Signs of burnout

By definition, burnout is a condition experienced by workers and other professionals, in which they develop depression-like symptoms as a result of aspects of their role. Burnout may manifest as showing signs of physical, mental and/or emotional exhaustion as a result of stress related to their job or workplace. 1

The stressors of a job or workplace causing burnout may affect a person’s life in a variety of ways. A number of possible physiological and psychological symptoms may develop, and these will significantly affect their overall quality of life. Common signs of burnout in the workplace include: 2 3

• Anxiety
• Headaches
• Lack of sleep
• Fatigue
• An increasingly cynical outlook on life and work

Physicians 4 and teachers 5 are among the types of employees who most commonly experience work-related stress, leading to being diagnosed with burnout. However, experiencing work-related stress, becoming burned out and feeling overwhelmed to the point of ill-health due to the demands of one’s job or work environment can happen to any employee, in any job, and at any stage of professional life.

Spotting the early warning signs of burnout in a coworker, employee, boss, someone with whom one is in a relationship, a family member or friend can be difficult, as the condition can develop over weeks or months, as their response to work-related stress evolves.

The symptoms to look out for may be different for every person. For instance, two coworkers in the same job role may respond to the same stressors in different ways; one may become burned out and the other may not. Alternatively, they may both become burned out, displaying different signs and symptoms from the wide range of possible symptoms that can characterize mental and/or physical burnout.

People affected by burnout from work-related stress may experience mental burnout, and present with some or all of the following psychological symptoms: 4 5 6

• Reduced performance and productivity
• Anxiety
• Detachment
• Feeling listless
• Low mood
• Difficulty concentrating
• Lack of creativity
• Fatigue
• Negative attitudes towards one’s coworkers or job
• Low commitment to the role
• Loss of purpose
• Absenteeism
• Quickness to anger
• Job turnover
• Cynicism
• Emotional numbness
• Frustration

Physical symptoms of burnout may include: 7 8

• Exhaustion
• Generalised aches
• Headaches
• Gastrointestinal disorders
• Hypertension
• Difficulty sleeping and/or a disrupted sleep cycle
• Increased susceptibility to colds and flu
• Muscle tension

Unsure if you, or a loved one, may be experiencing signs of burnout? Download the Ada app, your personal health guide for a free symptom assessment.

Although burnout is caused by work-related stress, the symptoms that an employee exhibits when they are burned out, and the signs that they may be becoming burned out, are different to the signs and symptoms of an employee experiencing stress. There are some key differences between the signs and symptoms of stress and burnout, as described in Harvard’s Helpguide: 9

Stress causes an employee to overengage with their work environment. Feeling anxiety that their productivity levels are not high enough, they will display symptoms like hyperactive, urgent behaviour, perhaps standing out from their coworkers. 10

In contrast, an employee who has experienced work-related stress to the point of becoming burned out will exhibit symptoms like disengagement and a lack of productivity, due to feeling detached from their work environment.

The damage to the health of an employee, from stress, is primarily physical; an employee who is experiencing stress continually is at increased risk of neurological and physical changes, due to having elevated levels of stress hormones such as cortisol and adrenaline. Symptoms of stress which an employee may display and experience include a decreased sex drive, insomnia and muscle tension. 9

An employee who has burned out has already been affected by these stress levels for weeks or months, during which time they will increasingly lose their energy. They are unlikely to experience new physical symptoms related to the ongoing work-related stressors that have caused them to burn out, as the physical symptoms of burnout are those of ongoing stress. Instead, the symptoms a person who is burned out will experience are primarily psychological, related to feeling increasingly listless and unmotivated in the workplace. 9

In general, becoming burned out follows on from experiencing a prolonged period of work-related stress. This means that both the physical symptoms of burnout, such as gastrointestinal disorders, and the psychological symptoms, such as cynicism, are likely to build up gradually over time, before a person, or their coworkers, family and friends, begin to realise that they have become burned out. 9 10

Every individual’s experience of burnout is unique, and treatment may require a specially tailored approach, taking into account a person’s life circumstances and medical and professional history. However, researchers have categorised the way people respond to chronic work-related stress into three main types: frenetic, underchallenged and worn-out. 11

Frenetic burnout occurs when people channel so much energy into their work, often as a result of anxiety, that the rewards of the role must eventually begin to seem negatively disproportionate to the effort they invest. Disregarding the concept of a work/life balance in order to channel maximum energy one’s work is common. Burnout occurs when a person works at an intensity to the point of exhaustion. 11

Underchallenged burnout occurs when a person feels trapped in a monotonous and unstimulating work environment, performing a role which does not provide job satisfaction. This contributes to an overall lowering of their mood. 11

Worn-out burnout occurs when people give up after experiencing a period in which their work environment is consistently a source of intense stress, or which yields negligible rewards. 11

These distinct types of burnout have been established as a prelude to the development of specific intervention strategies which can be employed in recovery from each kind of burnout.

Employees may begin showing signs of burnout slightly differently, depending on the demands of the their job, and the context in which they are burning out or beginning to burn out. This section provides job-specific guidance on how and why burnout occurs and spotting the specific signs of burnout in some of the most commonly affected kinds of employment.

The hospital staff most likely to be affected by burnout include: 12 13

• Nurses
• Physician assistants
• Physicians and surgeons
• Administrative staff
• Medical technicians

It is not surprising that working in a hospital or clinic is strongly associated with developing burnout, considering the definition of the word was coined by a member of hospital staff. In 1974, the psychologist Herbert Freudenberger first used it to described his own experiences at work when he was an unpaid volunteer at a free clinic catering to people experiencing problems with addiction.

Continuous stressors related to the clinic resulted in Freudenberger and his coworkers finding their experience of working there emotionally and physically wearing and also unrewarding. In his words, they became burned out.

The signs which these physicians showed of being adversely affected in the long-term by work-related stress are similar to the warning signs of burnout typically described by physicians and doctors experiencing burnout today. These include: 14 15

• Fatigue and/or lack of sleep, which may be due to anxiety, working long and often irregular hours, the inability to unwind and relax after work, or a combination of these factors.
• Depersonalization; this usually involves treating all patients and situations in the same way, rather than as individuals and being unable to approach each person or task with a fresh perspective.
• Low morale; medical professionals who are affected by burnout may show emotional signs, such as appearing withdrawn or unhappy at work, or losing confidence in their skills, abilities and decision-making powers. They may lack a sense of accomplishment and feel that their professional success is insignificant or insufficient, even if, in reality, they are performing well.-Absenteeism; taking multiple sick days, going for long breaks, failing to engage in professional communications.
• An increased tendency to make mistakes, such as making prescribing errors or having poor timekeeping, which can reinforce feelings of emotional burnout and low morale.
• A negative outlook; this may present as cynicism, feeling or expressing a lack of confidence in the medical establishment or the healthcare system as a whole, feeling irritated by the demands of patients or coworkers, focussing on the negatives, i.e. lives lost rather than lives saved, irritability and aggression.

A principal sign that a therapist, counselor or social worker may be experiencing emotional exhaustion or be burning out may involve developing a lack of interest in clients and their problems, also known as compassion fatigue. 16 In jobs which entail approaching one’s work with empathy on a constant basis, compassion fatigue can be a key sign of burnout.

Compassion fatigue can occur on its own, but can also occur as a result of secondary traumatic stress (STS). STS occurs when the sensation of being consistently presented with sensitive or triggering material leads people in these roles to experience a decrease in the compassion with which they react to sensitive material. This may come across as a diminished interest in, or disinclination to engage with, clients and/or their problems. 16

Therapists and counselors without an effective self-care routine to help process the sensitive material they encounter in the workplace, are more likely than others to experience compassion fatigue, secondary traumatic stress and workplace burnout.

Aside from compassion fatigue, signs of therapists or counselors experiencing burnout may include:

• Pessimism about their work with clients and its outcomes
• Cynicism about clients’ abilities to overcome problems
• Developing intolerant attitudes towards clients and coworkers
• Feeling increasingly self-critical about their own counselling or therapeutic abilities

Teachers experience a high level of burnout, because teaching is a job with multiple elements, each of which present their own emotional and intellectual challenges.

Factors which are commonly reported to contribute to teacher burnout include the long hours which teachers typically work and the pressure they experience as a result of being assessed regularly. A teacher’s professional success depends not only on their own performance, but also on the academic performance of their students. Additional stressors include the need to provide support for students from a wide variety of different backgrounds and with differing emotional and educational needs, and often the lack of an official support system for school or college staff. 17

Signs of teacher burnout may include: 17 18

• Emotional exhaustion: This may present as seeking out or needing more time to be alone than previously, having increasingly less patience with students and/or feeling overwhelmed by their educational or personal needs, smiling and laughing less, interpreting unruly behaviour from students as a personal attack, feeling hopeless about upcoming projects and their outcomes, or feeling frustration towards the educational establishment or jealous of the performance of other staff.
• Physical exhaustion: Feeling tired during or throughout the school day, taking more sick days, developing insomnia and/or headaches due to anxiety/depression related to the prospect of being in the school environment.
• Mental exhaustion: Feeling unable to accomplish as much as one ideally would each day, feeling like one is losing creativity and imagination in relation to both problem-solving and teaching the curriculum, feeling reluctant to take on anything new, and/or feeling too tired to make social plans surrounding the work timetable.

Teachers are more likely to experience workplace burnout in schools which lack a proper support system to address their personal needs and problems they may encounter in their role.

According to the doctors who classify burnout as a stand-alone medical condition, the key criterion for being diagnosed is simply that an employee’s daily occupation – whatever their job may be – must be directly related to the deterioration of their mental and/or physical health. This can encompass a real or perceived inability to cope with the demands of the role itself, a problematic response to stressors associated with the work environment, or a combination of the two.

It is also possible for burnout to affect people who are experiencing a stressor in their personal life which is affecting their ability to perform their job, such as going through a breakup, caring for a family member with an illness, or coping with the loss of a loved one.

Common possible causes of burnout include one or more of the following factors:

Particularly in professions where producing high-quality work is constantly required, such as being a lawyer, physician, therapist, nurse or teacher.

Maintaining a work/life balance is crucial to having a good quality of life. Certain jobs, such as being a physician or caregiver, usually involve working for long hours, which can make scheduling social plans, or making time for recreational activities and self care difficult. This is one reason why roles such as these are associated with high levels of burnout.

When a person is becoming burned out, they are often affected by fatigue and can feel unable to set aside time to mentally and emotionally detach from work, which can reinforce their symptoms of burnout.

Social workers, therapists and others who work in close contact with those experiencing stressors of a sensitive or triggering nature are at risk of burnout. This is most often due to becoming emotionally affected by elements of the situations and/or related material, such as interviews with upsetting content, that they encounter at work. 19

It is possible to develop secondary traumatic stress (STS) as a result of a standalone encounter with triggering material, such as a forensic analyst might experience on investigating a particular crime scene, or as a result of more long-term exposure to triggering content, for example counselling a trauma victim. Long-term exposure to triggering content can also result in the practitioner developing vicarious trauma and/or compassion fatigue, other possible causes of burnout.

Administrative and service jobs are associated with long hours and hard work, but mostly involve following set processes, with no possibility for innovation on the part of the person performing the role. Environments where this is the case for most employees generally have low overall morale.

This is because working within a structured system over which one has no control, in order to perform duties that do not vary on a day-to-day basis, can become monotonous. Jobs of this nature are often associated with a lack of motivation and feelings of boredom and/or frustration.

The sensation that the duties one performs at work are failing to have the desired effect, can cause a person to develop burnout, particularly if this occurs for a prolonged period of time. Not being given credit for one’s achievements, having one’s suggestions ignored, experiencing continual interruptions throughout the working day or having one’s work discarded rather than incorporated into projects can all be factors which engender a sense of futility, ultimately causing burnout.

It is widely accepted that one’s job will be more rewarding in some capacities than in others. For example:

• An accountant may not find their role emotionally rewarding, but would expect to be receive a good financial compensation for their efforts.
• A teacher, researcher or postgraduate student often accepts that they will not gain significant financial profit, but, as a trade-off, they expect their work to be intellectually stimulating and emotionally rewarding.

Feeling that one’s job is insufficiently rewarding in any capacity, however, can be a significant causal factor in burnout.

This constitutes any kind of professional environment in which one feels either personally unhappy or unable to work effectively, or both. This may involve:

• Having unproductive or negative interpersonal dynamics with one’s colleagues
• Feeling the strain of working in a fast-paced environment without a culture of caring for one another, such as a financial trading floor
• Trying to perform one’s role in an unsuitable or unstructured set-up where there are no protocols to follow when one encounters problems and/or needs guidance

Negative emotions and the increased stress associated with being treated unfairly by one’s coworkers and/or experiencing discrimination are both directly linked to burnout in many studies. 20 21 22

Most people spend the majority of their time at work. When a person has different values to the coworkers that they are surrounded by throughout the working day, even if one does not experience outright discrimination, this can lead to feeling alienated, which can cause stress, and burnout.

There are many different tests available to doctors who wish to ascertain whether a person is suffering from burnout. Occupation-specific scoring systems are continually being devised, for example, a hassle-based diagnostic questionnaire was recently trialed, which is specifically designed to detect burnout that stems from the work-related stress experienced by call-centre staff. 23

The tests most commonly used to diagnose burnout and detect symptoms of job dissatisfaction are the Maslach Burnout Inventory (MBI), the Job Diagnostic Scale (JDS) and the Utrecht Work Engagement Scale (UWES).

One of the most commonly used and well-established tests to define burnout in an individual is the Maslach Burnout Inventory (MBI) scoring system.

The MBI Surveys comprise three general scoring scales: 24

• Emotional exhaustion: Measures feelings of being acutely emotionally affected and drained of energy by the stress related to one’s work and/or working environment.
• Depersonalization: Measures the extent to which one has ceased to empathise with one’s customers, clients, or the people in one’s care.
• Personal accomplishment: Measures the extent to which one feels confident in performing one’s role, perceived productivity and the level of job satisfaction.

The MBI has been adapted in order to assess burnout as it occurs in a variety of different industries.

Available versions of the MBI Survey include: 25

• MBI-Human Services Survey (MBI-HSS): This questionnaire is designed to identify burnout in people working in professions which involve providing care, assistance or guidance to others, such as doctors, nurses, social workers, therapists, counselors, police, clergy and outreach workers. A specific version of the MBI-HSS has been adapted for medical personnel (MBI-HSS MP).
• MBI-Educators Survey (MBI-ES): This version of the MBI is suitable for anyone working in an educational establishment, including administrators, headteachers, teachers and volunteers.
• MBI-General Survey (MBI-GS): If one works in a profession which is neither related to human services nor education, the MBI-GS is the most appropriate version of the MBI to determine burnout. The MBI-GS will be offered to individuals working in jobs such as manufacturing, management, customer service or construction. A specific version of the MBI-GS has been adapted for adult students in college and university (MBI-GS-S).

The MBI-GS measures different criteria for burnout in the specialized surveys, rating a person’s exhaustion, cynicism (indifference or frustration towards one’s work) and professional efficacy (an estimation of the likelihood that one will continue to be able to perform one’s role).

Rather than evaluating a person’s experience of their work, the Job Diagnostic Scale (JDS) is used to examine the role itself, determining the likelihood that a given job will cause its employees to experience burnout. The JDS looks at both the tasks pertaining to a role and the overall work environment to determine the motivation potential of the role. Roles with a low motivation potential are more likely to engender burnout. 26

Work engagement – identifying and feeling able to bring high levels of energy to one’s work – is seen as the opposite of experiencing burnout. 27 A person with a low score in the Utrecht Work Engagement Scale (UWES) can therefore be considered at high risk of experiencing burnout.

The scoring system evaluates both a person’s personal resources, such as their self-esteem, belief in their ability to succeed and their capacity for optimism, and aspects of the work environment (such as the provision of performance feedback and supervisory coaching, and the extent to which the organisation makes its employees feel valued and able to work autonomously). 28

There is no set treatment course for burnout. Many people find it helpful to leave their workplace either temporarily or permanently. However, others find it possible – through proactive decision making and/or with therapeutic support – to alter their work environment and their attitudes to it, in ways that remove or reduce the factors responsible for causing burnout.

Feeling unwell? Get a symptom assessment with the free Ada app. Or find out more about how our symptom checker works before you try it for yourself.

Q: What are the signs of recovery from burnout?
A: When a person has developed new coping strategies for ensuring that their work does not impact on their quality of life, they will be able to approach their job with less reluctance or anxiety. They may start to show a happier and more relaxed manner in the workplace, and/or be more forthcoming with ideas or more willing to take on new projects. By devising a plan for recovery from burnout with a therapist or physician, a person will be able to overcome their symptoms of physical, mental and emotional exhaustion, and develop a more positive attitude to their job, workplace and/or industry.

Q: What are the signs of burnout in a caregiver?
A: Even though being a caregiver may be an unpaid, voluntary position, it can still produce feelings of burnout, due to its emotionally and physically exhausting nature. In a marriage or when caring for a parent or child, it can be impossible to separate the demands of caregiving from one’s feelings of love for those in one’s care. This can lead to sensations of guilt if the condition of the person or people in their care does not improve as expected, and/or reluctance to take any time off from caregiving for recreational activities or self care.

The caregiver burnout that develops as a result may present as feelings of hopelessness, depression, irritability, for example overreacting to minor problems, low mood, loss of interest in activities which the caregiver previously enjoyed, and, in some cases, compassion fatigue. 29

If you are a caregiver and think you may be experiencing burnout, download the Ada app to begin your health assessment.

Q: Do all physicians recognise burnout as a psychological condition?
A: Burnout has been recognized as a possible psychosocial hazard of work; particularly work in high-stress environments; by the World Health Organisation (WHO). 2 However, some doctors and researchers contest the idea that the signs of being burned out from work-related stress are unique enough for it to be regarded as a fully-fledged medical condition in its own right, arguing that it is merely a subtype of depression. 3 See this resource for more information about the signs of depression.