The World Health Organization has for the first time recognised ” burn-out ” in its International Classification of Diseases (ICD), which is widely used as a benchmark for diagnosis and health insurers.
The decision, reached during the World Health Assembly in Geneva, which wraps up on Tuesday, could help put to rest decades of debate among experts over how to define burnout, and whether it should be considered a medical condition.
In the latest update of its catalogue of diseases and injuries around the world, WHO defines burn-out as “a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed.”
It said the syndrome was characterised by three dimensions: “
1) feelings of energy depletion or exhaustion;
2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
3) reduced professional efficacy.”
“Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life,” according to the classification.
The updated ICD list, dubbed ICD-11, was drafted last year following recommendations from health experts around the world, and was approved on Saturday.
“This is the first time” burnout has been included in the classification, WHO spokesman Tarik Jasarevic told reporters.
The ICD-11, which is to take effect in January 2022, contains several other additions, including classification of “compulsive sexual behaviour” as a mental disorder, although it stops short of lumping the condition together with addictive behaviours.
It does however for the first time recognise video gaming as an addiction, listing it alongside gambling and drugs like cocaine.
The updated list removes transgenderism from its list of mental disorders meanwhile, listing it instead under the chapter on “conditions related to sexual health”.
“Burnout” seems to have become a mass phenomenon, receiving constant media attention. More and more people are missing work due to burnout. But is this set of symptoms a clearly-defined illness?
How is burnout different from depression?
Many questions haven’t been answered yet.
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 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 overworked employees and homemakers.
Surprisingly, there is no clear definition of what burnout really is. As a result, it’s not clear what burnout is exactly and how it can be diagnosed.
This also makes it impossible to say how common it is.
Various figures appear in the press; some German health insurance companies say that up to nine million people are affected in Germany.
These figures should, however, be met with caution: There are no reliable scientific data about how many people have burnout in Germany.
Is burnout a medical condition?
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 under time pressure, or having conflicts with colleagues.
Extreme commitment that results in people neglecting their own needs may also be at the root of it.
Problems caused by stress at work are a common reason for taking sick leave.
But sometimes changes in the working environment and more concrete support in everyday life can already help with things like problems at the workplace or the stress of caring for ill relatives.
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” reaction to stress? And how is it different from other mental health problems?
Experts have not yet agreed on how to define burnout.
And strictly speaking, there is no such diagnosis as “burnout.”
This is unlike having “depression” diagnosed, for example, which is a widely accepted and well-studied condition.
That is not the case with burnout. Some experts think that other conditions are 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 aren’t identified and treated appropriately.
What are the signs and symptoms of burnout?
Burnout is considered to have a wide range of symptoms.
There is no general agreement about which of those are part of burnout and which are not.
But all definitions given so far share the idea that the symptoms are thought to be caused by work-related or other kinds of stress.
One example of a source of stress outside of work is caring for a family member.
There are three main areas of symptoms that are considered to be signs of burnout:
- Exhaustion: People affected feel drained and emotionally exhausted, unable to cope, tired and down, and do not have enough energy. Physical symptoms include things like pain and stomach or bowel problems.
- Alienation from (work-related) activities: People who have burnout find their jobs increasingly stressful and frustrating. They may start being cynical about their working conditions and their colleagues. At the same time, they may increasingly distance themselves emotionally, and start feeling numb about 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 tasks, find it hard to concentrate, are listless and lack creativity.
How is burnout diagnosed?
There are no well-studied methods with which to diagnose burnout.
There are various questionnaires for self-assessment.
But because there is no generally accepted definition of burnout, it isn’t clear whether questionnaires can actually “measure” burnout and distinguish it from other illnesses.
The most common questionnaire is the “Maslach Burnout Inventory” (MBI), which is available for different professional groups.
But this questionnaire was originally developed for research purposes, not for use by doctors.
Online questionnaires on the risk of burnout are not suitable for determining whether someone has burnout or whether the symptoms are caused by something else.
The symptoms that are said to be a result of burnout can generally also have other causes, including mental or psychosomatic illnesses 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 consider other possible causes together with a doctor, and not to conclude you have burnout straight away.
Because then you might risk starting treatments that don’t help.
What is the difference between burnout and depression?
Certain symptoms that are considered to be typical for burnout also occur in depression. These include
- extreme exhaustion,
- feeling down, and
- reduced performance.
Because the symptoms are similar, some people may be diagnosed with burnout although they really have depression.
So people should be very careful not to (self-) diagnose burnout too quickly.
This could lead to unsuitable treatment.
For instance, someone with depression might be advised to take a longer vacation or time off work.
People who are “only” exhausted because of work can recover if they follow that advice.
But if people with depression do so it might actually make things worse because the kind of help they need is very different, such as psychological treatment or medication.
Some characteristics of burnout are very specific, though. For instance, in burnout most of the problems are work-related.
In depression, negative thoughts and feelings aren’t only about work, but about all areas of life. Other typical symptoms of depression include
- low self-esteem,
- hopelessness and
- suicidal tendencies.
These are not regarded as typical symptoms of burnout. So people with burnout don’t always have depression. But burnout may increase the risk of someone getting depression.
