Part I of II - What is Burnout, how can we recognise it, and what can we do to begin to help ourselves manage it?
This month's blog contains limited discussions around depression, self-harm, and suicidal ideation. Please do not continue to read if you feel that these themes might distress you.
The History and Impact of Burnout Syndrome (BOS)
Burnout Syndrome (BOS) has been widely discussed within psychological literature since the 1970s, yet it has only been a few years since the condition was included in the International Classification of Diseases - 10, (ICD - 10) for the first time. Despite this renewed focus upon BOS, it is still not widely recognised as a medical or psychological condition.
The World Health Organisation (WHO), classifies BOS as:
"A constellation of symptoms that occur in relation to chronic work-related stress which has not yet been successfully managed."
However, when we find ourselves physically, emotionally, and mentally depleted as a consequence of our jobs, we will also have nothing left to give outside of work. When BOS is not acknowledged and appropriately addressed, it can encroach on every facet of our lives; leaving us devoid of the physical, emotional, and psychological energy that we require to take care of our own basic needs, our homes, our health, our bodies, our self-care, and our relationships.
BOS usually presents as a gradual deterioration in the quality of our physical and mental health and our professional, personal, and social lives may begin to breakdown as a consequence. We may find ourselves engaging in unhelpful self-defeating behaviours such as avoiding people and certain situations, increasing our alcohol consumption, beginning to use or overuse prescription medications to sleep or combat pain, or engaging in illicit drug use. In an attempt at further avoidance of the real issue, we may shut off emotionally, isolate ourselves, and as a consequence, experience a low motivational state.
Changes in cognition and mood might cause us to ruminate, focus only on the negatives, and develop extreme cynicism about ourselves, others, and the world in general. The potential ramifications of these personality changes can be wide-ranging with the loss of employment, financial stability, and relationships being just some of the casualties that may follow. Anyone who is vaguely familiar with the symptoms of depression will be able to see that BOS appears to share many common characteristics of this potentially devastating mental health condition.
Given that BOS's symptom clusters are also common to those of anxiety, complex post-traumatic stress disorder (C-PTSD), and post-traumatic stress disorder (PTSD), at its most severe, BOS, in and of itself, may cause us to engage in increasingly dangerous thoughts and behaviours such as self-harm and suicidal ideation.
And, yet, often, we flippantly refer to BOS and we find that others regard those who speak out about feeling chronically stressed, their poor working conditions, or their sheer unhappiness with their lives with little empathy. We are told to "Man or women up," that "Life is hard," or more worryingly, "What doesn't kill you makes you stronger." I have to say, honestly, that all this toxic positivity nonsense, in today's society, makes me feel incredibly sad . Our attitudes have got to change; we really do have to learn that it's okay, to not be okay.
You might be able to sense that changing people’s perceptions of BOS is something I care about hugely, and that’s because I’ve seen first hand how it’s blatantly ignored and the harm it can cause. So, this month’s blog has been written for my former nursing and medical colleagues, my clients, and the many, many people who may be experiencing this vastly underestimated condition right now, and not even know about it.
If any of what you read today also resonates with you, in the first instance please try to make time for yourself, engage in self-care, and talk to a trusted friend or family member about what you are experiencing. If you feel you need to, reach out for immediate help, The Samaritans, Shout 85258, NHS 111 (or 999 in an immediately life-threatening situation) are available 24/7 to assist and support anyone who is experiencing a mental health crisis.
If you feel that you are not currently in crisis, but would like to seek help for yourself, your GP can help you to decide on the best course of action for you. Whatever the outcome, try to engage a suitably qualified mental health professional as soon as possible who can give you the support that you need and deserve. And please, always remember that accepting there's something wrong is not a sign of weakness; it is a marker of strength and there is always help available should you need it.
Who Experiences BOS?
It comes as no surprise that people in healthcare roles: nurses, doctors, ambulance staff, and the allied professions are at a higher risk of developing BOS. Indeed, research conducted within frontline healthcare professionals concludes that in excess of 40% of these professionals admit to or demonstrate some degree of burnout and it's obvious that their constant encounters with patient morbidity and mortality, poor pay, challenging shift patterns, and routine exposure to traumatic and ethical issues will test even the most robust human's resilience.
Alongside these individuals, teachers, those within the military, the police and fire services, and even psychotherapists comprise a huge number of those experiencing mild to severe symptoms of BOS. But, when almost every job in the world seems to demand bigger, better, faster, more, the truth is that anyone can experience burnout.
But, I've Always Been Mentally Strong, BOS isn't Something That Might Affect Me
BOS isn't a condition that manifests because of a diathesis or a leaning toward poorer mental health, in fact it often presents in individuals who have no prior history of psychological of psychiatric issues.
BOS appears to be triggered when we feel, even unconsciously, that there is a discrepancy between the expectations and ideals of us as employees and what our employers, company, or institutions feel is actually required of our position. In our contemporary society, this situation arises often.
The Stages of BOS
The initial stage of any job usually finds us in 'The Honeymoon Period.' At this time, we enjoy the challenge that a new role brings, we enjoy our time at work, and we push past our usual stress tolerance levels. During this stage, we maintain our ability to go the extra mile because our 'stress bucket' is not yet full; we can manage these extra demands.... for now at least. Ultimately, when we surpass our stress tolerance levels for long enough and without respite, three classic BOS symptom clusters develop: exhaustion, depersonalisation, and reduced personal accomplishment.
Stage 1 - Exhaustion
When we do not allow ourselves to relax, engage in self-care, or to 'switch off' from our job, we can become chronically stressed. Exhaustion manifests as generalised physical, emotional, and mental fatigue and may result from devoting excessive time and effort to a task that is not perceived to be beneficial. Maybe this could be caring intently for a patient who is not likely to survive, not having enough physical or financial resources to perform our job as well as is expected of us, or constantly feeling in limbo regarding the future of our company and therefore, our employment.
Stage 2 - Depersonalisation
Depersonalisation shows outwardly as a distant or indifferent attitude towards our job. We may become negative, callous, and cynical in our thoughts, words, and behaviours; interacting with colleagues, patients, and even loved ones in an impersonal manner which just doesn't match up with the person we used to be.
In a healthcare setting we may refer to patients as bed numbers or job numbers. We may become less supportive managers or mentors; make unprofessional comments or blame people for their own problems. Where we may have been able to control outbursts of frustration, irritability, anger, or even rage, it becomes increasingly difficult to keep these emotions and their resulting behaviours under control.
At its worst, we might even lose our ability to empathise with other people or to express our more 'negative' feelings of frustration, anger, guilt, shame, loss, or grief. At home, we may displace all of this unhappiness, expressing our negative thoughts, feelings, emotions, or behaviours toward loved ones. Alternatively we may focus all of this negativity inwards, upon ourselves. This 'turning inwards' is arguably, one of the most dangerous ego defence mechanism there is, and it can have far-reaching, harmful consequences with depression and anxiety being just some of the issues we might go on to develop.
At it develops, BOS may also cause us to lose our capacity to feel 'positive' emotions too. In numbing ourselves against 'negative' feelings, we then become incapable of feeling of joy, excitement, contentment, love, and happiness. As we unconsciously try to protect ourselves, we ignore the 'positives,' we group all of our negativity together, and we spiral. We may feel and be perceived by others as being disillusioned with and resentful of the entire world.
Stage 3 - Reduced Personal Accomplishment
The final stage of BOS sees us starting to negatively self-evaluate the worth of our work. We may feel that we are insufficient in our ability to perform our job and experience a generalised, poor, professional self-esteem.
Before, when we might have pushed ourselves to go the extra mile at work, we now find ourselves emotionally exhausted and unable to rationalise; hearing an inner monologue of "Who cares if I do this or not?" or "I'm not appreciated, so I can't be bothered." Worryingly, especially within a healthcare setting, we may experience thoughts such as, "I am a failure," or "I feel so guilty that I just cannot help as much as I want to." These thoughts turn into feelings of incompetence and guilt, which once again, we may dangerously begin to internalise.
Alongside these emotional and behavioural symptoms, we may also begin to experience or notice the exacerbation of non-specific physical symptoms such as feeling tired all of the time, insomnia, muscle tension, increased pain, headaches, changes in appetite, and gastrointestinal problems.
Risk factors for BOS:
These fall into two categories: individual and organisational. Individual factors may include:
Having low self-esteem.
Maladaptive coping mechanisms.
Younger adults with an idealistic worldview.
Unrealistically high expectations.
Having financial issues.
Organisational risk factors that may increase an individual's susceptibility to BOS include:
A heavy workload.
Conflicts with colleagues.
Diminished resources.
Lack of control or input.
Effort-reward imbalance.
Understaffing.
Rapid institutional changes.
A working environment with no natural light.
Inability to take scheduled breaks.
I Think I May be Experiencing BOS, What Should I do Now?
In an ideal world, employers would try to alleviate BOS within the workforce by implementing top-down management strategies, but evidence-based interventions to prevent and treat BOS are generally not available within organisations and workplaces.
There often appears to be only a fleeting focus on staff wellbeing, but I have been encouraged to see that some workplaces are becoming more proactive; offering resilience courses, putting in place designated, pleasant 'time out' spaces for staff, peer-to-peer trauma-focused interventions, and the opportunity to engage in timely debriefing. However, the fact remains that employee welfare is just not top of the agenda for many companies and institutions.
This being said, talking to your employer about what you are experiencing could turn out to be a great first move. This might see us starting by asking for support from managers and co-workers; asking them to help us to cope better with stress whilst at work. Most large-scale employers within the UK can refer you to an occupational therapist, a counsellor or psychotherapist through an Employee Assistance Program (EAP), so it might be worth seeing if this is a benefit that you are entitled to. EAP services are usually free at the point of contact, and you will have access to the support that you need much quicker than if referred through the NHS.
The key thing with BOS, whether we're working through it ourselves during the early stages, waiting for, or engaging in counselling, will be learning how we can help ourselves, both now and in the future, so please join me for October's blog in which I'll be writing a lot more about the bottom-up interventions and tactics that we can all use to combat BOS and all other forms of chronic stress.
Final Thoughts
Burnout is common and it can have very serious consequences. In a poll undertaken by Mental Health UK in March 2021, 46% more of UK-based workers felt more prone to extreme levels of stress compared to polling results from only a year earlier. With more of us working from home nowadays, the blurring of our work / life balance is even more of a risk than ever.
If you or anyone that you know is experiencing the following symptoms, then please speak with your GP, seek emotional and psychological support, approach your employer for help, and most importantly develop your support system, talk about it, and look after yourself and those around you.
Remember, you can be easily replaced at work, but YOU cannot be so easily replaced.
Emotional exhaustion.
Feeling helpless, trapped and / or defeated.
Feeling detached / alone in the world.
Procrastinating and taking longer to get things done.
Feeling overwhelmed.
Fatigue.
Irritability.
Increased mental distancing from your job.
Feelings of negativity and cynicism about your job, people, or the world.
Difficulty concentrating.
Reduced professional efficacy.
Depersonalisation.
Lack of care for yourself.
Helpful Contact Numbers
The Samaritans: Call 116 123 - (mental health support for all age groups - via phone 24/7 and free)
Shout 85258: Text SHOUT to 85258 - (mental health support for all age groups - via text 24/7 and free)
Papyrus: Call 0800 068 41 41 - (mental health support for people under the age of 35 - via phone - every day from 09:00 to 12:00 midnight and free)
NHS 111: Call 111 - (mental health advice, support, and intervention for all age groups - via phone 24/7 and free)
NHS 999: Call 999 - (for advice, support, and intervention during an immediate, life-threatening mental health crisis)
Disclaimer
Whilst all information and interventions offered within this blog are both factually correct and evidence-based, it does not aim to replace the individualised medical or psychological advice which may be given to the reader by their GP, or other suitably qualified mental health practitioner. Always seek the support of a qualified medical or psychological practitioner if you feel that you are struggling with your mental health.
References and Bibliography
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Mealer, M. Conrad, D. Evans, J. Jooste, K. Solyntjes, J. Rothbaum, B. Moss, M. (2014). Feasibility and Acceptability of a Resilience Training Program for Intensive Care Unit Nurses. American Journal of Critical Care. 23 (6): 97-105. Accessed online at:
Last accessed 21.08.2022.
Mealer, M. Moss, M. Good, V. Gozal, D. Kleinpell, R. Sessler, C. (2016). What is Burnout Syndrome (BOS)? American Journal of Respiratory Critical Care Medicine. 194. 1-2. Accessed online at:
Last accessed 22.08.2022.
Mental Health UK. (2021). Burnout. Accessed online at:
Last accessed 10.08.2022.
Theron, L. van Rensburg, A. (2018). Resilience Over Time: Learning from School-Attending Adolescents Living in Conditions of Structural Inequality. Journal of Adolescence. 67: 167–178. Accessed online at:
Last accessed 23.08.2022.
Tugade, M. M. Fredrickson, B. L. (2004). Resilient individuals use positive emotions to bounce back from negative emotional experiences. Journal of Personality and Social Psychology. 86 (2): 320–333. Accessed online at:
World Health Organisation. (2019). Burn-out an "occupational phenomenon": International Classification of Diseases. Accessed online at:
Last accessed 23.08.2022.