Burnout: recognising and treating the symptoms

The term “burnout” describes a state of deep emotional, physical and mental exhaustion. Since burnout is not an illness in its own right, the World Health Organization (WHO) classifies it as an occupational phenomenon in its International Classification of illnesses (ICD-11). From a medical perspective, burnout is associated with risk. Stress that persists over a long period of time without sufficient recovery carries a risk of mental and physical complications. These include depression, anxiety disorders, sleep disorders and cardiovascular diseases.

According to the Swiss Health Survey conducted by the Federal Statistical Office (FSO), the proportion of workers who experience stress increased from 18% to 23% between 2012 and 2022; 25% of working women and 21% of men find their workplace to be a permanent source of stress. More than half of these people – around 53% – feel emotionally exhausted. Overload and lasting stress significantly increase the risk of burnout.

The signs of burnout occur on three different levels: body, mind and intellectual performance. Sufferers notice the physical symptoms first: for example, they have trouble sleeping because their mind is racing or they experience palpitations. They often turn a blind eye to these warning signs. This is followed by (emotional) exhaustion – and eventually breakdown. 

Physical symptoms of burnout

Chronic stress puts the body in a permanent state of alert. The physical symptoms of burnout vary greatly. Common physical complaints include:

• Persistent tiredness and exhaustion: there is no noticeable recovery, even after periods of rest.
• Sleep disorders: burnout usually goes hand in hand with problems falling asleep and staying asleep. Sleep deprivation further exacerbates the sense of exhaustion.
• Stomach pains: the digestive system is also vulnerable to the chronic stress of burnout. This leads to nausea or abdominal cramps.
• Cardiovascular complaints: chronic stress raises your blood pressure and speeds up your heartbeat. Possible symptoms include a feeling of tightness in the chest, palpitations or chest pains.
• Limb pain: persistent tension leads to tenseness and pain in the musculoskeletal system. Burnout also often causes headaches.
• Changes in appetite and weight: chronic stress influences your metabolism and eating habits. As a result, it is not uncommon for burnout suffers to lose or gain weight.
• Weakened immune system: the body reacts to persistent strain by becoming more susceptible to infections. 

Psychological symptoms of burnout

In addition to physical complaints, burnout also manifests itself in symptoms relating to mental exhaustion. These usually depend on the stage of the condition. Frequently reported mental health complaints include:

• Despondency: sufferers feel hollow and permanently overwhelmed. Joy and motivation are increasingly hard to find.
• Irritability and emotional instability: moods can fluctuate enormously. Even minor stresses can trigger irritation or outbursts of anger.
• Anxiety and panic: burnout can spark anxiety. Panic attacks can also occur in tandem with burnout.
• Social withdrawal: sufferers pull away from family, friends and colleagues. Social contact is perceived as a burden.
• De-personalisation: people with advanced burnout report a sense of depersonalisation. They feel detached from their own bodies or have the feeling their surroundings are not real.
• Changes in sexuality: chronic stress influences sexual desire and sexual function. Both men and women may experience a loss of libido when they’re burnt out.
• Addictive behaviour: some people use alcohol, tobacco or medication to a greater extent. This is a strategy for coping with internal tension.

Cognitive symptoms of burnout

Burnout also impairs intellectual performance. Sufferers increasingly struggle with day-to-day thought processes. The longer the burnout lasts, the worse the cognitive impairment becomes. It affects various areas:

• Decreased performance: despite huge effort, performance declines. This in turn reduces confidence in your own abilities.
• Poor concentration: people suffering from burnout are easily distracted and quickly lose track of their tasks. Focused work becomes increasingly difficult.
• Forgetfulness: appointments, names and plans are harder to remember than usual.
• Issues with decision-making: even simple decisions take a disproportionate amount of energy. Sufferers put off making decisions or avoid them altogether.
• Reduced mental flexibility: your thought processes become restricted. You may struggle to come up with creative solutions and switch between different tasks.
• Changes to reactions and behaviour: relatives occasionally notice a personality change in burnout sufferers. Their responses may change – they may become noticeably more indifferent, cynical or irritable – and sometimes they can’t even recognise themselves.

Burnout does not occur suddenly. It develops gradually over weeks and months. In many cases, sufferers turn a blind eye to the initial warning signs. Complaints only consolidate as time goes on. The process can be divided into three phases:

1. Increased stress: Everyday life is characterised by a sense of nervousness, irritability and difficulty concentrating. Sufferers overreact (by working longer) and display initial vegetative complaints. If the symptoms of burnout are caught during this phase, they can completely subside with a prolonged recovery.

2. Mild to moderate burnout: The exhaustion is sustained and the ability to recover decreases significantly. Sufferers become socially withdrawn, lose their motivation and experience persistent sleep issues and concentration problems.

3. Severe burnout with clinical depression: Exhaustion reaches a level that severely restricts sufferers’ day-to-day lives. They struggle to feel joy or interest, and experience pronounced cognitive impairment and a sense of hopelessness. At this stage, burnout often leads to an emotional breakdown, with symptoms resembling clinical depression. Some people may experience suicidal thoughts.

The stages are not always linear. They may be reversed, overlapping or skipped entirely. 

In many cases, work-related stress is not the sole cause of burnout. Instead it comes from the interaction of multiple factors over an extended period of time. Experts draw a distinction between external pressures – in the workplace or family environment, for instance – and personal risk factors that increase susceptibility to burnout.

Occupational and social stressors

Burnout in the workplace is particularly common where unfavourable working conditions persist for an extended period of time. Key external stressors include:

• Time pressure and demanding work requirements: tight deadlines, increasing workload and constant availability put workers under constant pressure. Working under unrelentingly high pressure to perform depletes your reserves in the long run.
• Lack of appreciation and scope for change: without recognition for your performance, your motivation wanes. At the same time, without the scope for change, feelings of powerless and overload can increase.
• Conflict and bullying: a stressful working environment is one of the strongest risk factors. Being bullied at work and recurring conflicts within your team or with line managers significantly increase your level of emotional stress.
• Lack of recovery and boundaries: when the line between professional and personal life blurs, the body doesn’t have enough time to regenerate. 
• Strain at home or in the family: relationship stress or care responsibilities further exacerbate existing work-related pressures.

Personal risk factors

In addition to external stressors, individual characteristics and patterns of behaviour also influence your susceptibility to burnout. Certain personality traits leave you more likely to slip into a spiral of exhaustion. Relevant personal risk factors include:

• Perfectionism: the constant drive for error-free output is a permanent source of internal pressure. A perfectionist’s standards are often far above what is realistically achievable.
• Low self-esteem: people with little confidence in their own abilities are quicker to see demands as a threat. They have a tendency to constantly compare themselves and devalue their own performance. The feeling of a lack of appreciation reinforces this perception.
• Strong focus on others: the needs of others consistently take precedence over your own. In the long term, your own recovery falls by the wayside. This pattern is particularly common in social and care-related professions.
• Lack of coping strategies: people with low levels of resilience and few effective stress management strategies reach their limit more quickly when they come under prolonged pressure.
• Strong sense of empathy: people with a tendency towards burnout can sense when their colleagues are under pressure and shoulder their burdens, too. 

Doctors usually diagnose burnout in an in-depth consultation. This will include questions on your current issues, your professional and private situation, and the duration of the stress. If burnout is suspected, specialists can also use a stress test – in the form of a questionnaire, for example. This assessment forms the basis for further examination and any treatment that may follow.

It is particularly important to rule out other illnesses. Many complaints associated with burnout are similar to the signs of mental illnesses such as depression or anxiety disorder. There may also be physical causes. The neurological symptoms of burnout – such as dizziness, impaired concentration and numbness – also occur in thyroid diseases and neurological disorders. A careful differential diagnosis prevents a treatable underlying disease from being overlooked.

Treatments for burnout depends on the individual causes and the severity of the complaints. The sooner you do something about it, the better your chance of recovery. Early intervention shortens the recovery process and reduces the risk of complications.

Consulting your GP is an important first step. They will talk to you about the stressful situation you are currently in and discuss possible ways to recover from burnout. In many cases, sick leave provides necessary distance from the stressful situation. If necessary, they can refer you to a specialist. Depending on the severity of the condition, approaches range from self-guided strategies for everyday use to outpatient psychotherapy and inpatient treatment in specialist clinics.

Therapy and coaching for burnout

Psychotherapy plays a key role in burnout treatment. The methods depend on the individual situation. Cognitive behaviour therapy helps patients to identify stressful thought patterns and develop new coping strategies. By contrast, depth psychology approaches address the underlying conflicts and biographical influences. Treatment often incorporates elements of body therapy and relaxation exercises.

In addition to psychotherapy, many sufferers turn to burnout coaching. This helps with professional reorientation, lifestyle adjustment and bolstering of personal resources. 

It is important to note that coaching is most suitable in the early stages of burnout or as a supplement to therapy. It is not a substitute for well-founded psychotherapeutic treatment if you are suffering from severe psychological complaints or suicidal thoughts.

Inpatient treatment for burnout

An inpatient stay in a clinic is a sensible option if outpatient measures fail to resolve burnout, or if there are serious concomitant illnesses. During inpatient treatment, patients follow a structured therapy programme consisting of different components. Alongside individual and group psychotherapeutic discussions, sufferers learn methods such as progressive muscle relaxation or autogenic training. Exercise therapy and creative therapy are also part of the treatment concept in many institutions.

In some cases, specialists also use medication to treat burnout. This is not aimed at combating the burnout itself, but rather at resolving accompanying complaints such as depression or sleeping disorders.

How long does it take to recover from burnout?

The duration of burnout treatment varies greatly from person to person. It is governed by the severity of the condition, the patient’s personal situation and the time of the first treatment. Working through burnout will hamper the necessary recovery phase. It also takes time for your brain to regenerate after burnout, particularly capacities for concentration and memory.

For the return to working life, gradual reintegration with an adjusted workload is recommended. Slowly increase your endurance and demands bit by bit. Burnout leaves many sufferers less resilient than they were before. This is normal and not a sign of failure. Structural changes to your day-to-day working life and at home will reduce the risk of relapse and contribute to a stable recovery.

Stress and burnout are closely linked, so there is real benefit in recognising pressure as early as possible. The following strategies will help you prevent and treat burnout yourself and boost your recovery day to day:

• Set boundaries: a healthy work-life balance helps ward off overexertion. Fixed finish times and regular days off – when you can’t be contacted for work issues – provide space for relaxation.
• Manage stress: stress management techniques such as mindfulness exercises, meditation and breathing techniques help to improve your ability to deal with stress.
• Exercise: physical activity reduces your levels of stress hormones and promotes mental well-being. Even moderate exercise such as walking, cycling or swimming has a positive effect.
• Keep in touch: maintain stable relationships with family, friends and people you trust. Talking to people close to you can help lighten the load and strengthen your inner resilience.
• Recognise boundaries: learn how to move on from tasks and reject requests when your capacity is exhausted. Regular self-reflection helps you to spot the early warning signs of burnout.
• Relax: autogenic training, meditation and yoga have been proven to reduce inner tension. Even short exercise sessions have a noticeable effect if you do them regularly.
• Get professional help: take advantage of rehabilitation programmes such as burnout retreats in the event of prolonged strain or after an illness. This will help you establish new routines and maintain stability in the long term.
  
  

Set up a personal anti-stress programme that can support and protect you during busy times. This can include fixed recovery rituals, exercise routines or relaxation exercises – depending on what you find helpful. These strategies also help to ensure your long-term stability during the post-burnout healing stages.

In many cases, you can avoid burnout by taking the appropriate steps early on and openly addressing stress. If someone close to you is suffering from burnout, it is important to show patience and understanding. Take the time you need and don’t be afraid to seek support.