Burnout

The burnout syndrome is a set of physical and mental symptoms including exhaustion, fatigue, headaches, depression, anxiety, sleep problems, non-specific pain and digestive problems, although many other symptoms can also occur. The symptoms of burnout and CFS are identical except in their severity, with the dividing line between the two diagnoses being set at the point where the symptoms become highly disabling.

A study on teachers suffering from burnout found that those teachers who scored highest on the "Maslach Burnout Inventory" had the lowest levels of cortisol throughout the day. The teachers who said they were under stress but not suffering from burnout had the highest levels of cortisol. The study also found that those teachers who were highest on the burnout scales had the highest levels of physical illness complaints. The stress level did not alter the number of physical complaints among the teachers who were low on the scale. The factors associated with high levels of burnout were low job satisfaction, low perceived levels of support, low perceived levels of being able to cope with stress and high levels of emotional exhaustion (although this last one could be a symptom rather than a cause).

This study highlights a number of important findings. First of all, that mental attitude has a large influence over the ability to handle stress without suffering from burnout. Second, that people suffering from burnout have higher levels of physical illness complaints. And third, that low levels of cortisol (and a suppressed HPA axis) seem to be associated with low stress tolerance and high levels of burnout.

This particular study also found that stress and burnout are separate variables - people can suffer from burnout in the absence of stress, and vice-versa.

Causes of Burnout

Popular belief is that burnout is the result of excessive stress. This is the view that Hans Selye took when he presented his General Adaptation Syndrome theory of stress, which has the following three stages:

[1] The alarm phase at the onset of the stress, which causes the adrenal cortex to discharge all of its supply of stored hormones into the blood.
[2] The stage of resistance, where the adrenal cortex enlarges due to continued stimulation by ACTH, which results in an enhanced ability to manufacture and secrete higher levels of cortisol. During this stage there is a greater ability to deal with stress.
[3] The stage of exhaustion, which eventually comes after continued stress, and results in symptoms similar to the alarm phase. During this phase the adrenal glands shrink and levels of cortisol fall, resulting in an inability to cope with stress.

From his results, Selye proposed that many illnesses in humans which are not obviously caused by an external pathogen, such as liver disease and heart disease, may be due to the psychological stresses of modern life. He proposed that the continual stresses of modern life result in the exhaustion phase of the GAS, which then leads to one of any number of physical illnesses. This notion has been mostly rejected today due to the advances in understanding about how the body works, with a greater concentration on the underlying mechanism of disease. In fact, most of Selye's work seems to have been forgotten today, and his GAS has largely been rejected. While it is true that he tried to apply his theories too broadly, there is one very important fact which he discovered and which is largely ignored today, and that is the exhaustion phase of the GAS, which appears to be the same state as burnout.

Recent research shows that burnout (in terms of reduced HPA axis response and low cortisol) can be caused by four factors:

[1] Excessive long-term stress
[2] Stress followed by rest
[3] Long-term illness
[4] Negative mental attitude

Relationship to CFS

Burnout and CFS may initially appear to be very different, but closer investigation shows that they are in fact quite similar. The same hormonal abnormalities appear in both groups, namely reduced cortisol and a suppressed HPA axis, as well as a tendency to suffer from various physical illness complaints.

Also, a significant proportion of CFS patients say that their illness began during a period of high stress. In some cases this was emotional stress, but in other cases it was simply a high-pressure job (which in many cases the person did not find "stressful" in the negative sense).

In fact, all of the known triggers for CFS, such as emotional stress, negative mental attitude, viral infection, and working in a high-pressure job, are the same factors which cause burnout. CFS can therefore be thought of as a state of long-term burnout in the absence of stress.

References