The Diagnosis, Classification, and Treatment of Clinical Burnout


Our lives can get hectic from time to time as we work, assist others, or take care of our families. On occasion, we become overly preoccupied and forget to stop and relax. At that point, burnout is possible. Burnout is exhaustion brought on by a persistent sense of being overburdened. It is brought on by extreme and ongoing psychological, physical, and emotional stress. Burnout frequently has a connection to one’s employment.

In clinical psychology, people who seek psychiatric treatment and stop working due to their symptoms or face severe difficulties functioning at work are considered to have burnout. Since burnout results in low productivity and energy levels and feelings of helplessness and relentlessness, you’ll eventually feel drained. The negative effects of burnout can affect several aspects of your life, including your relationships with your family, friends, and work. This is why it’s important to understand how burnout develops, how it is treated, and what type of help you can get.

In this article, we will explore the significant insights from an article in the European Journal of Work and Organizational Psychology regarding the clinical perspective on burnout, its diagnosis, classification, and treatment. 

Introduction: Burnout and Clinical Burnout

Clinical psychologists and psychiatrists treat mental illnesses like diseases in mental health care. Whether you have the condition or not depends on the type and intensity of your symptoms. An illness or disorder’s symptoms include exhaustion, sleepness, fever, and pain that may be seen and felt. The occurrence of several distinct symptoms together characterizes an illness or disorder, which can also be applied to psychological conditions like clinical burnout.

This definition of clinical burnout is different from how it is defined by work and organizational psychologists, who view burnout as a multidimensional concept that can be measured using questionnaires in working populations that are generally in good health. The distinction between how clinical psychologists use the concept of burnout compared to work- and organizational psychologists lies in the role of biology. 

The addition of biology leads to several notable differences in the conceptualization of burnout, including;

  • Work-and organizational psychologists primarily concentrate on psychosocial aspects, while clinical psychologists view mental diseases from the perspective of both biological and psychosocial approaches.
  • From a biological point of view, burnout is not necessarily work-related but rather stress-related.
  • A biological perspective sees the development of clinical burnout as a process with several distinct phases rather than a linear progression.

Another distinction between the organizational and clinical approaches is that clinical psychologists examine feelings and behavior in specific individuals. This enables them to focus on the individual variations in how they cope and psychologically function. Learning about the distinction between short-term stress and clinical burnout is also important as short-term stress has a more favorable prognosis than clinical burnout.

Diagnosis and classification of clinical burnout

Because burnout is not recognized as an official mental condition in the Diagnostic and Statistical Manual of Mental Problems, it can be difficult for clinicians to diagnose it and distinguish it from mild stress disorders. According to several sources, here are some of the diagnoses and classifications of clinical burnout:

  • According to the International Classification of Diseases, burnout is classified as a “State of vital exhaustion” but is not considered a disorder.
  • A 2015 review states clinicians have no common agreement on which classification matches clinical burnout.
  • In some studies, clinically burned-out participants were mainly diagnosed with other types of anxiety and mood disorders.
  • “Exhaustion Disorder” was introduced by the Swedish Board of Health and Welfare, but this classification is limited to Sweden and not universally used to define clinical burnout.

This diversity in clinical burnout classifications needs to be viewed in the context of a larger debate over the validity of classification for psychiatric diseases. More so, because several mental disorders and short-term stress both show elevated levels of burnout measures, a clinician cannot solely rely on questionnaires to make a subjective distinction between mild stress disorders and clinical burnout. Instead, clinicians need to reconstruct the pathogenesis, which is the history and sequence of life events, symptoms, and mechanisms that lead to the syndrome.

Pathogenesis of clinical burnout

Pathogenesis refers to the sequence of events leading to a disease’s development. In this section, we will discuss the distinction between the development of clinical burnout compared to individuals who seek help when having relative short-term stress symptoms. Differences in the development of clinical burnout and short-term stress are as follows:

  • Those with short-term stress can clearly distinguish between a stressor and the mental problems within 3 months after the stressor emerged. 
  • On the other hand, patients with clinical burnout report that they ignored stress symptoms for several years.
  • In terms of coping strategies, those with clinical burnout tend to persist from stress without complaining.
  • According to the literature on fatigue in healthy individuals, fatigued individuals adapt their performance strategy to regulate the mobilization of mental effort.
  • For burnout patients, there is a tendency to cope with stress with perseverance and maintain high standards of task performance.

There are several stages in the progression of clinical burnout that can be identified and define the process of burning out, which include;

Lack of recovery

Lack of recovery from physiological stress reactions is where burnout begins. If restful ones break up difficult times, a person can withstand a lot of stress and recover. However, there are fewer chances to recuperate from stress when there are issues at work and home. During this stage, people could feel the need for recovery and resistance to exerting effort.

Changes in stress physiology

The stress system adjusts when stress levels are high for extended periods. A higher stress level is assigned as the organism’s default, resulting in new homoeostatic stress values. Sleep issues start to appear as a result of persistently high-stress levels. Another issue is that people can no longer unwind even when there is no pressure. Whether a stressor is present or not, the stress system is always in motion. As a result, people lose their ability to relax and become agitated. This frequently results in a lack of ability to unwind and restlessness during free time.

Chronic stress symptoms

Physiological stress that persists over time can cause issues with the body, mind, behavior, and emotions. Burnout patients may have various physical symptoms from headaches, gastrointestinal issues, muscle tension, or discomfort due to chronic stress. It also impacts cognitive functioning, such as attention, concentration, and working memory. Conflicts with others resulting from cognitive deficits and emotional instability are further problems brought on by persistent stress during clinical burnout.

Pseudo Psychopathology

People adopt more strict problem-solving techniques and cognitive simplification to lessen stress by simplifying the complexity of reality. People are less likely to employ adaptive coping mechanisms as stress levels rise, which prevents them from developing the professional and personal resources necessary to manage ongoing job demands. It could appear that the person has maladaptive personality traits due to this. According to a source, this syndrome, which arises due to ongoing stress, is best classified as pseudo psychopathology. The pseudo maladaptive personality that is often observed in clinical burnout is often dependent and paranoid personality traits which are observed through compulsive and rigid behaviors. It is important to determine whether the rigid maladaptive interpersonal style is a cause or result of chronic stress. Meanwhile, Pseudo personality psychopathology, which arises from chronic stress, disappears with the recovery from burnout.

Impaired motivation and passivity

The final phase of the development of clinical burnout is when a person meets the diagnosis of the condition. During clinical burnout, the hyperactivity from the first stage of chronic stress may change to indifference and nearly permanent reduced motivation. 

Individuals with clinical burnout often seem unable to motivate themselves, which is suggested by researchers to be related to the phenomenon called “learned helplessness.” Learned helplessness is when a person thinks that a situation is beyond their reach and they can’t do anything about it, which results in them not trying to cope with the situation anymore and experiencing high-stress levels.

Clinical Burnout Treatment

The differences in the concepts surrounding burnout also affect the knowledge on treating clinical burnout. Some interventions are more focused on preventing burnout, while others are directed at treating clinical burnout. This makes it hard to come up with firm conclusions about the efficacy of treatment schemes. 

Some therapeutic interventions commonly used in the treatment of clinical burnout for each specific phase are as follows:

Phase 1: Crisis

According to a source, crisis marks the first phase of treatment. The patient strives to complete their commitments at work and in her personal life despite extreme weariness and distress but will eventually become more sensitive about making mistakes, emotionally unstable, and prone to arguments. During the initial stage, therapists must be sympathetic to the patient’s sentiments while being open and truthful about the likelihood of a speedy recovery.

Phase 2: Recovery of the stress system

During this phase, it is important to reduce stress. Patients will gradually resume their normal activities in the second phase. An activity’s relative level of distress is noted, and the therapist encourages the patient to begin with low-stress, short-duration non-work activities, alternated with rest or calming activities. The ability of a person to transition from alertness to rest is crucial. As a result, the patient and therapist should devise plans that alternate between activity and rest. A healthy lifestyle should also be encouraged as it’s beneficial for recovery.

Phase 3: Prevention and learning from experience

In the final phase, the patient is close to recovery, and it is the perfect time to learn about the possible reasons for the person’s burnout. Understanding the causes of burnout may make it less likely that someone may experience years of ongoing stress.

Key Takeaway

A physician cannot depend entirely on questionnaires to make a subjective distinction between several mental disorders such as depression, anxiety, and clinical burnout since they all show elevated burnout measures. Knowing that biological processes play a significant role in the emergence of clinical burnout is crucial for organizational psychologists. To identify who is at risk for clinical burnout, they should focus more on coping skills than symptom severity.

Furthermore, interventions should be tailored to the different risk profiles so that each will be given the appropriate attention to help them recover from stress or clinical burnout.

Journal Reference

Van Dam, A. (2021). A clinical perspective on burnout: Diagnosis, classification, and treatment of Clinical Burnout. European Journal of Work and Organizational Psychology, 30(5), 732–741. 

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