Burnout: causes, symptoms and solutions to prevent professional exhaustion

By: Dr Davide Scelsa, occupational health doctor at the Office of Occupational Medicine (OMT)

Professional exhaustion syndrome (more commonly known as “burnout”) is not currently included in the International Classification of Diseases (WHO ICD-10), or in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). It is a collection of signs and symptoms (a syndrome) first described by healthcare professionals in the 1970s, notably by social psychologist Christina Maslach.

Evaluation and impact of burnout in the workplace

Quantifying burnout is a complex task given the lack of an agreed definition that really works, and the fact that it is not recognised as a disease results in absences from work that are usually attributed to depression. The Institut de Veille Sanitaire (French Institute for Public Health Surveillance) estimated that burnout affects around 7% of the 480,000 employees suffering from work-related mental health issues – that’s just over 30,000 people. (1) According to a European Agency for Safety and Health at Work report, 50–60% of lost working days in the European Union are associated with workplace stress. (2) A joint survey by the INRS (French National Research and Safety Institute for the Prevention of Occupational Accidents and Diseases), Arts et Métiers ParisTech (the French engineering and research institute of higher education) and the Groupe de recherche sur le risque ,l’information et la décision (Research Group on Risk, Information and Decision-Making) suggests that in 2007, workplace stress cost a minimum of between €1.9 billion and €3 billion. (3) Burnout is a commonly heard term, but one that is sometimes used without any real understanding.

How do psychosocial risk factors affect employees’ emotional wellbeing?

This is a vast and complex topic. The purpose of this article is not to provide a comprehensive description, but rather to open a window onto it. Using an analogy to simplify the concept, imagine burnout as the result of a chronic interaction between an (excessive) external force and resistance, the individual, which is slowly eroded over time. It is vital, in this context, to take into account the “emotional” aspect of work. On the one hand, then, there is the force represented by psychosocial risk factors, factors which are produced by workplace organisation, employment conditions and employee relations. Examples include value conflicts, a lack of autonomy, verbal abuse and job insecurity. On the other hand is the individual and his or her capacity for resilience. Every morning, we go to work with our ability to adapt, but also with our own baggage and our temperament.

The aspects and clinical presentation of burnout

It also appears that the people most likely to develop this syndrome are those who have a strong commitment to their work; those who are conscientious, hyper-organised and diligent. The syndrome is traditionally described according to its three aspects: Emotional exhaustion: the feeling of being completely worn out (physically and mentally), with extreme fatigue which is not relieved by rest. Dehumanisation: the person becomes emotionally distant from their work colleagues (loss of empathy) and may become “cynical”. Reduced personal achievement at work: the feeling of not being at the top of one’s game, disengagement, loss of professional identity. Clinically, the syndrome can present as (this is not an exhaustive list): Fear, sadness, withdrawal, irritability and sometimes aggression, and addictive behaviours (emotional and behavioural symptoms) Trouble sleeping, chronic fatigue, muscle tension, nausea (physical symptoms) Difficulty with concentrating, decision-making and multitasking (cognitive symptoms) Burnout is not the same as depression, but it can lead to it.

How to respond

By adopting preventive measures (primary prevention), taking action to tackle psychosocial risk factors to reduce the “force” of pressure. On an individual basis, by early detection of warning signs through listening to people carefully. It is worth emphasising the importance of synergy between the occupational health doctor and the GP, as well as specialist psychiatric/psychotherapeutic care where needed. 

1. Imane Khireddine, Audrey Lemaître, Julie Homère, Julie Plaine, Loïc Garras, Marie-Christine Riol, Madeleine Valenty and the Groupe MCP 2012, “La souffrance psychique en lien avec le travail chez les salariés actifs en France entre 2007 et 2012” [“Work-related mental health issues in current employees in France between 2007 and 2012”], Bulletin épidémiologique hebdomadaire, 2015
2. European Agency for Safety and Health at Work, OSH in figures: Stress at work – facts and figures, 2009.
3. Christian Trontin, Marc Lassagne, Stéphanie Boini, Saliha Rinal, “Le coût du stress professionnel en France en 2007” [“The cost of workplace stress in France in 2007”], INRS, 2010.