There is a great deal of misunderstanding when it comes to what it means to be “stressed out” and what it means to be “burned out”. Both terms have been plagued by definitional ambiguity throughout history. Let me explain some of the differences as well as similarities.
With stress there is an obvious stressor and usually an end in sight, but getting there depends on a number of individual factors, e.g. thought patterns, time management, communication style, lifestyle components, etc. Examples of obvious stressors would be things like project deadlines, a big presentation or an exam. Stress can be both negative (debilitating, when too extreme) as well as positive (invigorating, when more moderate). When it’s negative, symptoms can include anxiety, fatigue, irritability and sometimes impaired executive functioning. Stress can occur in all areas of life – at work, at home, in social and recreational settings, and in simple day-to-day activities such as going to the shops or picking the children up from school.
Burnout on the other hand is a purely occupational phenomenon (as defined by the WHO in 2019) and the causes are less obvious as there no single particular stressor. The symptoms fall under 3 dimensions – exhaustion, cynicism and professional inefficacy. Employees do not always know why they are burned out and mistake it for being stressed out. The actual causes or precipitators of burnout are found in the organization and there are 6 of these known as domains. Not all 6 are always contributing to the burnout.
Burnout has been thoroughly researched since the 1970s especially by the American Social Psychologist, Dr Christina Maslach. Initial research focused on her fellow mental health practitioners, but over the years it has diversified with the realisation that burnout can happen in any occupational setting. She developed the Maslach Burnout Inventory (MBI), which to date is still the most popular tool for measuring burnout in workers. People in human services as well as medical practitioners have unique survey questionnaires (MBI-HSS and MBI-HSS (MP) respectively), as do Educators (MBI-ES). For all other occupational categories there is the general survey (MBI-GS).
Stress is a normal part of life that cannot be eliminated, and it affects people of all age groups, even infants and small children. For example, hunger is stressful for an infant and separation can be extremely stressful for a young child. Burnout on the other hand, is not normal and affects only working adults. It can be prevented by understanding what it actually is and then by implementation of effective organizational changes.
Neither stress nor burnout are listed as mental disorders in the DSM-5. [PTSD is when a person has been exposed to or witnessed an extraordinarily stressful event from which severe, often debilitating, symptoms prevail. Examples of such stressful events include home invasions, fatal accidents, natural disasters, etc. Discussion for another day.]
Burnout (code Z73. 0) appears in the ICD-11 section on problems related to employment or unemployment. Stress, not elsewhere classified (Z73. 3) is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
There are no diagnostic tests for stress or burnout, therefore, diagnosis is based on the person’s subjective reports and the attending health practitioner’s experience and knowledge.
There are no cures for stress or for burnout…both need to be managed. Interventions for stress focus on the person (stress management), and for burnout, the focus is on the organization.
Depression can develop as a result of unmanaged stress and burnout. Situational or Reactive Depression, or Adjustment Disorder would be the possible DSM-5 diagnoses for this type of depression. Depression of this nature can be managed medically/pharmacologically by a Psychiatrist and/or therapeutically by a Psychologist.
Burnout is not a “badge of honour”. Some employees talk of themselves being burned out with an element of pride and even boastfulness. And some employers view their burned out employees as their hardest working, therefore, most valuable employees and frown upon those that are not burning out. However, in time this will change as the symptoms in the 3 dimensions of burnout take effect and these employers will be looking for ways to get rid of their truly burned out workforce. Alternatively, the employees will resign without adequate planning and therefore end up unemployed.
Because of the similarities and overlaps of stress and burnout, many people label themselves as burned out when in fact they are stressed out and vice versa.
Long term medical effects of unmanaged stress and burnout can be severe, even life threatening. Conditions such as hypertension, with potential for cardiac and vascular diseases such as heart attacks and strokes, diabetes, gastrointenstinal illnesses such as ulcers, musculoskeletal problems such as neck pain and tension headaches, and mental illness such as depressive, anxiety and substance use disorders have been confirmed as significant risks. There is no clear evidence to support a causative link between stress or burnout and cancer.
Finally, therefore, while there are subtle differences between stress and burnout, there are significant differences in the management of these conditions. Failure to identify the condition correctly will potentially lead to ineffective management and prevailing frustration for both employees and employers.
Take care everyone.
Your Partner in Mental Health Matters @ Work
Lesley