January 17, 2013.

Having a “burnout” seems to have become a mass phenomenon receiving constant media attention. More and more people are missing work due to “burnout syndrome.” But is this set of symptoms a clearly-defined disease? How is burnout different from depression? There are many questions that remain unanswered.

You can find more on this topic in our feature.

The term “burnout” was coined in the 1970s by the American psychologist Herbert Freudenberger. He used it to describe the consequences of severe stress and high ideals experienced by people working in “helping” professions. Doctors and nurses, for example, who sacrifice themselves for others, would often end up being “burned out” – exhausted, listless, and unable to cope. Nowadays, the term is not only used for these helping professions, or for the dark side of self-sacrifice. Anybody seems to be at risk: stressed-out careerists and celebrities, over-worked employees, or homemakers. “Burnout” has become a popular term.

 

It is surprising then that there is no clear definition of what burnout really is. And the lack of definition has consequences. Because it is not clear what burnout is and how it can be diagnosed, it is impossible to say how common it is. Different figures appear in the press; some German health insurance companies say that up to nine million people are affected. All these numbers should be met with skepticism: scientific research has no reliable information about how many people have burnout in Germany.

Is burnout a disease?

Distressing living conditions can put people under extreme pressure, until they may feel exhausted, empty, burned out, and unable to cope. Stress at work can also cause physical and mental symptoms. Possible causes include feeling either permanently overworked or under-challenged, being time-pressured, or having conflicts with colleagues. Extreme commitment that leads workers to neglect their own needs may also be at the root of it. Problems caused by stress at work are a common cause for being signed off sick. But sometimes changes in the job environment and more concrete support in everyday life can already help with problems at the workplace or stress from home care.

Exhaustion is a normal reaction to stress, and not a sign of disease. So does burnout describe a set of symptoms that is more than a normal feeling of exhaustion? And how is it different from other mental disorders?

Experts have not yet agreed on how to define burnout. And strictly speaking, there is no diagnosis “burnout.” This is unlike having “depression” diagnosed, for example, which is a widely accepted and well-studied disease. Burnout is different. Some experts think that other conditions might be behind being “burned out” – such as depression or an anxiety disorder. Physical illnesses may also cause burnout-like symptoms. Being diagnosed with “burnout” too soon might then mean that the real problems are not being recognized and treated appropriately.

What are the signs and symptoms of burnout?

Burnout is considered to have a range of symptoms. There is no agreement which of those are part of it and which ones are not. But all definitions given so far have in common that the symptoms are regarded as being the consequence of stressful activities in or outside the job. One possible source of stress outside the job is caring for a family member, for example.

Three main areas of symptoms are considered to be signs of burnout syndrome:

  • Emotional exhaustion: People affected feel drained and exhausted, overloaded, tired and low, and do not have enough energy. Physical symptoms include pain or problems with the stomach or bowel.
  • Alienation from (job-related) activities: People affected find their jobs increasingly negative and frustrating. They may develop a cynical attitude towards their work environment and their colleagues. They may, at the same time, increasingly distance themselves emotionally, and disengage themselves from their work.
  • Reduced performance: Burnout mainly affects everyday tasks at work, at home or when caring for family members. People with burnout regard their activities very negatively, find it hard to concentrate, are listless and experience a lack of creativity.

How is burnout diagnosed?

There are no well-studied methods yet to diagnose burnout. Various questionnaires can be used for self-assessment. The problem with these questionnaires is that there is no common definition of what burnout is. So it is unclear whether they are really able to measure burnout, or to distinguish it from other disorders. The most common questionnaire is the “Maslach Burnout Inventory” (MBI), which is available for different professional groups. This questionnaire was not developed for clinical practice, however, but for scientific research on burnout.

Online questionnaires on the risk of burnout are not suitable to find out whether someone has burnout or whether the symptoms are caused by something else.

Generally, symptoms ascribed to burnout can have other causes too, for example mental or psychosomatic disorders like depression, anxiety disorders or chronic fatigue syndrome. But physical illnesses or certain medications can also cause symptoms like exhaustion and tiredness. So it is important to look for possible causes together with a doctor, and not to think of “burnout” straight away. Because then you might risk using wrong and useless treatments.

What is the difference between burnout and depression?

Certain symptoms ascribed to burnout also occur in depression. These include

  • extreme exhaustion,
  • feeling low, and
  • reduced performance.

Because the symptoms are similar, some people may be diagnosed with burnout although they really have depression. So people should be careful with (self )diagnosis because it might lead to taking the wrong measures. It would be a mistake, for example, to recommend someone with depression to take a longer vacation or time off work. This can help people who are only exhausted from work recover, but it might cause more problems for people with depression because they need very different types of support such as psychotherapy or drug treatment.

Some characteristics of burnout are very different from those of depression, though. These include alienation, especially from work. In depression, negative thoughts and feelings are not only about work, but about all areas of life. Other typical symptoms of depression are

  • lack of self-esteem,
  • hopelessness, and
  • suicidal tendencies

These are not regarded as typical symptoms of burnout. So not every case of burnout will have depression at its root. But burnout symptoms may increase the risk of someone getting depression.

You can read more about depression in our feature on depression.

Published by the Institute for Quality and Efficiency in Health Care (IQWiG)

References

  • IQWiG health information is based on research in the international literature. We identify the most scientifically reliable knowledge currently available, particularly what are known as “systematic reviews.” These summarize and analyze the results of scientific research on the benefits and harms of treatments and other health care interventions. This helps medical professionals and people who are affected by the medical condition to weigh up the pros and cons. You can read more about systematic reviews and why these can provide the most trustworthy evidence about the state of knowledge in our information “Evidence-based medicine.” We also have our health information reviewed to ensure medical and scientific accuracy.
  • Korczak D, Kister C, Huber B. Differentialdiagnostik des Burnout-Syndroms. HTA-Bericht 105. Deutsches Institut für Medizinische Dokumentation und Information (DIMDI). Cologne; 2010. [Full text - in German]
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