Burnout: causes, symptoms, treatment routes BRIGITTE.de

What is a burnout?

With a burnout (also: burnout or burnout syndrome) you feel completely burnt out mentally, physically and emotionally. Those affected often lack the energy they need in their jobs and private lives. Contrary to popular belief, burnout does not only result from a stressful job – the causes of the phenomenon are diverse.

The earlier a burnout is detected, the better the chances of recovery, If it is left untreated, normal work stress can be perceived as extreme stress at some point, which can lead to permanent incapacity to work. In the worst case, a burnout leads to thoughts of suicide.

Burnout: illness or risk factor for depression?

So far, the term burnout has not been listed as an independent clinical picture. And the expert opinions on whether a burnout is actually a disease differ: Some experts suspect that affected patients are actually suffering from depression – and indeed the symptoms of burnout and depression are similar in many respects, but not in all. The line between the two is rather blurred. On the other hand, other experts consider burnout as a factor that can generally increase the risk of various mental illnesses, while others believe that burnout is a progressive process that leads to depression.

Burnout or Depression: The Differences

These symptoms can be used to differentiate between burnout and depression:

• Burnout: Affected people are often dissatisfied with their performance, have the feeling that they are standing next to themselves and feel lost ("depersonalization"), a mental and physical exhaustion is in the foreground. Triggering factors can often be clearly identified and assigned, mostly from the professional area. With symptoms of depression, these symptoms tend not to occur.
• Depression: Patients suffer from a very severe loss of self-esteem, which in turn is rather unusual at first in the case of burnout. Worried thoughts about anticipated disasters are in the foreground and can no longer be refuted even with the best arguments.

Why are the terms mixed up so often?

It may well be that patients are more likely to accept the diagnosis of "burnout" than the diagnosis of "depression". Because it is often assumed that a burnout occurs sooner because you have achieved a lot beforehand – whether at work or privately. Depression, on the other hand, is still widely held to be due to personal weakness. However, this is not the case. In the end, it is only possible to find out whether there is a burnout or a depression through a precise analysis by a therapist.

Burnout symptoms

The symptoms that can occur during a burnout can be roughly divided into different phases. However, the burnout syndrome is individual for everyone – and not all symptoms have to occur in all patients. "The first symptoms that are noticed usually take place on the physical level: the so-called psychosomatic symptoms," explains Prof. Dr. Michael Stark, Professor of Social Psychiatry from the Psychotherapeutic Center for the Treatment of Stress Disorders and Fatigue from Hamburg. These are symptoms for which no organic causes can be found at first.

Later there are often emotional and psychological signs performance may also be affected. The most common of the burnout symptoms, however, is extreme exhaustion.

The German psychologist Prof. Matthias Burisch has developed a 7-phase model in which typical symptoms of burnouts can be sorted. He has defined the following phases for burnout syndrome:

• Phase 1 – High energy consumption and ambition: The person concerned has the feeling of being indispensable – one out of ambition, the other out of idealism – and therefore works a lot. The patient's own needs are suppressed and the patient has difficulty recovering in his free time. Symptoms such as sleep disorders, lack of energy and a higher susceptibility to infection are added later.
• Phase 2 – Commitment decreases, personal withdrawal: The person concerned begins to expect rewards for the hard work from phase 1 and is extremely disappointed and frustrated when they fail to appear. As a result, he no longer feels valued enough, reduces his engagement, is impatient with other people and distances himself from work-related contacts. Compassion ("empathy") gives way to emotional coldness and cynicism – especially in caring professions. Personal leisure and fulfilling his needs are the focus of the patient.
• Phase 3 – Depression, anxiety, blame: The frustration from phase 2 also affects the emotions of those affected. The patient realizes that reality does not adapt to his imagination. For this, he either looks for the blame in his environment, which can lead to aggressive behavior – for example in the form of irritability, intolerance or impatience to anger. Or the person concerned thinks he sees the cause in himself, which can trigger a depressive mood. This manifests itself among other things through dejection, helplessness, lack of drive and a decreasing self-confidence. Prof. Dr. Stark says: "Strong mood swings then lead to frequent depressive moods up to pessimism, fatalism and a feeling of inner emptiness."
• Phase 4 – performance decreases, degradation: The high emotional load and the lack of motivation ensure more mistakes and concentration problems in the job. Creativity and the ability to make decisions decrease, complex tasks can hardly be solved, the person concerned reacts with resistance to desired changes. This leads to poor performance, missed appointments and the like, the energy level is low.
• Phase 5 – disinterest and flattening: The person concerned is indifferent to everything and everyone. The lack of energy ensures that hobbies and social contacts are also abandoned, the patient withdraws.
• Phase 6 – Psychosomatic reactions: Physical ("psychosomatic") complaints can also appear in the initial phase of the burnout, but become particularly clear in this phase. Symptoms of psychosomatics include sleep disorders, indigestion, increased blood pressure, weight gain or loss due to changes in eating habits and muscle tension. Prof. Dr. Stark: "With a wide variety of pain, the body signals its exhaustion, for example through muscle tension, headache and back pain."
• Phase 7 – Despair: The helplessness becomes hopeless. The patient becomes severely depressed, feels that his life is meaningless, and in many cases suffers from suicidal thoughts. "This condition begins to resemble a moderate to severe depression," confirms Prof. Dr. Strong.

Who is affected by burnout?

In theory, everyone can suffer from a burnout – first, the clinical picture was described in medical and nursing professions, for example, among nurses. However, people who volunteer were among the first documented cases.

Whether it actually burns out, depends among other things on the individual resilience. Some people throw a supposedly harmless circumstance or temporary pressure completely off the track, others also master severe crisis situations without running the risk of developing burnout. It becomes difficult when such stresses accumulate in a short time – even the most resistant people can quickly get into a state of exhaustion.

Causes and risk factors of burnout

Burnout can result from both internal and external causes. Generally, two specific types of people are particularly at risk – What they have in common is that recognition from others is very important to them and they have problems expressing their own feelings. The following types have an increased risk of burnout:

• Very ambitious people who are willing to invest a lot in order to achieve an idealistic goal in their eyes.
• Rather passive, sensitive people who suffer from a lack of self-confidence, who yearn for recognition and who are willing to adapt to others.

Other internal causes of burnout

Also the following internal factors increase the risk of burnout:

• Unrealistic goals that can only be achieved through extreme use or goals that are set by others and do not match your own needs
• High expectations for rewards
• Problems saying "no" and / or doing work
• Doubts about the meaningfulness of your own actions
• Problems admitting weaknesses

External causes of burnout

The first phase of burnout is often preceded by a drastic change in the life of the person concerned. For example, this can be a sudden case of care in the family or a new job. But there is also the other way around: For example, if you write an application for an application and only receive rejections or are skipped during the promotion, even though you worked extremely hard for it, you can also get burnout syndrome. The following external factors also increase the risk:

• Feeling of lack of recognition
• Missing or insufficient rewards
• Lack of control or loss of control (perceived)
• Lack of justice
• General overload (in the job or due to private duties)
• Missing social contacts and / or support
• Bureaucratic hurdles
• Smoldering conflicts that are not addressed / resolved

Diagnosis: how does the doctor recognize a burnout?

If unspecific symptoms such as sleep disorders or exhaustion persist, those affected usually first consult their general practitioner. In the first step, he will ask about symptoms and often about personal circumstances. In doing so, he asks, for example, whether the patient has recently worked more than usual and / or whether he has difficulty switching off in his free time. With this, the doctor often approaches the burnout diagnosis. In the next step, a physical examination should rule out other possible (including chronic) diseases – An underactive thyroid could also be responsible for persistent fatigue.

If the suspicion of burnout hardens, the patient is referred to a psychologist or psychotherapist. Using a clinical interview, the patient can determine whether there is actually a burnout. There are various tests for this, the most common being the Maslach Burnout Inventory (MBI). This includes 22 questions that primarily relate to the exhaustion, depersonalization and personal satisfaction of the person concerned. But Prof. Burisch has also developed a frequently used burnout test.

Burnout: which therapy helps?

Since burnout can lead to suicidal thoughts in the worst case, it is important that it is treated professionally as soon as possible. The therapy is carried out individually based on the symptoms and personality of the patient. For example, cognitive behavioral therapy can help, such as Prof. Dr. Strongly explained: "Behavioral therapy assumes that every behavior can be learned, maintained and also learned again according to the same principles. (…) The person concerned should be able to change their own – often habitual – behavior patterns that were previously theirs Well-being in the way. "

In addition, for example Medicines in the form of antidepressants be used when there is severe depression.

During treatment, it is essential that the patient recognizes the diagnosis and is prepared to deal with the extent to which he himself played a role in the development of the disease. If the person affected is only in the initial phase of burnout, a few therapy sessions can often lead to a significant improvement in self-awareness and symptoms. For example, the patient should learn to recognize their own stress limits sooner and how to better resolve conflicts and problems. This short-term therapy is also known as crisis intervention.

The following methods can be used in the therapy of advanced burnout:

• Cognitive behavioral therapy (form of psychotherapy): The concept is intended to help the patient identify behavior patterns that have contributed to the development of burnouts and to change them in a second step.
• Group therapy: Talking to other sufferers can help you face your own problems and relieve you.
• Deep psychological procedures: For example, psychoanalysis can address deep-seated problems such as insufficient self-esteem and can be corrected in a slow process. The procedure can be lengthy and uncomfortable for the patient, but in some cases it has to be done to progress in coping with burnout.
• Move: Research shows that physical exercise can have a positive effect on depression and poor self-image. With the help of so-called body therapy, patients can also learn how to properly perceive their bodies again and, for example, to identify stress-related tension.
• Relaxation techniques: Relaxation procedures such as autogenic training or progressive muscle relaxation are also suitable for the treatment of burnout, as Prof. Dr. Stark explains: "This is often a first step to avoid or reduce tension and stress and to feel positive again."
• Stay in a clinic: If you have a severe burnout, it can also make sense to get treatment in a special burnout clinic. Here, too, an individual treatment plan is drawn up for the patient and the inpatient admission ensures that the person concerned has to deal intensively with himself and the disease without being distracted by external influences.

Responsible and well-trained therapists are the most important prerequisite for a treatment that should do more than harm. – Prof. Dr. Michael Stark

Can I prevent burnout?

Since anyone can theoretically suffer a burnout, everyone should know how to prevent illness – especially those who are not very stress-resistant. The following tips and methods can help prevent burnout:

• Pay attention to needs: The main question here is what is important to you: a lot of free time? Career advancement opportunities? Recognition for achievements? It is important to consider your own needs and desires – they are just as important as those of others. If their implementation fails, For example, in the work environment, a clarifying conversation with the boss and / or colleagues can often help.
• Reduce unrealistic expectations: Even if, for example, recognition is basically a justified need, it hurts to overestimate your own expectations. Here a realistic view of reality and what you can actually expect helps.
• Maintain social environment: Friends and family provide the necessary distance to the job and are there for you even when things are not going so well. It is therefore all the more important to spend time with them actively.
• Build relaxation into everyday life: Everyone relaxes in a different way: while one of them prefers to enjoy a massage to switch off, the other prefers to read a good book. These little breaks from everyday life are essential if you want to prevent burnout.
• Stress Management: Dealing with stress is just as important as your own relaxation. The good thing: you can train stress management.
• Don't expect perfection: Many people particularly at risk of burnout always try to make everything perfect and can hardly handle mistakes. But nobody is perfect – so you shouldn't have this claim on yourself.
• Set (realistic) goals: Similar to the question of wishes and needs, everyone should ask themselves what they want to achieve in life and focus their energy on it. However, it is important to remain realistic.
• Improve lifestyle: A healthy lifestyle also helps prevent burnout. In addition to exercise, this also includes a balanced diet (e.g. through lots of fruit and vegetables, lean meat, fish, milk and whole grain products) and the extensive avoidance of alcohol and cigarettes.
• Learn to say no: Especially those who already have problems creating their own work should definitely learn to refuse requests from others. Incidentally, this also applies to tasks that you do yourself.

Note: This article has been written to the highest scientific standards and has been medically reviewed.

Recommended reading: We tell you more great tricks with a high burnout risk in the article Avoid Burnout. We also explain what fatigue depression is and what you should know about depressed mood.

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Swell:

Prof. Dr. Michael Stark, head of the psychotherapeutic center for the treatment of stress disorders and exhaustion in Hamburg, www.prof-stark.de

Burisch, M .: The Burnout Syndrome, Springer Verlag, 4th edition 2010

Schneglberger, J .: Burnout prevention from a psychodynamic point of view, Verlag für Sozialwissenschaften, 1st edition 2010