Burnout: recognize the symptoms | gesundheit.de

Burnout syndrome, often simply called burnout, describes a state of extreme mental and physical exhaustion. In addition to the feeling of “being burned out” with decreased performance and chronic fatigue, there are a wide variety of symptoms, all of which have in common that they are caused by excessive stress – in most cases due to work overload, but caring relatives can also lead to the fact that people “burn out”. Symptoms in men and women are largely identical. How does burnout manifest itself physically and how can the psychological signs of a burnout syndrome be identified? How do you differentiate the warning signs from those of depression? In this series of photos, you’ll learn what symptoms should make you think of burnout.

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Exhaustion and tiredness as a symptom of burnout

Exhausted exhausted man at desk
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There are many signs of exhaustion. Work-related stress usually leads to a persistent feeling of exhaustion and tiredness. Those affected feel overwhelmed by their work and often no longer feel up to the professional demands. In everyday life, too, they feel more and more that they are overwhelmed by the tasks that arise every day. The need for breaks increases, but sufficient rest and relaxation are no longer possible even in the rest phases.



Sleep disorders in burnout syndrome

Woman with exhaustion lies awake having trouble sleeping
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Despite permanent tiredness, those affected cannot fall asleep at night and often wake up too early in the morning. Disturbed sleep behavior means that much-needed recovery cannot begin and symptoms of exhaustion continue to develop. Elevated levels of the stress hormone cortisol lead to persistent alert states. In addition, fewer growth hormones are released, which ensures a deep and restful sleep. Disturbed hormonal balance greatly deprives the body of its ability to compensate for stress at work.



Loss of meaning in life and resignation as warning signs

Resigned man with exhaustion
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Although those affected initially see great importance in their work and immerse themselves in it with enthusiasm, this enthusiasm often gives way to dissatisfaction and a feeling of insufficient appreciation or recognition. Eventually, a certain indifference and inner emptiness arises. They lose all joy in their work and are no longer able to find the lost zest for life in their spare time. Everything is perceived as exhausting and stressful, hopelessness and cynicism determine the thinking of those affected.



Reduced performance as a sign

Woman with exhaustion has trouble concentrating
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Especially people who demand a lot of themselves and their performance tend not to know their own limits and develop a burnout syndrome. High expectations, perfectionism and a hunger for recognition gradually lead to the feeling of having to do more and more and finally to “exhaust” one’s strength. This also reduces physical and mental performance: the error rate increases, concentration and memory problems occur, complex activities become increasingly difficult, and difficulties in making decisions are noted.



Restriction of social contacts and loneliness.

Woman with exhaustion sits alone on the floor
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Due to the growing feeling of insignificance, the loss of old interests and the characteristic exhaustion, those affected by burnout withdraw more and more. The family, the circle of friends and the couple are neglected and hobbies are abandoned due to lack of drive. The inner detachment and depersonalization make those affected appear bored and uninterested in front of others, sometimes they also react with irritability, suspicion or aggressiveness. People are often unexplained and closed-minded to questions, so caregivers may confuse psychological symptoms with classic depression.



Psychosomatic symptoms of burnout syndrome

Woman with exhaustion has back pain
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As a consequence of mental problems, other psychosomatic symptoms usually occur in addition to sleep disorders. It refers to ailments that cannot be explained organically and that, consequently, are attributed to psychological causes. Some examples are physical symptoms such as:

  • Backaches, headaches, tension
  • dizziness
  • Abnormal sensations (“tingling”)
  • indigestion
  • sexual problems such as erectile dysfunction or sexual reluctance

In addition, the body’s own defense system can become overwhelmed and infections, such as colds, occur more frequently.



Substance abuse and addictions

Man with exhaustion smokes and drinks alcohol
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Similar to non-occupational depression, people affected by burnout also tend to use more alcohol and tobacco products. The abuse of other addictive substances and drugs is also significantly higher among them.

Addiction and subsequent physical damage can make it very difficult to return to normal daily life and pose a huge obstacle to a healthy lifestyle. Statistics also show that the accident rate among those affected with a tendency to dependence is significantly higher than among the rest of the population. Men are affected much more often than women.



Late effects and permanent damage

Desperate woman with exhaustion
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In many cases, burnout is not recognized early and therefore not treated. Then depression can develop in the long term; this is the most common consequence of burnout. Lack of drive, rapid tiredness and loss of interest, as well as depressed mood and low spirits, develop in the long term.

In addition, many patients develop anxiety disorders, usually in the form of panic reactions and somatoform illnesses. This refers to physical ailments that are not or insufficiently attributable to organic disease. Addictive disorders that arose during the active exhaustion phase (eg, alcohol, drugs, gambling) are often lifelong and require therapy in turn.

Diabetes mellitus and cardiovascular diseases, which result from a lack of exercise and an unhealthy diet, are also possible long-term consequences.



Damaged heart as a result of exhaustion

Woman with exhaustion has heart problems
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Burnout syndrome not only affects people mentally, but also causes physical damage. The heart is particularly affected. Although perceived stress and depressive moods lead to lack of exercise and an unhealthy lifestyle, stress also has a direct effect on the autonomic nervous system.

Stress hormones such as adrenaline and noradrenaline can contribute to premature aging of the cardiovascular system and damage the heart muscle and coronary arteries. As a result, increased blood pressure puts pressure on the cardiovascular system and can lead to acute heart problems and even life-threatening cardiac arrhythmias, heart attacks, or sudden heart failure. Therefore, stress is considered an important risk factor for cardiovascular deaths.



Burnout syndrome: difficult to diagnose

Therapist makes diagnosis of exhaustion
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Burnout syndrome is not considered an independent disease. Rather, it can be seen as a special form or even a preliminary stage of stress-related depression.

An exact diagnosis is often very difficult and requires a deep psychiatric and psychomotor diagnosis. Since there are no clear diagnostic criteria, the “Maslach Burnout Inventory” (MBI) test is sometimes used, which consists of 22 questions and three criteria and is based on a point system. However, this has not been clinically validated and is therefore of only limited importance.

Internal and neurological exams are also required to rule out other causes that can lead to severe exhaustion. Numerous diseases are possible here, for example diabetes, multiple sclerosis, kidney or thyroid diseases.



Burnout or depression?

man with depression
©Getty Images/Oliver Rossi

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It is usually difficult to make an exact distinction between burnout and depression, as meaningful classification systems are only available for depression. In both cases, the diagnosis is made solely on the basis of symptoms, but these are largely identical.

Therefore, the focus is on the origin of the sensation of “being burned”. Although depression can have numerous causes and its precise elaboration usually takes years, in burnout the professional context (or rarely also the care of relatives) is decisive. According to a review of the diagnostic catalog published by the World Health Organization (WHO) in 2022, one can speak of burnout when exhaustion is the result of “chronic stress at work (…) that has not been successfully managed” .

A professional and detailed history is of paramount importance for the diagnosis. This can only be provided by qualified doctors and psychotherapists. Burnout that is not recognized and treated carries a high risk of developing into depression and therefore requires early and appropriate therapy.

ICD codes for this disease: Z73

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