Burnout

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Classification according to ICD-10
Z73 Problems related to difficulty coping with life

Incl. Burn-out ICD-10-GM

ICD-10 online (WHO version 2019)

Burn-out or burnout (also burnout syndrome, from English burn out , "burn out") is a generic term for certain types of personal crises that occur as a reaction to constant stress and overload in the workplace .

General

Burn-out is associated with emotional exhaustion, a feeling of being overwhelmed and reduced performance satisfaction. The symptoms, however, are described inconsistently ( Matthias Burisch identified more than 130 symptoms) and overlaps with those of various other disorders (e.g. depression ). Burnout syndromes can begin with rather inconspicuous early symptoms and lead to complete inability to work or suicide .

The role of stress is often referred to as a cause of burnout; Both external factors of the (work) environment and personal dispositions (such as perfectionism or the inability to delimit) are discussed. Burnout can also go hand in hand with depersonalization as a result of a discrepancy between one's own expectations and reality and can be the final stage of a process of idealistic enthusiasm over disillusionment, frustration and apathy. The lifetime prevalence of burnout in Germany is 4.2% and the 12-month prevalence 1.5% , according to the representative “Study on Adult Health in Germany ( DEGS1 )”.

history

Herbert Freudenberger's observations , which he made in the course of his voluntary work in a free clinic and published in 1974 under the title Staff Burn-Out , are considered to be the context of the discovery . The term burnout appeared repeatedly in public in the United States in the 1970s in connection with the nursing profession. It had already become popular in 1960 with the novel by Graham Greene entitled A Burnt-Out Case . The first scientific articles on this topic alongside the article by Freudenberger appeared from 1976, for example by the social psychologist Christina Maslach ( University of California, Berkeley ). In this basic work, burnout syndrome is described as a reaction to chronic stressors at work. According to Maslach, it has three dimensions:

  1. an overwhelming exhaustion (overwhelming exhaustion) by a lack of emotional and physical resources (energy) as a personal aspect,
  2. Feelings of cynicism and detachment (detachment) of the professional task (job) as interpersonal aspect and
  3. a feeling of ineffectiveness ( inefficacy - due to a lack of resources) and reduced performance as an aspect of self-assessment (self-image; see self-efficacy expectation ).

Professions that work with people (as clients ) who are in emotionally stressful situations are particularly affected . Since the 1990s, burnout has been discussed again and again in connection with other professional groups, which, however, must be assessed critically on the basis of meta-analyzes. Since 2007, the discussion on burnout threats and causes has generalized to management staff. The term burnout has also spread in the media. Many psychiatrists , on the other hand, consider the burnout syndrome to be a fashion diagnosis , which, as the basis of numerous certificates of incapacity for work, has become a health- economic factor and can hinder the diagnosis of depression.

Burnout as a diagnosis

In the International Classification of Diseases (ICD-10), burnout is assigned to the factors that influence the state of health and lead to the use of the health system (Z00-Z99) - in particular to characterize people who use the health system for other reasons (Z70 -Z76). In the German adaptation ICD-10-GM, burn-out belongs to category Z73 as "burned out" - together e.g. B. with the "state of total exhaustion". Section Z73 comprises “Problems relating to difficulties in coping with life”. In the current classification system of the American Psychiatric Association , the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ), burnout is not listed as an independent diagnosis .

In contrast to depression, burnout is not a treatment, but a framework or additional diagnosis. A pure burnout syndrome is an exclusion criterion for neurasthenia (F48.0), which is described in the diagnosis as burnout-based and can justify a health insurer's obligation to provide benefits. The is depersonalization (F48.1) considered a possible symptom of burnout.

In the ICD-11 version, which is to apply from January 2022, burn-out is defined as a syndrome due to “stress in the workplace that cannot be processed successfully”. It expressly states that the syndrome should not be used to record experiences in other areas of life, but should be limited to the workplace.

Symptoms

The leading symptoms are non-specific with exhaustion and reduced performance. If one follows the diagnosis code of the ICD (vital exhaustion) and takes the research results for the diagnosis of burnout syndrome since the mid-1970s as a basis, then the most important validated test procedures show which symptoms the burnout syndrome is operationalized today. The starting point is the Maslach Burnout Inventory (MBI) , which is most frequently used worldwide . This was modified by the Copenhagen Burnout Inventory (CBI) and the Oldenburg Burnout Inventory (OLBI), but not changed in essence. On this basis, the symptoms can be divided into three categories (dimensions):

Illustration of symptoms of burnout syndrome
  1. Emotional exhaustion ( exhaustion or fatigue ): This exhaustion results from excessive emotional or physical exertion (tension). It is the stress dimension of burnout syndrome. Those affected feel weak, powerless, tired and dull. They suffer from weak drive and are easily irritable.
  2. Depersonalization: With this reaction to the overload, those affected create a distance between themselves and their clients (patients, students, people in need of care or customers). This manifests itself in an increasing indifference and sometimes cynical attitude towards them and the work becomes an impersonal routine.
  3. Experiencing failure : Those affected often have the feeling that despite being overworked, they are not achieving or achieving much. There is a lack of experiences of success . Because the requirements are increasing quantitatively and qualitatively and are constantly changing, one's own performance appears low compared to the growing requirements. The affected person perceives this discrepancy between requirements and performance as personal ineffectiveness or inefficiency. This is one of the consequences of depersonalization, because those affected have moved away from their clients and can no longer effectively respond to their expectations. Belief in the meaning of one's own activity suffers as a result.

The symptoms of burnout syndrome are similar to those of boreout syndrome : The term comes from the English bore = (to be) bored and describes the state of insufficient professional demands and dissatisfaction. This condition can be accompanied by a high level of activity and reduced productivity as well as emotional exhaustion.

Diagnosis and delimitation of burn-out

The symptoms associated with burnout can also indicate other mental illnesses. Therefore, a diagnosis can only be made by appropriately qualified experts.

According to the ICD, burnout can be used in differential diagnosis when there is no occupational disability or no other psychiatrically defined illness such as neurasthenia (F48.0), panic attack (F41.0) and no general fatigue (R53) that occurs after hard work or too short sleep occurs. The construct validity of the burnout syndrome was the subject of scientific discussion as early as the 1980s and it became clear that burnout correlates more closely with depressive tendencies than with job satisfaction and that there is overlap in this relationship.

In addition to general diagnostic methods (e.g. taking anamnesis ), specific questionnaires are also used for diagnostics . The diagnosis is not based solely on the individual, but also includes environmental conditions ( stress and other objective characteristics of the activity as well as social relationships). Diagnostics can also be dependent on external assessment . The specialist decides which diagnostic tool to use. Tests provided anonymously can usually not provide a reliable diagnosis of burnout. This also applies to the now unmistakable variety of guides that have not been created by specialists.

Suitable and frequently used questionnaires are:

  • The Maslach Burnout Inventory - MBI, in which statements from the categories emotional exhaustion, depersonalization and performance satisfaction have to be answered according to intensity and frequency . The questions in the first version of the MBI related exclusively to helping professions . In later revisions, a version for teachers (MBI-Educators Survey) and a cross-professional version (MBI-General Survey) were introduced. The only official German translation of the MBI (the MBI-D) refers to "patients".
  • The Trier inventory on chronic stress - TICS records on the one hand the requirements ( work overload , social overload and pressure to succeed ) and on the other hand the lack of satisfaction of needs (dissatisfaction with work, excessive demands, lack of social recognition) as well as social tension and isolation.
  • The Copenhagen Burnout Inventory - CBI aims to overcome some of the disadvantages of the MBI and measures burnout using 19 items in the three scales: (1) extent of personal experience of exhaustion (physical and psychological), (2) stress and exhaustion that are ascribed to work and (3) frustration and exhaustion resulting from working with clients.

Burnout phases

Herbert Freudenberger and his colleague Gail North have identified twelve phases in the course of the burnout syndrome. However, the order does not have to be as in the following listing:

  1. Urge to want to prove something to yourself and to other people
  2. extreme striving for achievement in order to be able to meet particularly high expectations
  3. Overwork with neglect of personal needs and social contacts
  4. Overwriting or ignoring internal problems and conflicts
  5. Doubts about one's own value system as well as about things that were previously important, such as hobbies and friends
  6. Denial of emerging problems, lowering of the tolerance limit
  7. Withdrawal and avoidance of social contacts to a minimum
  8. obvious changes in behavior, progressive feeling of worthlessness, increasing anxiety
  9. Depersonalization through loss of contact with oneself and with other people; life is increasingly functional and mechanistic
  10. inner emptiness and desperate attempts to cover up these feelings through overreactions such as sexuality, eating habits and drugs
  11. Depression with symptoms such as indifference, hopelessness, exhaustion and a lack of prospects
  12. first thoughts of a suicide as a way out of this situation; acute danger of mental and physical breakdown

Causes and favorable conditions

stress

Since research began on burnout syndrome, it has been described as a reaction to chronic stressors at work. According to Jaggi, burnout is physical, emotional and mental exhaustion due to work overload. According to Richard Lazarus , burnout is triggered by stress that, from the perspective of the person concerned, cannot be managed. It is a subjectively perceived gap between

  • external (professional) requirements or burdens on the one hand and
  • individual abilities to cope with the demands on the other hand.

This discrepancy is often linked to feelings of powerlessness. Central is the (supposed or correct) assumption of excessive demands or lack of control ( conviction of control ). According to David Myers, some animal experiments were carried out for this purpose, the findings of which can also be transferred to humans.

Imbalance between achievement and recognition

To explain the causes of the burnout syndrome, the concept of the imbalance of performance and recognition, or ERI (Effort-Reward-Imbalance Model) by Johannes Siegrist, is often used. Theoretically, it is based on reciprocity , the legitimate expectation that one will receive recognition for achievements. To investigate this imbalance, Siegrist has developed the internationally applied and more validated measuring instrument, the questionnaire for recording professional gratification crises (ERI questionnaire). The questionnaire is available as a long and a short version.

Examples of scales and items according to the English version of the ERI are:

  • "Effort"
    • "I'm under constant time pressure."
    • "I have a lot of responsibility."
    • "I am often disturbed at work."
    • "In the last few years my job has become more and more demanding."
  • "Reward"
    • "I am not treated with the necessary respect by my superiors."
    • "I don't get adequate support in case of difficulties."
    • "I am often treated unfairly."
    • "My professional future is uncertain."

In addition to the imbalance between effort and reward , the ERI model also takes into account the aspect of overcommitment (excessive propensity to spend or over-commitment) as an independent influencing factor. According to Siegrist, this is the intrinsic component of exertion. The excessive tendency to spend can be understood as a bundle of behaviors, emotions and cognitions. When developing the scales for measuring overcommitment, the concept of striving for control was used as a further development of the type A behavior concept by Friedman and Roseman. The so-called A-type behavior characterizes people who are often highly qualified or active in social professions.

The fact that bonus crises, measured with the ERI model, can lead to burnout syndrome with a certain probability is plausible on the basis of studies that show their influence on essential elements of burnout syndrome such as "vital exhaustion" and depressive moods.

Since the use of the ERI questionnaire is a recognized procedure in the context of occupational health and safety, no individual behavioral preventive measures to build up skills are derived from the results obtained, but structural measures that are preventive. This model appears to be somewhat better suited to predicting work-related mental health problems than the JDC (S) model by Karasek et al. a.

Burdens from the workplace

In Karasek's (1979) requirements control model , two characteristics of occupational activities were first identified in order to assess their characteristics:

  • the amount of requests ( demands ) which are placed on the work, and
  • the amount of control ( control ), which one has in relation to its work.

According to this model, a particularly high health risk (in so-called high strain jobs ) is when a high level of requirements and a low level of control (in the sense of one's own decisions) coincide. According to this, the health of those people are endangered by work stress who are constantly subject to high demands, for example by intensifying work , while at the same time the control and the freedom of decision in the execution of the tasks are limited. Typical examples are industrial workers on the assembly line, salespeople in the supermarket or employees in call centers. High work demands are also placed on senior managers or doctors in the hospital, but they usually have greater scope for control and decision-making.

The model was expanded by Johnson and Hall in 1988 to the Job Demand Control Support (JDCS) model by an additional factor:

  • Support as social support: socio-emotional support ( socioemotional support ) in the form of compassion, attention, etc. negative to mitigate the psychological effects of stress ( job strain social) and instrumental support ( instrumental social support ) as a direct, job related assistance by the Additional resources are made available to the individual.

A lack of support can further increase the extent of the psychological risk and social support can alleviate the stress (the mental strain ). Karasek and Theorell also speak of the demand control support model in 1990.

Job demand control and support model reduce the factors that influence the reality of work on health to a few assumptions. While the so-called strain hypothesis (stress caused by work demands) of the models has been confirmed by studies, the state of research on the so-called buffer hypothesis (moderating influence through decision-making latitude) is inconsistent.

Burnout prevention

The Occupational Safety and Health Act has stipulated the risk assessment of psychological stress in Section 5 (3) No. 6 since 2013. The investigation of psycho-mental stress in companies is standardized internationally by EN ISO 10075 . In companies with employee representatives they have in distinguishing between legitimate and harmful burden incorrect loading participation rights . Risk assessments determine stresses as a property of the workplace and not the stress on individual employees. An obligation of the employer to assess psychological stress can also be found in the VDU work regulation .

Since burnout is not considered a disease, the recommendations for prevention vary depending on the explanatory model. A distinction can be made between measures for relational prevention, which address (occupational) stress, and measures for behavioral prevention, which are dedicated to the individual and his or her resilience . To distinguish between different types of prevention, see Disease Prevention .

Relationship prevention

In the professional environment that gives Labor Protection Act of environmental prevention priority. Relationship preventive measures are described in the article Stress (Psychology) . Occupational health and safety regulations oblige employers to ensure through preventive measures that the burdens associated with a job are not harmful to health.

In the professional field of social work , in addition to support and appreciation from colleagues and superiors, the offer of supervision and enough time for leisure activities (e.g. sport) are important for burnout prevention. It is also important to avoid too high the number of cases when working with difficult client groups.

Behavior prevention

In occupational health and safety, individual protective measures are “subordinate to other measures”, but employers can also support behavioral preventive measures. Measures to strengthen self-management , self-control and self-regulation as well as the positive effects of volition as well as leadership concepts are discussed .

Treatment of burnout

In standard psychotherapeutic works there are hardly any specific references to the treatment of burnout, presumably because burnout itself is not very specific. Christina Maslach, co-founder of burnout research, pointed out that teachers, doctors, nursing staff or prison guards evade uniform intervention due to different burnout profiles. Against this background, therapy proposals are often limited to very general recommendations for the use of Western or Eastern medicine, for the doctor-patient relationship, for striving for satisfaction, the search for interpersonal support or the improvement of social skills.

A meta-study on the effectiveness of intervention programs for burnout syndrome, which dealt with 68 percent personal, 8 percent organizational and 25 percent a combination of both aspects, shows that around 80 percent of the programs lead to a noticeable weakening of the Burnout syndrome. Even if this speaks for the effectiveness of interventions in burnout, the authors believe that the interventions are individual measures that are not based on a scientifically based explanatory model of the burnout syndrome. The measures did not go beyond the level of common sense , the research on this was just beginning.

Economic significance of burnout

The economic importance is assessed differently. The European Agency for Safety and Health Protection at Work put the economic follow-up costs of the burnout syndrome in the EU at around 20 billion euros annually in 2010 . In contrast, the DAK determined a significantly lower number of sick reports due to burnout in 2013 and stated that the spread of burnout was "significantly overestimated".

Burnout in literature

The term became more popular thanks to the story A Burnt-Out Case by Graham Greene from 1960. It describes a disaffected architect who gives up his job to then live in the African jungle ( dropout ). Miriam Meckel described her experiences with burnout syndrome in her autobiographical novel Letter to my Life , which was filmed with Marie Bäumer in the lead role. In the meantime, the emotional exhaustion of burnout is receiving wide attention in the interdisciplinary advisory literature on coping with stress as well as in the health tourism sector.

Broadcast reports

Web links

Ulrike Gebhardt: Mental illnesses: burnout and what's behind it. In: Spektrum.de. Spectrum of Science, May 21, 2019, accessed September 25, 2019 .

See also

literature

  • Serge Brand, Edith Holsboer-Trachsler: The Burnout Syndrome - an overview. In: Therapeutischer Umschau , 67 (11), 2010, pp. 561-565.
  • Ellen Braun, Steffen Hillebrecht: Operational perception of burnout. In: Der Betriebswirt , Vol. 54, No. 3/2013, pp. 16–22.
  • Petra Buchwald, SE Hobfoll: Burnout from a resource- theoretical perspective. In: Psychology in Education and Teaching. 51. 2004, pp. 247-257.
  • Matthias Burisch : The Burnout Syndrome. Internal exhaustion theory . Springer, 2006, ISBN 3-540-23718-6 / 4. Revised. 2010 edition, ISBN 978-3-642-12328-3 .
  • Cary Cherniss: Beyond Burnout. Helping Teachers, Nurses, Therapists and Lawyers recover from Stress and Disillusionment . Routledge, New York 1995, ISBN 0-415-91206-7 .
  • Position paper Burnout . DGPPN German Society for Psychiatry, Psychotherapy and Neurology, March 7, 2012.
  • Constant availability - how stressed are we? In: IAG Report , 1/2012, accessed on February 22, 2013.
  • Herbert Freudenberger, Gail North: Burnout in women. About the feeling of being burned out . 13th edition. Fischer-Taschenbuch-Verlag, Frankfurt 2008, ISBN 978-3-596-12272-1 .
  • Linda V. Heinemann, Torsten Heinemann: Burnout Research: Emergence and Scientific Investigation of a Contested Diagnosis . In: Sage Open . tape 7 , no. 1 , 2017, doi : 10.1177 / 2158244017697154 ( [1] ).
  • Ferdinand Jaggi: Burnout - practical . Georg Thieme Verlag, Stuttgart / New York 2008, ISBN 978-3-13-145901-5 .
  • Christian Julmi, Ewald Scherm : Burnout despite low requirements: Why unemployed people can also get burnout . In: SEM Radar. Journal for systems thinking and decision-making in management . tape 12 , no. 2 , 2013, p. 17–27 ( fernuni-hagen.de [PDF; 192 kB ]).
  • Roland von Känel: The Burnout Syndrome: A Medical Perspective. In: Practice. Volume 97, Bern 2008, pp. 477-487 ( congress-info.ch PDF).
  • Tage S. Kristensen, M. Borritz, E. Villadsen, KB Christensen: The Copenhagen Burnout Inventory: A new tool for the assessment of burnout. In: Work & Stress , July-September 2005; 19 (3), pp. 192-207.
  • Wolfgang P. Kaschka, Dieter Korczak, Karl Broich: Fashion diagnosis burn-out . In: Deutsches Ärzteblatt , 46/2011, pp. 781–787; Review article.
  • Christina Maslach, Wilmar Schaufeli, Michael Head: Job Burnout. In: Annual Review of Psychology , 52, 2001, pp. 397-422.
  • Sieghard Neckel, Greta Wagner (ed.): Performance and exhaustion. Burnout in a competitive society . Suhrkamp, ​​Berlin 2013, ISBN 978-3-518-12666-0 .
  • Svenja Niescken; Ellen Braun: Prevention of Depression and Burnout in the Workplace. In: Der Betriebswirt , Volume 53, No. 2/2012, pp. 8–12.
  • Peter Schulz, Wolff Schlotz, Peter Becker: Trier inventory on chronic stress . Hogrefe, Göttingen u. a. 2004.
  • Stefanie Weimer, Maureen Pöll: Burnout - a treatment manual: modular module for individual therapy and groups, clinic and practice. Klett-Cotta, Stuttgart 2012, ISBN 978-3-608-89123-2 .
  • Wilmar B. Schaufeli, Bram P. Buunk: Burnout: An Overview of 25 Years of Research and Theorizing. In: Marc J. Schabracq, Jacques AM Winnubst, Cary L. Cooper (Eds.): The Handbook of Work and Health Psychology. 2nd Edition. John Wiley & Sons, Chichester 2003, ISBN 0-471-89276-9 , pp. 383-425.

Individual evidence

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  60. ↑ Margot van der Doef, Stan Maes: The Job Demand-Control (-Support) Model and psychological well-being: A review of 20 years of empirical research. In: Work & Stress 13 (1999), pp. 87-114
  61. ^ Decisions AZ 1 ABR 4/03 (see in particular points 12 and 33) and AZ 1 ABR 13/03 of the Federal Labor Court on co-determination from 2004.
  62. ↑ On burnout as a subject of occupational safety, for example: Bavarian State Office for Health and Food Safety
  63. ↑ Irmhild Poulsen: Burnout prevention in the professional field of social work. VS Verlag, Munich 2009, p. 59 ff.
  64. ↑ Occupational Safety and Health Act , Section 4
  65. ^ Albert Bandura: Social Cognitive Theory of Self-Regulation. In: Organizational Behavior and Human Decision Processes , 50, 1991.
  66. ↑ Evaluated specialist literature (selection): Roy F. Baumeister, Kathleen D. Vohs (Eds.): Handbook of self-regulation, research, theory ans applications . Guilford Publications, New York 2004. Joseph P. Forgas et al. a. (Ed.): Psychology of Self-Regulation . New York 2009. Rick H. Hoyle (Ed.): Handbook of Personality and Self-Regulation . Blackwell Publishing, 2010
  67. ^ Howard Gardner: Leading Minds, An Anatomy of Leadership . New York 1995
  68. ^ H. Levinson: Burn Out. In: Harvard Business Review , July-August 1996
  69. ↑ Selected examples for standard textbooks without burnout syndrome: Klaus Grawe: Neuropsychotherapie . Göttingen 2004. Luc Isebaert: Kurzzeittherapie . Stuttgart 2005. Christian Reimer, Jochen Eckert, Martin Hautzinger, Eberhard Wilke: Psychotherapy . 3. Edition. Heidelberg 2007. Claas-Hinrich Lammers: Emotion-related psychotherapy . Stuttgart 2008. Reinhold Becker, Hans-Peter Wunderlich (Ed.): How does psychotherapy work . Stuttgart 2007. David Myers: Psychology . 9th edition. New York 2008
  70. ^ F. Jaggi: Burnout - practical . Stuttgart 2008, p. 6
  71. ↑ C. Maslach, WB Schaufeli, MP Head: Job Burnout. In: Annual Review of Psychology , 2001, pp. 407 ff.
  72. ^ M. Nelting: Burnout . Munich 2010, p. 285 ff.
  73. ^ F. Jaggi: Burnout - practical . Stuttgart 2008, p. 6
  74. ^ W. Awa, M. Plaumann, U. Walter: Burnout prevention: A review of intervention programs. In: Patient Education and Counseling , 78, 2010.
  75. ↑ Quoted from: Wendy Awa and co-authors: Burnout prevention: A review of intervention programs. In: Patient Education and Counseling , 78, 2010, pp. 184-190.
  76. ↑ Health Report 2013. Accessed on February 11, 2020 .
  77. ↑ Burisch, 3rd ed. 2006, p. 6.
  78. ↑ Miriam Meckel in an interview with Julia Kainz: Letter to my life. Freely based on motifs from the book of the same name by Miriam Meckel. In: ZDFmediathek. April 25, 2016, accessed September 7, 2019 .
  79. ↑ Danny Penman, Vidyamala Burch: Pain Free Through Mindfulness: The Effective Method for Relief from Illness and Stress . Rowohlt Taschenbuch, Reinbek 2014, p. 1 ff.
  80. ↑ Burnout - just exhausted or already sick? In: Guest Landscapes Rhineland-Palatinate. Rheinland-Pfalz Tourismus GmbH, accessed on August 8, 2019 .