Burnout symptoms causes treatment practical doctor

Burnout can affect anyone in our fast-moving times. A working environment that praises multitaskers, creates high prere to perform, combined with new and changing demands every day, favors serious illnesses. More and more people show the typical symptoms of burnout.

Coupled with numerous private obligations and high demands on oneself, the path often leads to deep exhaustion, from which even a long, relaxing weekend is no longer a way out. The following article clarifies how signs of burnout can be recognized and what measures can be taken

What is burnout?

Burnout is a state of total physical, emotional and mental exhaustion, depersonalization (alienation in the social environment) and reduced performance.

The World Health Organization does not refer to burnout as a disease in its own right, but rather as a problem with the current life situation and management. Burnout is therefore a disease state. In so-called Z-diagnoses, complaints that are common in life are qualified and differentiated from illnesses. Burnout is listed there as a condition of a combination of factors that affect the state of health and lead to the use of medical measures.

According to the Robert Koch Institute, about four percent of German adults are affected by burnout. This corresponds to approximately two million people affected in Germany. In the year 2011 as a peak year already scarcely 60 million work incapacity days were registered due to mental illnesses.

Burnout or depression?

Depression is usually characterized by long-lasting symptoms such as severe joylessness, listlessness, inner exhaustion, coupled with sleep disturbances and hopelessness. Many symptoms of burnout are comparable to depression, but arise from fatigue, overwork, exhausting conflicts or impressive experiences of loss. It is often difficult to determine an exact trigger. However, some symptoms differ significantly. For a burnout it is typical to suffer from depersonalization and dissatisfaction with performance, which is not characteristic for depression.

Often the diagnosis of "burnout" is more readily accepted than that of depression. For many, a burnout means that you have achieved something before, while a depression is mistakenly interpreted as a symbol of weakness. In addition, burnout is often not seen as a disease in its own right, but only as a risk factor for psychological problems or a precursor to exhaustion depression.

Burnout – Causes

Burnout syndrome is a serious personal crisis in which various causes and several disturbance patterns can overlap each other, making a clear diagnosis difficult. The causes of burnout can be of different nature. Often not be directly tangible. Previous excessive strain at work, stress, excessive demands or other personal circumstances are external influences that can lead to the illness. As a rule, however, a persistently high stress level is one of the known triggers. This can take effect externally in the form of great stress at work and/or grow into a burnout syndrome via additional environmental factors.

Personal factors play a major role in the development of burnout. Individual tendencies, such as perfectionism or a lack of separation from other people's expectations, cause high levels of stress for the person affected. Periods of particularly high stress are part of life. This is especially dangerous when stress phases are no longer replaced by regeneration phases.

The cardinal sign is the fact that even recovery phases are no longer sufficient to restore well-being, quality of life and performance. Especially permanent overstrain due to unfulfillable tasks, high time prere and a bad working atmosphere promote the chance of "burning out". With the loss of the regenerative ability it comes to a total exhaustion condition, which makes the own life mastering massively more difficult.

In both professional and personal life, low-level factors can play a major role in the process:

– Lack of positive feedback – own unattainable perfectionism – problems with hierarchy – administrative constraints – overload of tasks – persistent high prere from superiors – poor work organization

The course of the disease is influenced by the so-called depersonalization. Depersonalization is a state of self-alienation, in which the affected person experiences himself as alien and unreal. Personality awareness is impaired. With it the individual performance (see also under Depersonalization!).).

Who is particularly at risk of burnout?

Burnout can happen to anyone, regardless of lifestyle or profession. When burnout was first described in 1974 by the American psychotherapist Herbert J. Freudenberger, it was said that mostly healing and nursing professions are affected, but also people who are physically and emotionally exhausted and do not get recognition for their work. However, we now know that it can affect anyone, because everyone reacts differently to stress and even if you are considered quite resilient, this does not mean that you are protected from burnout.

Risk factors

In the meantime, people with a particularly high risk of burnout are divided into two groups. The first group includes people who have a weak self-confidence and are therefore sensitive, passive, adapted and in need of love, and the second group includes determined and dynamic people who display a great deal of ambition, commitment and idealism.

For those affected in both groups, it is difficult to express feelings and they need a lot of recognition from their environment.

In addition, internal factors can contribute to a risk of burnout. These include:

– Unrealistically high goals – Self-image is dependent on successful results of individual activities – Goals correspond to one's own expectations rather than needs – Expectation of reward is high – Problems with admitting personal weakness and helplessness – Problems with saying "no" – to others or to oneself

In addition to internal factors, there are also external ones that can result in burnout:

– Change in life situation, for example, starting a job, starting university, changing jobs, etc. – The consequences can be a shaken self-image, disappointed expectations or destroyed life goals – No hoped-for change in life, for example, when one is not promised a longed-for job after all – Work overload – Lack of autonomy – Lack of control – Lack of or inadequate recognition – Lack of justice – Obstacles in the bureaucracy – Conflict between requirements and one's own values and views – No social support in private life – Unresolved conflicts – Insufficient pay

Burnout – Symptoms

In burnout, predominantly psychological symptoms occur. In addition to these psychological signs, physical complaints also occur.

Emotional exhaustion

A deep feeling of exhaustion on an emotional level is one of the most important burnout symptoms. This can arise as a result of emotional, but also physical exertion. Because the necessary regeneration does not take place, a feeling of weakness and powerlessness arises in the affected person as a result of exhaustion. Burnout sufferers often feel unusually dull. But also lack of drive and especially slight irritability are clear signs of burnout.


In order to compensate for the permanent overload and at the same time high performance expectations, many of those affected become depersonalized. With this burnout symptom, sufferers create between themselves. The stress trigger a distance (self-alienation). This can be related to work tasks, but also clients are increasingly rejected. The burnout syndrome therefore also includes the fact that those affected only perform "work to rule" and tend to be cynical and have a conspicuously indifferent attitude.


A clear symptom of burnout is when the feeling for the value of one's own performance dwindles. Despite the subjective and mostly actual overload, those affected by burnout syndrome feel that they achieve less than they have to or would wish for themselves. Despite the high stress level, there is no sense of achievement. Those affected experience themselves predominantly as inefficient. In fact, many of those affected are no longer able to respond adequately to their clients because of their tendency toward depersonalization. Good performances become more and more rare, a drop in the performance level is therefore also considered a burnout symptom.

Feeling of futility

Where the knowledge of self-efficacy dwindles, personal performance also decreases. In burnout syndrome, high performance expectations can no longer be met. Actions are therefore carried out by the affected persons as far as possible only mechanically. This costs less energy than actually carrying out actions consciously. Especially in the advanced stage, a lack of strength. Exhaustion is an important burnout symptom.


Unfulfillable tasks, unclear criteria for success and high expectations of one's own performance by others and oneself create a high level of frustration in the person affected. Despite the subjectively great effort, the desired requirements cannot be achieved. The stress that arises from such a constellation as a burnout symptom is conceivably high and intensifies the problems even further.

Anxiety and panic attacks

If unclear anxiety states or panic attacks dominate life, a burnout syndrome must also be considered. Diffuse anxiety is a common sign of burnout in the early stages. It arises from the permanently high tension of the persons concerned, which does not allow any more regeneration. If the anxiety attacks intensify into manifest panic attacks, the quality of life of the affected person is massively reduced.


Another common burnout symptom is fatigue that persists even after extensive periods of recovery. The feeling of being overtaxed is constantly present in the affected person. Increasingly difficult to cope with everyday tasks as well. At the same time, the need for further rest periods increases, but the expected recovery no longer occurs. As a consequence, a chronic fatigue manifests itself, which makes a structured daily routine difficult to manage.

Sleep disturbances

The inability to simply "switch off" is a clear symptom of burnout. Those affected often fail to draw a clear line between work and private life for many reasons. Still answering business emails in bed in the evening. The mind is preoccupied with professional problems even during free time. Sleep disturbances can therefore be found in every phase of the burnout syndrome.

Headaches and dizziness

Affected persons not infrequently first notice the unspecific signs of burnout in themselves. These include psychosomatic complaints that have no concretely identifiable physical cause:

– Muscular tension – headache – dizziness – abdominal pain – nausea – feeling of tightness – palpitations

Increased susceptibility to infections

That stress negatively affects the immune system in the form of a particularly high susceptibility to infections with frequently recurring illnesses. Germs have an easy game with the stressed body. In addition, the often unhealthy lifestyle associated with stress. Nutrient-poor diet (fast food) and lack of sleep reduce the immune system's ability to adequately counter the multiple daily "stress attacks" (germs, prere, negative emotions).

Concentration disorders

All stress-related problems cause sufferers to lose concentration on their work tasks. Concentration problems therefore count as a burnout symptom. They lead to difficulties in making decisions and make the completion of tasks particularly difficult and energy-sapping. Errors accumulate because the affected person has difficulty concentrating on his work.

Other psychological symptoms

In addition to the aforementioned complaints, there may be other psychological problems:

– Exhaustion – Indifference – Dejection – Listlessness – Avoidance of social contacts – Irritability – Anxiety – Abuse of alcohol and drugs – Decline in performance – Loss of self-confidence – Pessimism – Despair – Helplessness – Hopelessness – Even suicidal thoughts

Physical signs

In addition to the various psychological symptoms, physical complaints also occur:

Burnout – Diagnosis

Burnout is only spoken of when there is no other underlying illness that triggers incapacity for work or even occupational disability. For diagnosis, the visit to the family doctor is therefore also indispensable as the first point of contact. Affected people are not seldom afraid of this, because the visit to the doctor is considered as "outing". Nevertheless, it is very important not to postpone a visit to the doctor for too long and to take the illness seriously. Doctors often ie a sick note directly in the case of burnout, so that the affected person can be treated and recover again. The burnout signs are usually explored in more detail during this process. Tests are used for assessment, and a phase model can be used to identify burnout.

Psychiatric-psychotherapeutic interview

A discussion with a psychologist can also be helpful in the diagnosis. Here the psychologist asks some questions to find out the exact causes and symptoms of burnout. This includes current circumstances and complaints as well as personal attitudes towards work, family and friends. Consequential illnesses that have already been noticed, such as depression or pain disorders, can also be diagnosed during such a discussion.

Physical examination

Initial physical symptoms of burnout such as fatigue, exhaustion and sleep disturbances prompt the family doctor to ask the following questions:

– Can you come to rest? – Are there many tasks that only you can accomplish? – Have you recently been working more than usual? Sleep well at night. Do you feel tired during the day? – Feel valued in your job? – Feel exploited? – Feel listless? – Are there any other physical complaints?

With the help of physical examinations, the doctor can rule out other causes, since fatigue and exhaustion, for example, can also point to a thyroid dysfunction. Blood tests, ultrasound and other specific methods can be used to determine whether this is the case or whether other illnesses are involved.

If the family doctor suspects burnout, the patient is referred to a specialist. A specialist for burnout is considered a psychological or medical psychotherapist.

Differential diagnosis

Since many symptoms of burnout overlap with other conditions, such as depression or chronic fatigue, it is important to differentiate between them in order to make a correct diagnosis. Unfortunately, there is still no general clinical definition for burnout, which makes it difficult to clearly diagnose burnout as such. In the case of burnout, special attention is paid to three dimensions: emotional exhaustion, depersonalization and other typical symptoms. This makes it easier to distinguish other illnesses.

Burnout – Test

There are various tests for detecting burnout, for example the MBI, the Tedium Measure and self-tests. These are presented in the following sections.

Maslach Burnout Inventory (MBI)

The MBI is the most common test used for Burnout. The patient answers 22 questions, the answers to which are divided into three scales. These scales are based on emotional exhaustion, depersonalization (including cynical behavior) and personal fulfillment including performance satisfaction. The test filters typical statements such as "I feel emotionally exhausted by my work" or "I feel like I'm at my wits' end"."However, not all symptoms are taken into account in the MBI, such as the initially high level of commitment and the change to disinterest.

Tedium Measure (Burnout Measure)

The Tedium Measure, also called Burnout Measure, contains 21 questions. These must be answered by the sufferer on a scale of one to seven as to the extent to which the question applies to themselves – 1 here stands for "never applies" and 7 stands for "always applies". In the questionnaire physical, emotional and mental exhaustion are queried. Typical questions here are: "Are you physically exhausted??", "Do you feel emotionally exhausted?" or "Do you feel worn out?". The difference to the MBI is that here depersonalization and performance satisfaction are not included in the scoring.


If you do not want to visit a doctor, you can also do a self-test at home. This cannot replace the diagnosis of a doctor, but it can provide initial indications. For an initial self-test, one can consult various sites on the Internet. One of them is the page help-with-burnout.de, which offers a self-test here. You can choose between a two-minute quick test and a detailed Burnout Test, which takes about 20 to 30 minutes to complete. Burnout is a serious illness. Should be treated professionally. The earlier burnout is detected, the better this condition can be cured. There are different levels of treatment for burnout syndrome. From associations and self-help groups to healing practices and psychotherapy. We will present the different options in the next sections.

Short-term therapy

Short-term therapy is aimed at people for whom, for various reasons, a longer stay in hospital is not possible and whose burnout is only in the initial phase. Here, attention is paid to working on and also alleviating psychological and psychosomatic complaints. Improved ability to distance oneself from job stresses and everyday worries helps to improve symptoms. Afterwards, the focus is on defusing the problem and working out coping strategies, such as self-control and self-care.


A cognitive behavioral therapy helps to invalidate and dissolve wrong behavioral patterns and ideas. This is because burnout sufferers have internalized these over a long period of time. In behavioral therapy, these thought patterns are questioned and analyzed, as the goal here is to recognize the problematic patterns and then slowly but surely change them.

In all known psychotherapeutic schools, efforts are made to establish connections between the illness and the way of life. An attempt is made to find out which external and internal influences affect one's own state of health. Depending on the intensity, the affected person can make use of outpatient help, visits to day clinics or inpatient stays (for example in the form of a cure).

Depending on the type of therapy, health insurance will cover this treatment either completely or proportionally. In the context of outpatient psychotherapy, the following are available in Germany with health insurance approval

– Psychoanalysis – systemic therapy – depth psychology based therapy (psychodynamics) – behavioral therapy

All of them are carried out by medical or psychological psychotherapists.

In addition, after consultation, there is also the possibility of a cure in a psychosomatic clinic. The stay is usually between three to six weeks. In the case of particularly pronounced symptoms of burnout, a stay in a psychiatric clinic must take place as intensive treatment. It helps the person concerned to cope with the situation and provides clear daily routines and individual or group support. Group discussions bring back a routine that would be difficult to regain with burnout and without treatment.

Other therapy options

On the Internet, you can find various self-help groups in your region throughout Germany. Acknowledging that one is affected by burnout and actively dealing with this disease state – which includes communicating about it with other sufferers – is an important step in the healing process.

Alternative therapies sometimes offer questionable concepts, such as micronutrient balancing without proven deficiencies, elimination of toxins from the body and bioresonance. Holistic coaching on a mental and psychological level can always be considered helpful, however, there is a risk that differential diagnostic significant factors are overlooked and a misdiagnosis is made. Also far eastern therapy approaches like Traditional Chinese Medicine (TCM) Offer help with burnout. About Acupuncture therapy and by means of herbal essences one tries to take influence on the symptoms.

In addition to the above-mentioned therapies, many clinics also offer body therapy, art therapy and occupational therapy to combat burnout. The therapy plan should be tailored as individually as possible to the person affected, who is given the intensive opportunity to deal with the problems in peace and quiet during an inpatient stay. He should learn to perceive his own needs and to release physical tension. Mindfulness-based methods such as (Mindfulness-Based Stress Reduction – MBSR play an increasingly important role. Many health insurance companies offer these methods to their members in advance to avoid the burnout trap.

Physical activity in the form of Muscle and endurance training is essential to speed up the recovery process, as it has an extraordinarily positive effect on body sensation and self-confidence. Physical activity also includes relaxation techniques, for example autogenic training or Progressive muscle relaxation according to Jacobson.

As one of the newest forms against burnout is the Biofeedback Coaching has been developed. With the help of sensors that can be easily attached to the skin, coach and client receive feedback on the body's own stress reactions. This is how the course of the skin conductance value gives a picture of the client's reactivity to stress stimuli. With a simple app and a chest sensor, breathing, heart rate variability and pulse can be put into relation. A special anti-burnout coaching concept provides the best questions in a progressive setting for rapid progress and thus enables the efficient treatment of burnout and its consequences.

Medication treatment

Unfortunately, there is no special medication against burnout. In addition to psychotherapy, antidepressants can be prescribed if the patient suffers from severe symptoms of depression. These include lack of drive, loss of interest, and inner emptiness, among others.

Burnout prevention

Since burnout can affect anyone, it is important to behave preventively in a meaningful way. In the next sections possible strategies will be presented to you.

Set personal goals

An important strategy is to set personal goals and decide what is really important for oneself. In this way, energy can be targeted and one says goodbye to ideas that have been instilled by others and by society. Freeing oneself from perfectionist attitudes. Competitive conditions in the working world. With good structure and organization, you can pursue your personal goals and still have little stress.

Build self-esteem

People who make their self-esteem primarily dependent on their role in their job or private life are particularly susceptible to burnout. Building self-esteem and self-acceptance is therefore a central concern of any burnout treatment. A balanced self-confidence ensures independence in one's decisions and prevents over-commitment and burn-out due to the need to constantly confirm and prove oneself.

To build up self-esteem, for example, helps:

– To be there for oneself – revive old hobbies – read a book, go to the cinema o.a. go – schedule appointments with yourself – a special biofeedback coaching that improves self-awareness

Time management

Stress often arises from incorrect scheduling. Time management is especially important in demanding jobs, so that one does not get bogged down and additionally stressed out. It is helpful to plan your tasks at work and in everyday life carefully and to arrange them according to their importance and to assign specific times to the tasks when they must be completed. Care should be taken to ensure that tasks do not overlap and need to be completed at the same time. In time management it is also important to pay attention to breaks and rest periods, so that one can relax oneself.

Social contacts

Social contacts are helpful to avoid burnout. By taking time for friends and family, a balance to the working life is created. It is helpful to schedule fixed appointments. Build rituals into everyday life. It is enough to cook together or just spend time together. Just being close to others is good for you, hugs, touches and tenderness have calming effects. You can pour out your heart and talk about things and feelings that often fall by the wayside in everyday life. However, care should be taken to spend time primarily with people who give energy and who do not steal energy. A balanced diet, especially in combination with regular exercise. Plenty of everyday exercise can help prevent burnout. It is considered helpful to avoid stimulants such as caffeine and nicotine or stimulants such as alcohol and sugar, or to limit their consumption as much as possible. "Time for eating" forms a maxim that can be implemented quickly, is effective every day and contributes to deceleration. Some people find it helpful to decorate the dining room table or to consciously spend their lunch break away from their desk.

Stress reduction and relaxation

Time off in everyday life and at work plays a key role. Even a 15 to 30 minute break helps to relax. During this time, for example, you can listen to relaxing music, take a nap or go for a walk. It is also helpful to schedule one day off per week. On this day, one should not work, clean or pursue other obligations. The energy level decreases. The body recovers.

In order to reduce stress, one can keep a stress diary. This is a quick way to find stress factors. Can reduce it. Here you evaluate the feeling of stress on a daily basis. How high this was on a scale of 1 to 10. It is important to explain the triggering situations and the feeling of stress.

Sufficient exercise

In this day and age we spend a lot of time sitting down. This must be balanced with sufficient exercise, as exercise triggers endorphins. It is enough to move two to three times a week for about 30 minutes. Whether walking, cycling, jogging or any other kind of exercise can contribute to more movement. If possible, many everyday journeys can be made on foot or by bicycle and the car can be dispensed with.

Healthy sleep

With enough healthy sleep, you are more resilient during the day. Before going to bed, it is better to avoid exciting thrillers and extreme action movies, and rather read relaxing reads. Alcohol and heavy food also worsen the quality of sleep. When the weather is good, an evening walk is also helpful. Other tips for healthy sleep include:

– Establish a sleep rhythm and go to bed at similar times – Don't use the TV, laptop or cell phone for an hour before bed – Turn off your smartphone – Listen to something relaxing like music, audiobooks or podcasts – Incorporate meditative rituals into your daily routine (e.g., "power naps").B. power naps)

Power naps can be helpful during the day. These are short breaks or naps, lasting two to five minutes in mini format and 10 to 20 minutes in max format, which help the body to z.B. relaxing during the digestive phase after a meal.


Prevention, i.e. precaution, is also the best therapy for burnout. Burnout can be prevented in many cases with clear rules and good foresight, and it can be easily treated if it is detected early enough. It is essential to have a solid daily structure and intelligent self-awareness training, which strengthens self-reflection and helps recognize the early warning signs of burnout.

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