What are the symptoms of burnout?

What is burnout?

Burnout has been recognised by the World Health Organization (WHO) and is classed as a major problem for professions including healthcare. However, burnout is not classified as a medical condition but an 'occupation phenomenon'.

Burn-out is defined in International Classification of Diseases (ICD-11, 2019) as:

"A syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed... Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life."¹

Standardised scores are available to assess risk of burnout, such as the Oldenburg Burnout Inventory (OLBI) on which the British Medical Association bases its own burnout questionnaire.

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What causes burnout?

Dr Josephine Perry, chartered psychologist and co-author of Power Down to Power Up, sees a lot of burnout at work in clients presenting at her clinic, she says: "Burnout is really tricky because it is often felt by people who are used to just doing more and working harder in order to find their way out of problems."

"Unfortunately, when you've got burnout, doing that is like digging yourself into a deeper and deeper hole. Techniques that people would often use to handle stress, like exercise or seeing friends just dig you deeper and deeper into that hole. People with burnout often struggle to stop and recover, but they get to a point where they have no choice."

What are the symptoms of burnout?

The ICD classification gives three signs for burnout:

• Feelings of energy depletion or exhaustion.

• Increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job.

• Reduced professional efficacy.

These three signs around work/life balance correlate with broader signs of chronic stress, according to a guide by Mind.

Fatigue and sleep problems

Feeling tired and over-burdened are signs that you may be under stress. Feelings of energy depletion or exhaustion in burnout would fall under this broader sign of stress.

Stress can also have physical symptoms including: panic attacks, chest pain, headaches and muscle aches, nausea, dizziness, indigestion, heartburn and constipation or diarrhoea, all of which increase the burden of the problem.

Depression

Increased mental distance or feelings of negativism or cynicism about work might fall under a broader sign of stress, such as depression. Feeling neglected or lonely can be another sign of stress, as can feeling uninterested or unable to enjoy yourself. If you used to enjoy your career, feeling distant or negative about your job might be a sign you are burning out.

Dr Perry says she's used to seeing depression-like symptoms in clients who are burning out.

"It can be very hard for people to distinguish whether they are depressed or burnt out - often the symptoms are the same," she says. "When burnout is at its worst you might be unable to get out of bed for weeks at a time. Your body will just shut down, having done too much for too long.

"Burnout doesn’t sound like it is that serious, but it can be very distressing when you are in the middle of it. The earlier you can notice and deal with it, the quicker you can recover."

Feeling overburdened or overwhelmed

Reduced professional efficacy - not being able to do your job as well as usual - is the third sign of burnout and falls under a broader sign of stress and feeling overwhelmed. Stress can make existing mental health problems worse and feeling tired or sleep-deprived may affect your ability to work well.

How to recover from burnout

To recover from burnout Dr Perry advises patients to work on coping mechanisms to build up a toolkit of healthy coping mechanisms.

One approach Dr Perry recommends is the feeling wheel. "When you can identify specific emotions, you're going to have a much more effective coping mechanism for managing stress. We're identifying the actual feelings and we're proactive about planning for how to handle them."

How long does burnout last?

There are no accepted rules about recovery from chronic stress and burnout. Some experts advise that the idea of recovery is a continuous process that is dynamic and ongoing.

How to avoid burnout

Evidence-based stress reduction techniques - such as yoga and meditation - work to prevent stress from becoming chronic stress or burnout.

For example, Dr Perry recommends techniques for 'grounding': "When we are stressed, although it has big implications for our body, it's our brain that's running away, thinking through future outcomes - usually disastrous - and all the things that could go wrong. Grounding helps bring us back to the here and now and what is actually going on.

Other evidence-based techniques include sleep, exercise, and mindfulness-based stress reduction. Experts also recommend being with others - friends or otherwise - sex, creative hobbies, spiritual practice, being in nature, and imaginative time.

Further reading

1. WHO: Burn-out an occupational phenomenon.