Burnout - causes, symptoms and treatment

Burned out strategies to defeat the burnout syndrome

The issue of burned out is very topical in our time. We want to be perfect in all areas of life - at work, in our private lives and also in our free time. We can hardly forgive weak achievements, we keep going, we do our best - until we reach a point where nothing seems to work so well and we feel burned out, aimless and exhausted. In medical terms, this condition is also referred to as the burn-out syndrome, as long as the state of fatigue and overuse persists for a prolonged period of time and there is no improvement even after prolonged periods of rest. However, the actual development of burn-out begins much earlier, so it is important to interpret the first signs in time to prevent severe events.

contents

• Burned out strategies to defeat the burnout syndrome
• Burn-Out - what is it??
• causes
• symptoms
• diagnosis
• therapy

Burn-Out - what is it??

The term "burned out" does not come by chance. For example, like an oil lamp that relies on fuel in the form of oil to glow, our body needs energy to function. However, if the body lacks this energy, for example through chronic overwork, which suffers from the body's own energy reserves, it will cause people to feel burned out and the burn-out syndrome develops.

"Being burnt out" is a serious issue in our times and increasing job pressure in the workplace is one of the main reasons. (Image: Wellnhofer Designs / fotolia.com)

Now burn-out is still no official medical concept of illness, although it was first described in the 1970s by the German-American psychologist Herbert Freudenberger. He himself suffered from the syndrome according to his own statements, after he had permanently overworked for years and then volunteered for a rehabilitation clinic. Working with addicts, as well as many other professions in nursing and care, is known to be one of the most strenuous activities and it comes as no surprise that Freudenberger repeatedly observed signs of burnout from his colleagues as well. It also happened that Burn-Out was initially viewed as a kind of "occupational disease" of nurses and social workers.

Both the term burn-out as a disease, and the assumption that only persons who work in the social or care sector, could suffer from the burned out, but are wrong. Especially in our modern world of work, people from other professions are increasingly falling ill with this treacherous complaint. Especially in workplaces with high levels of stress, the number of people who experience at least one burn-out during their career is very high.

However, burn-out is not an independent clinical picture, or not (yet) defined as such. Rather, it is a symptom complex and thus a syndrome that is characterized by complaints such as lack of drive, lack of motivation and a feeling of futility and emptiness. Since symptoms are also found in depressed people, some doctors assume that the burn-out could be more of a special form of depression. At least, every sixth patient who presents to the doctor for burn-out can also attest to depressive tendencies.

causes

How exactly the burn-out syndrome comes about, is still not fully understood. However, a concept used by experts to explain the burn-out phenomenon is the effort-reward-imbalance (ERI) model of the Swiss medical sociologist and university lecturer Johannes Siegrist. He assumed that patients with burn-out experience a strong imbalance between their own performance and the recognition received for it. However, the symptoms can not be reduced solely to this feeling, because there are also other aspects in the burned out with a. These can be roughly divided into three terms:

• everyday factors,
• personal factors
• and nutrient factors.

Stress in everyday life

As already mentioned, a stressful working life is one of the most important risk factors for the development of a burnout syndrome. In addition to nursing occupations, there are also a number of other job descriptions clearly under the risk groups. For example, burnout is also increasingly affecting people in management positions and office workers. The constant juggling of appointments, coordinative work steps, customer correspondence and other challenging occupational aspects obviously contributes to a prolonged exhaustion.

A busy schedule, permanent calls, and too many responsibilities can quickly lead to fatigue or burnout. (Image: Kaspars Grinvalds / fotolia.com)

In addition, there are occupations that require a high level of mental work and thus increase the mental stress level. This is the case, for example, with academics, architects or even with writing and teaching staff. With regard to the latter field of activity, a risk aspect is also mentioned which drastically increases the risk of burn-out in the care sector: the professional approach to the groups of persons to be cared for.

Where caring for the elderly or nursing care for patients in need of care benefits professional stress, the care of children and adolescents poses a great stress potential for teachers as well as for nannies, educators and social educators. These, including their family background, can sometimes be very "exhausting small customers" and consume heavily on the nerves or energy reserves of the social service provider.

Speaking of services, even call center staff, service personnel and large parts of the catering industry are among the risk groups at burn-out. In addition, work-independent stress in everyday life should not be underestimated as the source of a burgeoning burn-out. Because even private life holds countless situations ready, which come as causes of the burned out in question. In general, the following everyday factors can be recorded as possible causes:

• enormous deadline or performance pressure,
• time-demanding profession,
• special mental challenges in the workplace,
• Conflict situations in the workplace (such as bullying or stress with customers),
• Conflict situations in private life (eg divorce or illness in the family)
• and problems in reconciling work and family life.

by the way: In the meantime, the performance pressure of our modern age is increasingly reaching the youngest in society. With increasing concern, medical professionals are watching the trend of the so-called burnout kids, who can no longer cope with the increasing performance requirements in the school sector. Burn-out is no longer a health problem that affects only adults.

Personal factors

Another important issue that plays a role in the development of burn-out are certain personality traits. For example, people are often affected who are very perfectionist and therefore always want to give 100 percent. Such people usually also tend to show more willingness to perform than others. A behavior that on the one hand is happily exploited by other people and thereby strengthened, on the other hand, however, also means that those affected often can no longer realistically assess their performance limits. For this reason, they often do not realize at the beginning that their bodies will not be able to take on the demanding workload for much longer. With this point, however, only one possible personality trait is addressed, which can promote burnout. Overall, as risky to evaluate in this cause field:

• idealism,
• perfectionism,
• Workaholic behavior,
• Fruster experiences and disappointments,
• Offenses and mental injuries,
• low self esteem,
• lack of balance between work and relaxation
• and performance-based conditioning in childhood.

In addition to typical workaholic behavior, for example, frustration situations and disappointments are also involved as personal factors in the development of burnout. (Image: Teodor Lazarev / fotolia.com)

Unbalanced nutrient balance

The aspect of the body's own nutrient supply is greatly underestimated in the development of burnout. If we look back at our comparison with the oil lamp, which has a certain amount of lamp oil in stock, the human organism also has energy reserves that provide energy for the daily challenges when needed. The most important substrates for energy production are here

• glucose,
• glycogen,
• Fats (mainly in the form of triglycerides)
• and proteins / proteins (mainly in the form of amino acids).

In order to ensure a trouble-free energy balance, appropriate nutrients should therefore be supplied to the body in sufficient quantities. If it is also burned out in combination with an unfavorable state of mind and depressive moods, a few other substrates play an important role, including a number of vitamins in particular:

• Vitamin B: Vitamin B is one of those vital substances that the body can only store very badly. However, the different variants of this vitamin play an essential role in energy metabolism. For example, they are involved in the energy supply of the body's cells and are needed for energy production from fats and proteins. A vitamin B deficiency therefore inevitably leads to fatigue symptoms and fatigue. In addition, vitamin B is important to prevent disorders in the neural network of the brain. These can contribute to mental health problems such as depression and sleep disorders. The most important vitamin B components in this context include:
  • Vitamin B1 (thiamine),
  • Vitamin B2 (riboflavin),
  • Vitamin B3 (niacin),
  • Vitamin B6 (pyridoxine),
  • Vitamin B9 (folic acid)
  • and vitamin B12 (cobalamin).
• Vitamin C: When it comes to mental and psychological well-being, vitamin C also plays an important role. This is partly responsible in the body for the production of serotonin, the famous happiness hormone. It serves as a neurotransmitter for the nervous system and is especially responsible for feelings such as serenity, inner balance and contentment. In case of serotonin deficiency, however, there is a risk of increased irritability, depression and dissatisfaction. In addition, serotonin also affects the cardiovascular system and thus the performance of the body. If it can not be adequately prepared due to an insufficient intake of vitamin C, there is a risk of performance decline in addition to depressive moods, which then becomes noticeable through tiredness and exhaustion.
• Vitamin D: Vitamin D also affects the performance (especially brain performance) and mental state of a person. As vitamin C, it is involved in the biosynthesis of serotonin and therefore essential to prevent depression or performance degradation. However, the problem is that vitamin D can often only be built up by sufficient sunlight in the body. Especially in the autumn and winter months, the seasonal sun deficiency causes for many therefore also a lack of vitamin D and thus for the notorious autumn or winter blues. And the annual burn-out season can also be settled in the second, low-light half of the year.
• Iron: With iron, the body is given a mineral that can control the oxygen conduction in blood and cells. Because iron binds oxygen, thanks to iron molecules, it can easily be transported through the bloodstream to all areas of the body. On the other hand, if there is iron deficiency, not only will the blood become poor in oxygen. In addition, it also lacks the cells, organs and especially the nerves of oxygen, which is urgently needed for energy. In addition, iron also regulates the production of neurotransmitters, which in turn is critical to mood and sensation.
• Magnesium: As a mineral, magnesium is as important to the body as iron. Magnesium deficiency can also lead to symptoms similar to iron deficiency. Cardinal symptoms include fatigue, inner restlessness, mild irritability, and tiredness, the very symptoms that are typical of burnout. Even severe depression and even schizophrenic psychosis are not excluded in magnesium deficiency. Hardly surprising, considering that magnesium plays a major role in the functionality of the energy metabolism, nervous system, cardiovascular system and even the immune system.
• Trace elements: As trace elements, relatively small particles of minerals are defined, which does not mean that they are less significant to the body. Quite the opposite, it shows just in exhaustion and depression, how much trace elements health can influence. Above all, the functioning of the neurotransmitters as transmitters of any nerve signals as well as the signal conduction in the energy balance are decisively shaped by trace elements. The most important trace elements for this are:
  • copper,
  • selenium
  • and zinc.

An important aspect in the development of burned out is the body's nutrient balance. A lack of vitamins and trace elements can quickly lead to noticeable effects. (Image: StefanoT / fotolia.com)

worth knowing: The fact that nutrient deficiency and associated dysfunctions in the area of ​​energy metabolism and the nervous system can lead to permanent fatigue with depressive symptoms can also be seen in Chronic Fatigue Syndrome. In contrast to the burn-out syndrome, this is in fact an independent disease, which must be distinguished from the burn-out in view of the almost identical symptoms by careful exclusion diagnosis. For Chronic fatigue symptoms are usually not the cause of mental factors, but there is a tangible dysregulation of the nervous, immune and endocrine systems.

symptoms

The phenomenon of burn-out arises as shown mostly as a result of a combination effect of various causative factors and can manifest itself in very diverse symptoms. These can manifest both on the physical level as well as in changes of perception and experience, ie on a psychological level.

The symptom complex, which is usually the first to be noticed, naturally includes the body's energy balance. Those affected have to struggle with problems of getting in and out of sleep, which means that they lack the necessary regeneration pauses to counteract ongoing fatigue. Understandably, therefore, they feel little rested in the morning, wake up un-sleep and they lack the required energy reserves at the beginning of the day to do their daily tasks. This quickly results in a feeling of being tormented only by the demands and obligations that have to be fulfilled. The sleep disorders can have very different characteristics here:

• Falling asleep (for example, very late falling asleep despite adequate bedtime),
• Sleep through problems (e.g., frequent waking up after short periods of sleep),
• Permanently short-planned sleep phases (for example, permanent power-mapping to meet all tasks and requirements),
• and sleep disorders that have a physical ill health (e.g., difficulty breathing, restless leg syndrome, circadian sleep disorders).

Incidentally, a recent study at Harvard University, led by Thomas Scammell, has once again shown that persistent sleep deficits also increase sensitivity to pain. From pain of any kind sufferers with burn-out are also very often plagued. The states of pain and discomfort can be very different and sometimes occur simultaneously in several places. Cause and effect are not always clearly differentiated. For example, sufferers very often give back and neck problems, which can result from muscle tension and can also lead to permanent headaches. However, headaches can also be caused by fluid and nutrient deficiencies, since sufferers often have irregular and unhealthy eating and drinking. This behavior in turn favors short-term stomach and intestinal complaints and long-term even cardiovascular complaints and an increased propensity for infections.

Problems falling asleep or staying asleep are a symptom of burnout. The resulting lack of sleep is also associated with increased sensitivity to pain. (Image: ALDECAstudio / fotolia.com)

In the area of ​​hormone regulation, burnout also has undesirable effects. You can enter here, among others:

• menstrual disorders,
• erectile Dysfunction
• and libido loss.

Even with these symptoms cause and effect are rarely clear. However, it is more likely to be a kind of gear phenomenon in which an effect of burnout (e.g., unhealthy or insufficient nutrition) favors the development of another symptom such as cycle disorders.

Now, apart from the physical symptoms of burn-out, there are also enormous psychological consequences. Unfortunately, human beings tend to perceive physical ailments earlier and, more importantly, to recognize them as signs of ill health rather than mental symptoms. But especially in the context of the feeling of being burned out, the psychological symptoms become all the more relevant, as early detection often allows for a defusing of the problem. Unfortunately, sufferers perceive such health complaints in a variety of cases as a temporary and one-off affair rather than as a serious warning signal. Often people are only then shaken awake and confess that they need medical support, even if the body clearly shows that it comes to its limits.

In the anamnesis discussion by specifically asked questions of the doctor will then usually only ever aware that their current state was not an acute event in recent weeks, but the first signs were there much earlier, but were successfully suppressed. These psychic changes in the perception and experience of those affected typical of the state of burnout include:

• Unusual motivation low,
• Concentration disorders over a longer period,
• listlessness,
• Lack of motivation for things that used to bring happiness and satisfaction,
• Joylessness and dissatisfaction,
• Tendency to mood swings and quarrelsome,
• increased aggression potential,
• resignation,
• Inability to accept criticism,
• isolation,
• Perception of fear of failure
• and feelings of futility and helplessness.

The above-mentioned mental symptoms are not uncommon and are by no means to be considered as leading symptoms. Just because you can not motivate yourself for a few days to work, that does not mean that you are close to burn-out. Rather, sufferers should always consider the context and not immediately fear the worst. Perhaps the tasks to be done simply do not create an inviting mood either because they have to be done or are a chore before or after a completed project. However, if symptoms persist for an extended period of time and do not improve after a period of rest (such as a weekend break), or if the symptoms also shift to the home environment, it is very likely that it is not just a transient condition.

Mental fluctuations and disputes that are typical of the state of burnout also include, for example, mood swings and disputes about the person's perception and experience. (Image: LIGHTFIELD STUDIOS / fotolia.com)

diagnosis

Before the diagnosis of burn-out can even be addressed, sufferers themselves must have a sufficient degree of disease insight. You should be honest with yourself and reflect on whether it would be necessary and could bring relief to get help. Close relatives, friends and acquaintances can also be a helpful tool as they can observe much more objectively and for that reason not infrequently develop the feeling that something is wrong. Here an open conversation in a relaxed atmosphere, without reproaches and hostility, can help to raise an honest view of their situation with those affected. If the decision for professional help then fell, the first way goes through the family doctor. Although this can not address the underlying causes of the burnout, it is possible for him to get a first break (best one to two weeks incapacitation), and then jointly create another treatment plan.

However, the complexity of mental and physical symptoms does not make it easy to make a diagnosis in conversation with the attending physician, because they may as well be an indication of other illnesses. It is therefore all the more important to have a detailed anamnesis interview with those affected in a calm and relaxed atmosphere in order to gain clues as to whether the symptoms are a temporary state of burnout or whether other illnesses are behind it. The following diseases can also be considered in differential diagnosis:

• chronic fatigue syndrome,
• Fatigue Syndrome,
• depression,
• Hypothyroidism,
• Adrenal Fatigue
• and vitamin D deficiency.

In order to be able to narrow down this wide range of possible diagnoses, various tests are available to the physician. In order to exclude physical causes, such as hormone imbalances due to damaged organs (for example thyroid or adrenal gland), it is advisable to carry out laboratory diagnostic examinations of the blood. The following parameters should definitely be determined here:

• Differential blood count,
• thyroid hormones,
• ferritin,
• cortisol,
• diverse antibodies
• and vitamin and mineral levels.

In order to be able to limit the various mental illnesses to be considered, the doctor can use various questionnaires as an instrument. In these, those affected are asked specific and trend-setting questions, which make a distinction possible after the evaluation.

To limit the diagnosis or to exclude organ-related causes in addition to the usual questions during the anamnesis also laboratory diagnostic means are used. (Image: cameravit / fotolia.com)

therapy

In order to be successful in the burnout, it is important to set concrete therapy goals. The goals of treatment can be formulated as follows:

• Developing stress management measures,
• Learning relaxation techniques,
• Optimization of time management
• and rethinking personal priorities.

Based on the different symptoms and the different therapeutic goals, it can be seen that there is no standard therapy for the treatment. Rather, it must fit into the company in terms of lasting compliance (cooperation of the person concerned), its life plans and life situation.

behavior therapy

An important pillar in the treatment of states of exhaustion is the change in one's own behavior, which ultimately led to the condition in the first place. Even self-help counselors, group meetings with other victims or mindfulness seminars can provide the necessary food for thought, provided the state of exhaustion has not yet reached uncontrollable proportions. Affected persons should not be afraid to consult a suitable psychotherapist. In a one-on-one interview, the underlying causes can be identified and processed. The goals of working on one's own behavior and thinking are:

• Development of strategies for dealing with personal and professional burdens (conflict and stress management),
• Strengthening self-confidence,
• Perceive warning signals earlier
• and adapt perspectives and own requirements to the life situation.

nutritional intervention

In order to ensure a trouble-free energy balance in addition to a regular everyday life and the avoidance of stress, the right nutrition is of essential importance. In particular, the vitamins B, C, D and the minerals iron and magnesium must be supplied to the body in sufficient quantities. Ideally, this is a balanced diet with plenty of fruit and vegetables to meet the needs of vitamins. The need for vitamin D in particular, in addition to walks in the sun can also be covered by the regular consumption of fresh fish. Iron and magnesium are also abundant in fish. In addition, the minerals are found in cereals and dairy products.

In addition to a diet rich in fruits and vegetables, sunlight is especially important for the vitamin D household, as well as fresh fish. (Image: Halfpoint / fotolia.com)

medicinal herbs

Especially from Ayurvedic and Traditional Chinese Medicine, many herbs are known that are considered vitalizing, invigorating and energizing. You can also use it as a supportive therapy during the treatment of burn-out and, for example, take it as tea. And also in Western herbalism, there are some medicinal plants that are used as standard for the treatment of fatigue. Corresponding examples are:

• valerian,
• Damiana,
• ginseng,
• hop,
• Jiaogulan,
• St. John's Wort,
• lavender,
• Melissa (lemon balm),
• passionflower,
• rosemary
• and taiga root.

Alternative medical treatment offers

Also derived from TCM are treatments such as acupuncture or the tunic massage to eliminate burnout. Also, sufferers can think about special courses such as yoga, qigong or autogenic training to bring their body back into a balanced state. (Ma)