The World Health Organization has a new definition of Occupational Burnout: “A syndrome resulting from chronic stress at work that has not been successfully managed.” This new definition of burnout will be published in the International Classification of Diseases, ICD-11, which will go into effect in January 2022.
Not technically a medical condition, the WHO calls burnout an occupational phenomenon which is a “factor influencing health status or contact with health services.”
There are three primary symptoms: 1. Feelings of energy depletion or exhaustion 2. Increased mental distance from one’s job or negativity and cynicism related to one’s job 3. Reduced professional efficacy
Burnout is reaching epic proportions in many industrialized countries. Recent Gallup research, for example, showed that 2.7 million workers in Germany report feeling the effects of burnout. A 2013 survey of human resource directors in the United Kingdom found that nearly 30% reported that burnout was widespread within their organization. Doctors in the US experience symptoms of burnout at almost twice the rate of other workers, resulting in more medical errors and patients with worse outcomes. The economic impacts are also significant, potentially costing the economy $4.6 billion a year.
Just as the impact of burnout stifles healthy professional growth, emerging research shows that the chronic psychosocial stress that characterizes burnout not only impairs people’s personal and social functioning, it also can overwhelm their cognitive skills and neuroendocrine systems — eventually leading to distinctive changes in the anatomy and functioning of the brain.
According to a study led by Armita Golkar at the Karolinska Institute in Sweden, burnout changes neural circuits in the brain and inhibits the ability to cope with stressful situations. It’s a vicious cycle: The more stressed one is, the harder it is to deal with stressors in the future.
For the study, researchers recruited 40 participants with diagnosed burnout symptoms. All participants attributed their condition to prolonged work-related stress: They worked 60 to 70 hours a week continuously over the course of several years. The researchers also recruited 70 healthy participants with no history of chronic stress to serve as the control group.
All participants performed an emotion-regulation task, in which they looked at neutral and negative pictures and were asked to either suppress, intensify, or maintain their emotional response. While the participants were looking at the picture, the experimenters played a startling sound and measured the participants’ reaction to the stimuli using electrodes placed in participants’ cheeks. Results showed that burnout subjects had a harder time suppressing their reactions to the loud sound. In other words, the people who were stressed to begin with had a harder time dealing with new stressors.
Researchers also scanned participants’ brains while they were sitting quietly and found that the amygdala, a part of the brain associated with fear and aggression, was bigger among participants in the burnout group. More stressed participants also had stronger connections between the amygdala and brain areas linked to emotional distress.
As for why the burned-out participants had trouble regulating their emotions, the brain scans revealed that they had weaker connections between the amygdala and the medial prefrontal cortex, a brain area associated with executive function.
In addition to dysregulation in brain function, emerging evidence suggests that — much like other chronic stress conditions — burnout also leads to turmoil within the regulation of the neuroendocrine system. The hypothalamic–pituitary–adrenal (HPA) axis is an important component in the regulation of the stress response, controlling the release cortisol. Under normal conditions, when the body perceives a threat, cortisol is released from the adrenal cortex. Under conditions of prolonged stress, however, the HPA axis ceases to produce higher-than-normal levels of cortisol. When cortisol levels remain too high for too long, the body responds by eventually downshifting cortisol production to abnormally low levels. These abnormally low levels of cortisol are associated with severe stress and trauma, as though the body’s stress response system itself has been burned out.
So, what can be done?
Providers are in a unique position to help their patients see the link between burnout and health. Each patient is different in how they perceive stress in their lives and whether they feel consumed by it. For this reason, testing HPA axis function and neurotransmitter secretion can be an important tool in helping to address the imbalances that can result from long term chronic stress. Essentially, they provide a way to objectively measure the degree of a patient’s burnout, allowing health care providers to provide much needed support.
While the ICD’s 11th edition will not go into effect until 2022, with this announcement, the WHO is presently helping to bring attention to a serious health issue.