We would like to thank Philippe Bouhours, psychiatric doctor specialised in behavioural and cognitive therapies, for his help in preparing this article.

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Work offers many benefits to employees’ health. It stimulates the mind and enables us to blossom as individuals. However, it can also have negative consequences. In the UK, in 2020, mental health and absenteeism cost more than 6,000$ per employee, per year (Deloitte, IES and CIPD). Our professional commitment, our reactions to stress and our working conditions can be vehicles of professional illnesses. Especially burnout.

What is burnout?

It is an ache that affects many employees in or outside of their company every year. Not only is in an individual problem, but also an organisational one. If, at the beginning of the Industrial era, physical conditions were really put to the test, work today is “directed” towards psyche, with the growth of the tertiary sector and new technologies.

Burnout definition

Burnout is a psychological pain related to work. We define it as the professional exhaustion syndrome. It results from chronic stress. The National Health Service (NHS) defines it as:

A state of emotional, physical and mental exhaustion caused by excessive and prolonged stress. It occurs when an individual feels overwhelmed, emotionally drained and unable to meet constant demands.

Christina Maslach, pioneer in professional exhaustion research, characterise burnout as a 3 dimensional syndrome :

  1. Emotional, psychological and physiological exhaustion are only the visible part of the iceberg.
  2. We also have to take into account depersonalization regarding work. Employees progressively disengage from their colleagues and their tasks. The individual attempts to staunch the depletion of emotional energy by treating others as objects or numbers rather than people
  3. Lastly, the third dimension is the reduced personal accomplishment at work. Employees denigrate themselves and are under the impression of being inefficient.

Is burnout an occupational illness?

In recent years, burnout has evolved from a syndrome resulting from chronic stress at work to a work-related phenomenon according to the the World Health Organization (WHO).

However, it is still not recognised as an occupational disease. In the United Kingdom, it is possible to take a stress leave if you are struggling with anxiety and depression. The employee can self-certify their sickness by providing a work-related stress sick note for seven days. After that period, they’ll need a note from their doctor to continue their absence.

The different stages of burnout

Burnout does not suddenly appear. It is a slow process made of different “stages”. The starting point of this syndrome is stress. It gradually becomes unmanageable and chronic for employees. According to Christina Maslach (2011):

Burnout would be the consequence of daily stressful reactions that have worn out the individual.

We distinguish 5 development stages for this illness. It is very important to note that those phases are not all mental health risks for employees.

office worker very tired

Enthusiasm

The first stage is characterised by strong enthusiasm from employees towards their work. They are full of ambition and energy to meet their objectives. They are very engaged within their organisation. The role of the company is to enthuse its employees by providing meaning to their work. This stage is therefore welcomed both for the company and for the fulfilment of employees. However, preventive measures need to be put in place to keep employees in this enthusiastic stage.

Over-investment

Over-investment is the second stage leading to burnout. Employees invest all their time and efforts to carry their tasks out. Nevertheless, the efforts asked and the conditions of work develop an intense level of stress difficult to manage. We talk about overheating.

Why do employees enter into this over-investment stage?

The demands and loads of work are the main factors pushing individuals to enter in a stage of over-investment. Stress endured by employees pushes them to redouble their efforts and to sacrifice their personal life at the expense of their professional life. Over-investment also originates from an imbalance between the efforts produced by individuals and the rewards (recognition, validation) obtained in return. Lack of recognition is a major source of professional exhaustion syndrome.

Disillusionment

The disillusionment stage is the penultimate stage before burnout. Employees start to be drained of their energy in the face of constant pressure from their work. Chronic stress prevents them from progressing and makes them irritable.

Why do employees enter in a disillusionment stage?

Emotional demands and lack of autonomy, combined with an important work load crush employees into a continuous stress. They do not find meaning to their work and their self-esteem is strongly degraded. It is important to note that this stage does not necessarily lead to burn out. As a matter of fact, many employees remain in that stage for many years before getting better or being completely drained out of their energy.

Burnout

The last stage is burnout. Employees are physically, emotionally and mentally worn out. They exhausted all their energy and are not fit for work.

Why do employees get to the burnout stage?

Professional exhaustion arises when employees evolve in a degraded work environment. It develops due both to characteristics specific to the individual, and characteristics related to work. Organisational factors play a major part in the development of this syndrome. Quality of management is a decisive feature. It is not uncommon to observe employees from the same company suffering from burnout. Pathogenic management or management by fear deteriorates employees’ working conditions. Indeed, overuse of subordination relationships, disciplinary rules and management authority are not well received by employees and can generate suffering at work.

After burnout

There is a light at the end of the tunnel. After burnout, the recovery stage appears. Indeed, there comes a time when we start feeling better and moving forward. This stage enables to redefine your personal and professional objectives to open new horizons. Recovery time depends on the initial severity of the illness. Unfortunately, some employees might not be able to fully recover and will have trouble getting back to work. Nevertheless, most of the time, a few months of rest (and follow up by professionals) should enable employees to come back to work.

Burnout symptoms

There is not a unique symptom to diagnose burnout. The combination of physical, emotional and intellectual warning signals enables to detect it. Scientific research identified more than 130 symptoms. It is important to note that those manifestations are not specific to this illness. They can appear following up periods of intense stress or prolonged exposure to factors of psychosocial risks.

Physical symptoms

Physical manifestations are the most frequent when an employee is suffering from burnout. We primarily identify:

  • Chronic fatigue
  • Muscle tension
  • Migraines
  • Insomnia
  • Stomach pain

Emotional and behavioural symptoms

There are early emotional and behavioural signs to professional exhaustion syndrome:

  • Anxiety
  • Loss of control
  • Unusual cynicism
  • Disengagement
  • Irritability
  • Isolation

Intellectual and cognitive symptoms

Intellectual symptoms have direct repercussions on people’s ability to work and their commitment to their company. We generally observe:

  • Difficulty to concentrate
  • Difficulty to take decisions
  • Memory disorders
  • Professional reconsideration
  • Low self-esteem

Stress is the common link between the various symptoms of burnout. It is therefore essential for companies to prevent stress and psychosocial risks sources.

Burnout prevention and management

employee suffering from burn-out

Averting professional exhaustion relies on the implementation of an appropriate prevention and benevolent management

Managing your burnout when you are an employee

When you are an employee and you suffer from exhaustion, it is very important to speak up.

Most of the time, it is a lack or the absence of communication that leads to this situation. You should not hesitate to make an appointment with the Human Resources department or the company doctor. Subsequently it is important to consult your family doctor. They can issue a medical leave. Lastly, the intervention of a psychiatrist can help the employee rebuilding their professional identity.

Managing a burnout case in your team

Professional exhaustion is a product of pathogenic management and of a lack or recognition. If this is not the desired outcome, it is vital to question and analyse the cause (mental pressure, workload) that led the employee to burnout. You have to find solutions internally by implementing more agile and flexible work methods, in accordance with the quality of work life of your employees.

Preventing burnout at a company level

Joint efforts between occupational health and company management needs to be institutionalised. Together they can set up a process to prevent burnout and mental illnesses stemming from work.

In order to avoid burnout, the company must asses and measure all 6 families that cause psychosocial risks:

  • Work intensity and work time
  • Emotional requirements
  • Lack of autonomy
  • Social relations at work
  • Values conflict
  • Work insecurity and work status

Companies must move towards new work organisations by implementing agile and flexible methods. Carrying out a quality of work life (QWL) policy is one of the keys of prevention. Indeed, QWL creates a work environment and working conditions that are conducive to employee satisfaction and blossoming. It is also a medium of recognition and giving work meaning for employees.

Sports is also an effective way to prevent professional exhaustion. Corporate culture should incentivise employees to be active and practice physical activities. It improves concentration, moral and constructive thinking.

Finally, training your managers and employees on psychosocial risks and stress management prevents burnouts. Mr Bouhours recommends hiring a work psychologist, whether on an ad hoc basis or for a full period of time. This support is beneficial for employees in order to pre-empt risks and to find suitable solutions tailored to their professional situations.

 

Conclusion:

Burnout is a 3 dimensional professional exhaustion symptom: physical, emotional and mental exhaustion; cynicism towards work and a decline of personal fulfilment at work. It is still not recognised today as a professional illness and usually arises as a consequence of chronic stress. Companies must strive to stir up enthusiasm across their workforce by giving meaning to their work. Recognition and valuing employees work are keys to prevent burnout.

References:

Maslach C. “Understanding burnout: Definition issues in analyzing a complex phenomenon”. In W.S.Paine (éd.), Job Stress and Burnout. Sage Publications, Beverly Hills (California), 1982.

Olié J-P, Légeron P. « Rapport sur le burn out », Académie nationale de médecine, 2016.

OCDE. « Mal être au travail ? Mythes et réalités sur la santé mentale et l’emploi ». Santé mentale et travail. Rapport 2012.

Maslach C., Leiter M.P. ”Burn-out, le syndrome d’épuisement professionnel”. Les Arènes, Paris, 2011.

Schaufeli WB, Enzmann D, Girault N. “Measurement of burnout: A review. In Professional burnout: Recent developments in theory and research”. Schaufeli WB, Maslach C, Marek T. Philadelphia, PA, US: Taylor & Francis; 1993:199–215. [Series in Applied Psychology: Social Issues and Questions.]

Giorla, JF. « Le médecin libéral face à la souffrance au travail de ses patients ». Union régionale des professionnels de santé.

Boudoukha A-H. « Repérer et évaluer le burn-out pour définir une prise en charge TCC adaptée ». LPPL EA 4638, 2019.

Repérage et prise en charge cliniques du syndrome d’épuisement professionnel ou burnout. Haute autorité de santé, 2017.

Chapelle G-F. Modélisation des processus d‘épuisement professionnel liés aux facteurs de risques psychosociaux : burn out, bore out, stress chronique, addiction au travail, épuisement compassionnel. Journal de thérapie comportementale et cognitive, 2016 (vol 26), pp 111-122.

Ministère du Travail, Direction générale du travail « Le syndrome d’épuisement professionnel ou burn-out: mieux comprendre, pour mieux agir ». Guide d’aide à la prévention, 2015.


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