Burn-Out

Burn-out is a gradual process which sets in when stress, especially at work, is maintained at high levels for long periods, and eventually becomes chronic.

Exposed subjects can experience significant imbalance between the resources they use to carry out their work (resources used, representation of the value of their work, possibility of finding support, recognition), and the demands they are faced with. This can have an influence on their health and compromise their professional undertaking.

Coined for the first time in the 1970s, in a context of changes in the working world and social sphere, the term burn-out described a state of ‘extreme fatigue, along with a loss of interest and idealism for one’s work’, in particular among professionals ‘serving people’ 1,2, or even ‘a state of physical, emotional and mental exhaustion, resulting from prolonged investment in emotionally demanding work settings’3.

The concept of burn-out, even if it does not represent a clinical diagnosis in itself in the referenced medical classifications such as the DSMV (its symptoms and causes not having been sufficiently well-established), is defined as a set of clinical symptoms, and is subject to close surveillance (WHO, Burn-out, 1998).

Scientific research has made it possible to conceive burn-out as a process of degradation in the subjective relationship of the person with their work, through three dimensions:

  • Emotional exhaustion: intense fatigue, lack of energy despite rest periods, feeling of being ‘drained of energy’;
  • Cynicism with respect to work (or depersonalisation): development of impersonal, detached, negative and cynical behaviour towards work and towards people (colleagues, management, subordinates);
  • Reduction in the feeling of personal accomplishment at work: self-depreciation, of work and skills, feeling useless or not up to standard in one’s work.

Certain occupational risk factors and individual determinants are believed to be more frequently related to burn-out. Among the occupational risk factors, studies have mainly identified a high and prolonged quantitative and qualitative work load, conflicts of value, lack of resources (social support from management and colleagues), independence, recognition, equality or safety4. Among the individual determinants, we mainly find a strong commitment to work, conscientious persons (organised, persevering, meticulous), and the tendency to perceive events as difficult or problematic5.

Burn-out syndrome is often diagnosed at a late stage, and is seen specifically in the work context (Guide d’aide à la prévention, DGT-INRS-ANACT, May 2015):

  • Physical symptoms, the most common: sleep disorders, persistent fatigue despite rest, muscular tension, back pain (back, neck), change in weight, headaches, nausea and sometimes dizziness;
  • Emotional symptoms: anxiety, lack of motivation possibly going as far as sad mood with self-depreciation, irritability, hypersensitivity or hidden emotions;
  • Cognitive symptoms: distractedness, inattention or omissions, reduced ability to concentrate, to prioritise, to put in perspective, to take decisions, to multi-task;
  • Motivational symptoms: withdrawal, lack of motivation;
  • Behavioural symptoms: isolation, aggressiveness, resentment, cynicism, development of addictive behaviours (smoking, drinking, taking sedatives or drugs).

Depression and burn-out, according to the studies, appear to be separate entities even if they share common characteristics, as much in the symptoms as in their physical consequences; they may co-exist, and develop one into the other6-8. Anxiety disorders and burnout are also believed to share the same symptoms4.

Even if treatment for burn-out should essentially be preventive, if left to reach an advanced stage, the clinical symptoms may require hospitalisation.

At Nightingale Hospital Paris-Clinique du Château, we place emphasis on the need to break with the usual environment and stressful stimuli in such a situation. Our hospital environment is ideally tranquil and we provide the necessary rest and treatment, enabling patients to take a step back from their situation and to reflect on it. Psychiatric treatment is adapted to each individual and according to any related disorders (depression, sleep disorders, addictions, anxiety disorders).

Hospitalisation has 4 objectives:

  • Rest and distancing from stimuli;
  • Symptom management (such as depressive mood, insomnia, anxiety, etc.);
  • Understanding how the burn-out came about, reflection on work;
  • Creation of strategies for returning to work and for preventing burn-out relapse.

This psychological work takes place in daily meetings (8 psychiatrists for 44 patients) and information meetings.


Literature

  1. Freudenberger, H. J. The issues of staff burnout in therapeutic communities. J Psychoactive Drugs 18, 247-251 (1986).
  2. Maslach, C. Burned-out. Can J Psychiatr Nurs 20, 5-9 (1979).
  3. Schaufeli W, E. D. The burnout companion to study and practice: a critical analysis. 1998).
  4. Lindblom, K. M., Linton, S. J., Fedeli, C. Bryngelsson, I. L. Burnout in the working population: relations to psychosocial work factors. Int J Behav Med 13, 51-59 (2006).
  5. Bakker, A. B., Van der Zee, K. I., Lewig, K. A. Dollard, M. F. The relationship between the Big Five personality factors and burnout: a study among volunteer counselors. J Soc Psychol 146, 31-50 (2006).
  6. Ahola, K. Hakanen, J. Job strain, burnout, and depressive symptoms: a prospective study among dentists. J Affect Disord 104, 103-110 (2007).
  7. Bianchi, R., Schonfeld, I. S. Laurent, E. Burnout-depression overlap: a review. Clin Psychol Rev 36, 28-41 (2015).
  8. Schonfeld, I. S. Bianchi, R. Burnout and Depression: Two Entities or One. J Clin Psychol (2015).
Post-traumatic stress disorder (PTSD) Bipolar disorders