From Nervous Breakdown to Burnout Syndrome
At CHMC in Dubai Healthcare City, we have seen a number of patients who tell us that they are having a nervous breakdown. They say that they can’t cope with the stress at work anymore and are calling in sick, are isolating and not showing up for appointments, and are not eating well, sleeping enough/or too much, and sometimes are not even motivated to take care of basic hygiene. Clearly, this is alarming to the affected, the people in their lives, as well as their employers.
The term “Nervous Breakdown” historically has been used since about 1900 and rose to its highest usage in the 50ties, and to this day is a familiar term used by the public to describe a breakdown of functioning. The attraction in the term lies in that it is vague and does not reveal too much, thereby preserving privacy. It puts emphasis on the idea that there is an issue with the nerves and not the mind, and it is fixable. Fact is that a “Nervous Breakdown” never was a proper psychiatric diagnosis.
What is Burnout?
Since the 70ties the term “Burnout” has cropped up. It came into existence as a word to describe the effects of severe stress and high ideals among people in the “helping professions,” such as doctors and social workers, who began to feel exhausted, listless and unable to cope. Today the word is used for anyone who is feeling like they are no longer able to put up with the physical and emotional demands placed on them by families and employers.
In the mental healthcare field conditions are defined and described in two publications. One is the Diagnostic and Statistical Manual for Mental Health Disorders (DSM-5) put forth by the American Psychiatric Association, and the other is the International Classification of Diseases (ICD-10) published by the World Health Organization. Only the ICD has burnout listed as a disorder and defines it as, “a state of vital exhaustion.”
Experts have not agreed on a formal definition of burnout. Burnout is not considered a mental illness, but rather a form of chronic workplace stress. Pressure at work can make people feel exhausted, empty, burned out and unable to cope. Such stress can cause physical and mental symptoms.
The Signs and Symptoms of Burnout
There are 3 main areas of symptoms according to the National Center for Biotechnology Information (NCBI), (2017):
– Exhaustion: People affected feel drained and emotionally exhausted, unable to cope, tired and down, and do not have enough energy. Physical symptoms include things like pain and stomach or bowel problems.
– Alienation from (work-related) activities: People who have burnout find their jobs increasingly stressful and frustrating. They may start being cynical about their working conditions and their colleagues. At the same time, they may increasingly distance themselves emotionally, and start feeling numb about their work.
– Reduced performance: Burnout mainly affects everyday tasks at work, at home or when caring for family members. People with burnout are very negative about their tasks, find it hard to concentrate, are listless and lack creativity.
If you are working in Dubai and are feeling burned out, it is very important to consult with a licensed psychiatrist or psychologist/counselor. There are online self-assessment tests, but they cannot tease out the difference between burnout, physical symptoms possibly triggered by underlying medical conditions, and mental health disorders, such as depression.
Symptoms for depression and burnout can be similar, but each require a different treatment approach. In burnout the majority of symptoms relate to work; however, with depression negative thinking and feeling low are about all areas of life.
What depression and burnout have in common:
– Extreme exhaustion
– Feeling down
– Reduced performance
Symptoms related to depression that are not regarded typical for burnout are:
– Low self-esteem
– Suicidal tendencies
At CHMC in Dubai, either the psychiatrist or psychologist/counselor can establish the correct diagnosis. When depression is diagnosed, the severity of the depression will be determined and a treatment plan developed. Mild and moderate depression can be treated with psychotherapy by a counselor or psychologist using Cognitive Behavioral Therapy, Existential Therapy, and/or Client Centered Therapy. More severe depression, that prevents daily functioning at home and at work, is most effectively treated with medication prescribed by a psychiatrist in conjunction with psychotherapy provided by a psychologist/counsellor. At CHMC, Dr. Gregor Kowal provides psychiatric services, and Dr. Annette Schonder provides psychotherapy.
Treatment for Burnout in Dubai
– Cognitive Behavioral Therapy (CBT) is an evidence based treatment approach for people suffering from burnout. In this approach people can begin to change their thoughts about their work role, performance, and self/other imposed expectations relating to their jobs.
– Counseling helps people identify areas of their work that are problematic and solutions are discovered. Here it also is important to learn about leadership styles to address the basic need for autonomy and respect with managers.
– Through counseling a person with burnout can also learn how to set boundaries when a workload is too much and reduce “people pleasing” by learning to say “no,” politely and firmly.
– Work-life-balance also needs to be addressed. Everyone needs to practice good self-care, which includes time to decompress on a daily basis, vacation time, healthy nutrition, and adequate sleep. In an effort to preserve well needed downtime, gadget usage needs to be analyzed and possibly trimmed down.
– If sleep has been negatively affected, a counselor will provide the basics on sleep hygiene. If sleep has become so poor that it cannot be reestablished with good sleep habits, the psychiatrist can prescribe medications to facilitate good sleep and regulate sleep cycles.
– During counselling basic techniques to relax are discussed and taught, such as mindfulness, progressive relaxations, self-hypnosis, and meditation. Exercise is encouraged as a stress relief and relaxation technique.
– People with burnout will acquire a new set of skills and to make changes in their work and private life. An important part of burnout treatment is to observe the effects of the changes and to reinforce new habits for a permanent, healthy work and lifestyle change.
If you feel that you are suffering from burnout, know that it is a treatable condition and you have expert mental healthcare services at your disposal, in Dubai Healthcare City, provided by the psychiatrist Dr. Gregor Kowal and the counselor Dr. Annette Schonder.
List of References
Burnout, Oct. 31, 2018, https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024813/
Depression: What is Burnout?, Jan. 12, 2017, https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072470/
Depression: What is Burnout?, Jan. 12, 2017, https://www.ncbi.nlm.nih.gov/books/NBK279286/