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Depression: What is burnout syndrome?

Last Update: January 17, 2013; Next update: 2016.

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 illness? What is the difference between burnout and depression? Many questions remain unanswered.

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. It seems it can affect anyone, from stressed-out careerists and celebrities to over-worked employees and 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 a 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. These figures should however be met with caution: Scientific studies are yet to provide reliable information about how common burnout is in Germany.

Is burnout an illness?

A stressful lifestyle can put people under extreme pressure, to the point that they 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 employees 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 working 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 is not a sign of illness. 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 such diagnosis as “burnout”, unlike depression, which is a widely accepted and well-studied illness. That is not the case with burnout. Some experts think that there might be other symptoms behind being "burned out" – depression or an anxiety disorder, for instance. Physical illnesses may also cause burnout-like symptoms. Diagnosing "burnout" too quickly could then mean that the actual problems are not identified and treated properly.

What are the signs and symptoms of burnout?

Burnout is considered to have a range of symptoms. There is no agreement on which are part of it and which ones are not. But all definitions of burnout syndrome so far have in common that the symptoms are a result of stress at work or elsewhere. One example of stress outside of work is caring for family members.

There are three main areas of symptoms that are considered to be signs of burnout syndrome:

  • Emotional exhaustion: People feel drained and exhausted, overloaded, tired and low, and do not have enough energy. Physical problems include stomach pains and digestion problems. 
  • Alienation from (job-related) activities: People 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 are very negative about their activities, find it hard to concentrate, are listless and lack creativity.

How is burnout diagnosed?

There are no well-researched methods to diagnose burnout yet. 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 rather 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 said to be a result of burnout can also have other causes, for example mental or psychosomatic disorders like depression, anxiety disorders or chronic fatigue syndrome. But physical illnesses or certain medications can cause symptoms such as exhaustion and tiredness too. So it is important to look for possible causes together with a doctor, and not to think of “burnout” straight away. Otherwise there is a risk that you might use the wrong or ineffective treatments.

What is the difference between burnout and depression?

Certain symptoms said to be a result of burnout also occur in depression. These include:

  • Extreme exhaustion
  • Feeling low
  • Reduced performance

Because the symptoms are similar, some people may be diagnosed with burnout although they really have depression. For that reason, people should be very careful not to (self) diagnose too quickly, as that could mean they get the wrong treatment. It would be a mistake, for example, to advise someone with depression to take a longer vacation or time off work. That can help people who are only exhausted from work to 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. They include alienation, especially from work. With depression, negative thoughts and feelings are not just restricted to work but spread to all areas of life. Other typical symptoms of depression are:

  • Low self-esteem
  • Hopelessness
  • Suicidal tendencies

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

Sources

  • Korczak D, Kister C, Huber B. Differentialdiagnostik des Burnout-Syndroms. HTA-Bericht 105 (in German). Deutsches Institut für Medizinische Dokumentation und Information (DIMDI). Cologne; 2010.
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