Burnout syndrome: what are its causes, symptoms and stages?

In addition to psychological difficulties, burnout syndrome also brings problems in the social sphere of life. It often has a negative impact on a person's physical health. It can lead to long-term incapacity for work.

The key to preventing burnout syndrome is to know its initial signals and prevention.

The most at risk group are people working in the so-called helping professions, e.g. doctors, nurses, workers in social service homes, medical staff working in oncology wards, etc.

The work that a person does should naturally bring satisfaction from a job well done. It should give meaning to the environment and to the person themselves. However, sometimes work is the source of negative factors in a person's life.

These negative factors are due to the conditions in which one works, team and interpersonal relationships, leadership, work style and overall job assignment.

In some types of occupations there is an increased incidence of stress factors that can negatively affect an individual's personality.

Doctors, nurses, social workers and other so-called helping professions are most exposed to such negative stress.

This type of work is characterised by the fact that it requires excessive physical and mental effort on the part of the individual. Moreover, the success rate in these professions is disproportionately low.

Doctors and nurses take frequent failures at work personally. They perceive them as their own failures, incompetence, feelings of helplessness and hopelessness.

A state of psychological exhaustion and hopelessness leads to a condition called burnout syndrome.

The technical name burn-out was introduced into the world of psychology and psychiatry in the 1970s by Henrich Freudenberger.

Burnout is a condition in which an individual experiences excessive physical, emotional and mental exhaustion. This condition is caused by prolonged and excessive persistence in emotionally challenging situations.

Burnout syndrome is different from other emotional, physical and psychiatric conditions:

• Stress - Everyone is stressed at some time, but burnout syndrome only occurs in people who are overly dedicated to their profession, have unreasonable goals, extreme motivation and expectations. These are usually professions in which there is close contact with people.
• Depression - In burnout syndrome, the individual has no feelings of guilt, remorse and relates only to work activities and relationships with colleagues.
• Fatigue - Compared to burnout syndrome, fatigue refers more to physical exhaustion, which can be overcome by rest. Prolonged physical rest or sleep does not help with burnout syndrome.

The causes of burnout involve a number of factors. The factors can be divided into external environmental factors and internal factors that result from the personality type of the individual.

External factors include:

• physical and psychological overload
• often a lack of manpower
• lack of communication in the workplace between management and the team
• lack of positive motivation through rewards, praise, recognition
• competitive team and nature of work

Internal factors include the following character and personality traits:

• goal orientation
• competitiveness
• perseverance
• low self-esteem
• low tolerance to stress
• lack of empathy
• closed-mindedness and lack of communication
• need to help others

Women are more prone to burnout.

This is probably due to the higher workload of women. Women are busy with work and managing household, parenting and childcare on top of that.

Women's greater emotional involvement at work and overall approach to problem solving in the workplace also contribute to their increased risk of burnout.

In addition to these factors, the loss of work ideals, long-term frustration with inadequate pay and existential problems, unfulfilled expectations of social recognition, etc. also contribute to burnout.

For some ambitious and goal-oriented people, there is the so-called terror of opportunity.

This is a situation where an individual cannot resist several tempting job offers and cannot choose. He accepts multiple jobs, sets unrealistic goals and has no boundaries, especially in terms of workload.

Such a person gradually becomes stressed, time-consuming, emotionally stressed and more likely to fail. This leads to loss of self-esteem, worry, psychological exhaustion and burnout.

Symptoms of burnout syndrome manifest primarily in three areas of life:

• Mental health
• social contacts
• physical symptoms

In the mental area, negative emotions and attitudes begin to predominate:

• depressed mood
• disinterest (apathy)
• inability to enjoy anything (anhedonia)
• nervousness
• irritability
• fear
• anger
• anxiety
• lack of focus
• loss of motivation
• exhaustion

In social relationships, there is a loss of contact with the outside world, and disinterest in interpersonal relationships develops.

Medical staff lose interest in patients, resort to clerical work or work alone, empathetic behaviour disappears.

Characteristic features of social behaviour in burnout syndrome are:

• dehumanisation
• irony
• cynicism
• underestimation of patients' difficulties
• incomprehensibility
• contempt
• criticism

Communication with such a person is increasingly difficult. He reacts to any criticism with an outburst of anger or crying, while at the same time he himself makes unreasonable demands on his surroundings and is very critical.

This behaviour carries over into his personal life and family. Relatives are not his support, but rather a burden.

The physical symptoms are associated with psychological difficulties and gradually worsen.

These include:

• chronic physical fatigue
• exhaustion
• weakness
• malaise
• difficulty sleeping
• frightening dreams
• abdominal pain
• diarrhoea
• lack of appetite or overeating
• weight loss or weight gain
• tendency to addiction (alcohol, drugs, medication)

Various mental health questionnaires are used to diagnose burnout, most commonly the BM Mental Health Questionnaire (Burnout Measure).

This questionnaire was compiled by Ayala Pines and Elliot Aronson in 1980 and is still popularly used by many physicians and psychologists.

It contains 21 easy-to-understand questions about an individual's mood and feelings. Answers are assigned by the patient in the form of numbers from 1 to 7. The numbers represent the frequency of feelings (from never to always) that the questionnaire asks about in each question.

The rating consists of the sum of the scores according to the assigned answers.

The questionnaire is a simple and quick way of diagnosis.

The course of burnout syndrome has several characteristic phases:

1. The enthusiasm phase - The joy and motivation with which workers, such as doctors and nurses, enter a new job.
2. Stagnation phase - Comes after entering a "reality" that is not what they imagined and expected. Disappointment, demotivation, loss of enthusiasm for the job and negative emotions begin to prevail. If the problem is not addressed, the next phase sets in.
3. The frustration phase - In a long term unresolved bad situation in the workplace, physical and psychological exhaustion gradually occurs. Workers begin to question what the meaning of their work is, whether they are being sufficiently rewarded for it. It is not only about financial reward, but also about gratitude, praise and recognition from those around them.
4. The apathy stage - The worker in the previous stage does not find a positive meaning in his work. He gets into a state where he is no longer interested in the work, he does not care, he does not try. He becomes withdrawn. The negative mood is reflected in the communication with the patient. Empathy disappears, misunderstanding, irony and dehumanization come. If he does not ask for help in this stage, the last stage comes - the burnout itself.
5. The burnout stage - Complete mental, emotional and physical exhaustion. It manifests itself in physical problems that often lead to the worker's incapacity.

Burnout itself has three phases:

1. The first stage of burnout is characterised by the time pressure that workers, particularly in the health care sector, often experience. The situation is caused, for example, by inadequate staffing, equipment, the need to work in shifts and frequent night shifts. In addition, this feeling of distress can also be caused by a lack of expertise, ignorance of the treatment or diagnostic process. Those who have difficulty coping skilfully with stressful and emotionally demanding situations are the most vulnerable.
   • There is a sense of hopelessness and a decline in self-esteem, which the employee carries over into his or her personal life.
2. The second stage is characterised by an incipient neurosis as a result of prolonged exhaustion. The desire to remedy, resolve and change the situation is at the forefront. It is characterised by the word 'must'.
   • However, the result of this incessant need to do something is chaos, distraction, lack of focus, frequent mistakes and a pile of unfinished work.
3. In the third phase, apathy and disinterest in work set in. The word 'must' becomes 'don't have to'.
   • Anhedonia sets in, which is the feeling of not being able to enjoy anything. One does not feel good about a job well done, nor does one enjoy any of the activities that used to satisfy one's professional or personal life. Resistance and disappointment end in exhaustion and chronic fatigue.

Prevention

Preventing burnout is the easiest prevention. It is possible to avoid the difficult life situation that burnout brings.

We have summarised the principles in a few points:

• setting realistic goals
• Awareness of one's own capabilities and abilities
• knowing your limits
• division of responsibilities (for managers)
• balance between activity and rest
• Prioritising active rest
• inclusion of activities outside work
• striving for the best possible communication
• showing appreciation to those around you
• accepting supervision of your work
• empathy and respect for patients (for healthcare professionals)