How to recognise burnout?

After having lived for 9 months with burnout syndrome I have learned a great deal about it.

As a Medical Doctor I had obviously heard about burnout, but I never knew that burnout was so physical and so scary. I always thought it was ‘just being stressed and overworked and you will have to take a break’. Now that I’m 9 months in and still have concentration issues, more bad days of exhaustion and physical pain than good days, you won’t ever hear me say that again. Burnout is a serious condition, with serious implications for the patient and his/her surroundings and has to be taken seriously to prevent life-long damage to the body, brain, coping abilities and career.

I’m on a mission now. I consider it my duty to share my story and some facts about burnout to educate people and to make them aware about it, so they can seek help and prevent hitting a brick wall.

Burnout is defined as a stress related disorder by the World Health Organisation and is considered one of the most prevalent stress-related disorders at this moment. It is especially prevalent in people within caring or serving professions (medical personnel, social workers, teachers), stressful positions or a combination of stressful situations, both at work and at home.

What is burnout?

The “burnout syndrome” has been defined as a combination of emotional exhaustion, cynicism or depersonalisation, and reduced personal accomplishment caused by chronic stress – World Health Organisation

Emotional exhaustion represents the basic individual stress dimensions of burnout and refers to feelings of being depleted of one’s emotional and physical resources. The cynicism or depersonalisation/detachment component represents the interpersonal context dimension of burnout and relates to difficulties in social relationships with self and others. Reduced accomplishment represents the self-evaluation dimension of burnout and refers to feelings of incompetence and a lack of achievement and productivity.

Usually, burnout is mentioned in the context of a job situation, but it can occur in other situations as well, for example due to severe interpersonal stress (conflict) or chronic stress in personal life (e.g. taking care of family members, life events). Contributing factors are high amounts of stress, high work load, heavy job demands, low supervisor or co-worker support (or family/friends), inconclusive communication and uncertainty about demands, conflict of responsibility (e.g. between expectations of the organisation and the employee, or conflict between work demands and personal needs), low control, low empowerment. Usually people with a coping strategy of striving, pushing through difficulties and persevering (the people you definitely want on board!!), are the ones who crash themselves into burnout. I can now absolutely see how my masculine energy that made me accomplish a lot in my life, finishing medical school in under 6 years for example, completely wiped out the balance and drove my head into the ground after 5 major life events and never taking a break to integrate and recuperate.

What struck me when I was confronted with burnout, were the prominent physical symptoms. It started with chest pains that I ignored for months, and I ended up suffering from palpitations, tachycardia (fast heartbeat while resting) of 170 bpm, sleeplessness, weight loss and severe problems in filtering light and sound. The latter made a visit to the grocery store between all the products and choices a true nightmare. Taking the kids to school or going to a classical music concert was also stepping into a hell of sound which I had to escape as soon as possible. What also struck me where the severe cognitive symptoms, like executive brain function disorders (I couldn’t cook a meal or label a package anymore, I just didn’t know how to perform small tasks). There is evidence that burnout changes neural circuits in the brain. It can lead to impaired memory and cognitive performance. It can also lead to impaired ability to modulate emotion, which means that it is harder to deal with strong emotions caused by stressful situations. The chronic stress that caused burnout, also created a vicious cycle of being less able to cope with stress.

How to recognise burnout?

Burnout is never something that happens overnight. The symptoms come and go and increase until a threshold is crossed. The symptoms that can tell you that burnout is imminent or happening, are listed below (source: www.psychologytoday.com).

  • Signs of physical and emotional exhaustion:
  1. Chronic fatigue. In the early stages, you may feel a lack energy and feel tired most days. In the latter stages, you feel physically and emotionally exhausted, drained, and depleted, and you may feel a sense of dread for what lies ahead on any given day. I wasn’t able to sit upright for most of the day.
  2. Insomnia. In the early stages, you may have trouble falling asleep or staying asleep one or two nights a week. In the latter stages, insomnia may turn into a persistent, nightly ordeal; as exhausted as you are, you can’t sleep.
  3. Forgetfulness/impaired concentration and attention. Lack of focus and mild forgetfulness are early signs. Later, the problems may get to the point where you can’t get your work done and everything begins to pile up. Like I was having problems planning and organising simple tasks like cooking, schoolrun, packing bags, choosing groceries, making lists. Impossible. Talking on the phone or finishing a sentence took all my energy.
  4. Physical symptoms. Physical symptoms may include chest pain, heart palpitations, shortness of breath, gastrointestinal pain, dizziness, fainting, and/or headaches (all of which should be medically assessed). I was assessed for arrthythmia attacks.
  5. Increased illness. Because your body is depleted, your immune system becomes weakened, making you more vulnerable to infections, colds, flu, and other immune-related medical problems. It’s better I don’t go into this… the list is endless.
  6. Loss of appetite. In the early stages, you may not feel hungry and may skip a few meals. In the latter stages, you may lose your appetite all together and begin to lose a significant amount of weight.
  7. Anxiety. Early on, you may experience mild symptoms of tension, worry, and edginess. As you move closer to burnout, the anxiety may become so serious that it interferes in your ability to work productively and may cause problems in your personal life. I wasn’t able to drive or use public transportation because of my anxiety, something I’ve never had before.
  8. Depression. In the early stages, you may feel mildly sad, occasionally hopeless, and you may experience feelings of guilt and worthlessness as a result. At its worst, you may feel trapped, severely depressed, and think the world would be better off without you. (If your depression is to this point, you should seek professional help immediately.)
  9. Anger. At first, this may present as interpersonal tension and irritability. In the latter stages, this may turn into angry outbursts and serious arguments at home and in the workplace. (If anger gets to the point where it turns to thoughts or acts of violence toward family or coworkers, seek immediate professional assistance.) 
  • Signs of Cynicism and Detachment
  1. Loss of enjoyment. At first, loss of enjoyment may seem very mild, such as not wanting to go to work or being eager to leave. Without intervention, loss of enjoyment may extend to all areas of your life, including the time you spend with family and friends. At work, you may try to avoid projects and figure out ways to escape work all together. This was very hard as I didn’t want to slip into depression. Luckily I was always able to see the beauty in nature. 
  2. Pessimism. At first, this may present itself as negative self-talk and/or moving from a glass half-full to a glass half-empty attitude. At its worst, this may move beyond how you feel about yourself and extend to trust issues with coworkers and family members and a feeling that you can’t count on anyone.
  3. Isolation. In the early stages, this may seem like mild resistance to socializing (i.e., not wanting to go out to lunch; closing your door occasionally to keep others out). In the latter stages, you may become angry when someone speaks to you, or you may come in early or leave late to avoid interactions. I have been stuck to my home for 6 months. I have never felt so alone in my entire life. I even felt disconnected from the Source.
  4. Detachment. Detachment is a general sense of feeling disconnected from others or from your environment. It can take the form of the isolative behaviors described above, and result in removing yourself emotionally and physically from your job and other responsibilities. You may call in sick often, stop returning calls and emails, or regularly come in late.
  • Signs of Ineffectiveness and Lack of Accomplishment
  1. Feelings of apathy and hopelessness. This is similar to what is described in the depression and pessimism sections of this article. It presents as a general sense that nothing is going right or nothing matters. As the symptoms worsen, these feelings may become immobilizing, making it seems like “what’s the point?” My kids were the reason I pulled through, I don’t know what would have happened if I didn’t have them to be around for. 
  2. Increased irritability. Irritability often stems from feeling ineffective, unimportant, useless, and an increasing sense that you’re not able to do things as efficiently or effectively as you once did. In the early stages, this can interfere in personal and professional relationships. At its worst, it can destroy relationships and careers. I remember being so angry with my sweet neighbours across the street for slamming the doors of their cars which I could hear through the wall (no filter….). 
  3. Lack of productivity and poor performance. Despite long hours, chronic stress prevents you from being as productive as you once were, which often results in incomplete projects and an ever-growing to-do list. At times, it seems that as hard as you try, you can’t climb out from under the pile. Well, I’m so happy to have found my husband, he did EVERYTHING for months without complaining. I wasn’t worth a dime in the home and he took care of the laundry, the kids, the dishes, the groceries…

Whenever you recognise a few of the symptoms from the lists, even mild ones, or when you think you are suffering from burnout or heading towards it with increasing speed, seek help. Stopping the train from derailing and taking a step back is more effective than having to remove the wreck from the track, like I had to do. Don’t wait, take action towards self care, self compassion and talk to somebody who can help you in taking action if you can’t.

Burnout is serious. I hope my story inspires you to take action TODAY.

 

 

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