Exhaustion or burnout?

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. If someone has problems at their workplace, changes in their working environment can already make a positive difference. For people who can no longer cope with the stress of caring for ill relatives, more concrete support can help to improve their situation.

Exhaustion is a normal reaction to stress, and not necessarily 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?

What are the signs and symptoms of burnout?

All definitions of burnout 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 don't have enough energy. Physical symptoms include things like pain and gastrointestinal (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 various questionnaires for self-assessment. But because there's 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 aren't 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's important to consider other possible causes first together with a doctor, and not to conclude you have burnout straight away.

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 it's important to not (self-) diagnose burnout too quickly. Doing so could lead to the wrong treatment: For instance, advising someone with depression to take a long 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 (thinking about killing yourself).

These aren't 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.

Sources

• Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN). S3-Leitlinie und Nationale Versorgungsleitlinie (NVL): Unipolare Depression. AWMF-Registernr.: nvl-005. March 2017.
• Korczak D, Kister C, Huber B. Differentialdiagnostik des Burnout-Syndroms. 2010. (Schriftenreihe Health Technology Assessments (HTA); Volume 105).

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

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