Burnout or stress? Signs to notice and what helps

Stress is the body and mind’s response to pressure, and it can come from any part of life. Burnout is narrower: the World Health Organization (WHO) describes it as a syndrome resulting from chronic workplace stress that has not been successfully managed. The main signs of burnout are exhaustion, feeling distant or cynical about your job, and feeling less effective at work. If you recognise these signs, it is worth taking them seriously and talking to someone, whether that is your GP, your employer or a therapist.

Key points

• The WHO includes burnout in ICD-11 as an occupational phenomenon, not a medical condition.
• It describes three dimensions: exhaustion, mental distance or cynicism about your job, and reduced effectiveness at work.
• Stress can show up in your body, your thinking and your behaviour, and it is not limited to work.
• The NHS suggests talking to someone, small achievable goals, breathing exercises and not relying on alcohol or drugs to cope.
• See a GP if you are struggling to cope or have physical symptoms that worry you. In England you can also self-refer to NHS Talking Therapies.

What is burnout?

In its International Classification of Diseases (ICD-11), the WHO describes burnout as a syndrome that results from chronic workplace stress that has not been successfully managed. It is listed as an occupational phenomenon rather than a medical condition, in a section covering reasons people may come into contact with health services.

The WHO describes three dimensions:

• Exhaustion: feelings of energy depletion or being worn out.
• Mental distance: feeling increasingly detached from your job, or negative and cynical about it.
• Reduced professional efficacy: feeling less effective or capable at work than you used to.

The WHO is clear that the term refers specifically to work and should not be used to describe experiences in other areas of life. That does not mean the exhaustion people feel from caring, parenting or long periods of pressure outside work is not real. It means the word “burnout”, in this definition, is about work.

What are the signs of stress?

The NHS describes a range of symptoms of stress, which can affect your body, your mind and how you behave:

• In your body: headaches or dizziness, muscle tension or pain, stomach problems, chest pain or a faster heartbeat, sexual problems.
• In your mind: difficulty concentrating, struggling to make decisions, feeling overwhelmed, constant worrying, forgetfulness.
• In your behaviour: being irritable or snappy, sleeping or eating too much or too little, avoiding certain places or people, drinking or smoking more.

The NHS suggests talking to a GP or contacting NHS 111 if stress is affecting your daily life, or if you have symptoms that worry you.

How is burnout different from stress?

The two overlap, and burnout, as the WHO describes it, grows out of chronic stress at work. But comparing the NHS description of stress with the WHO description of burnout suggests some differences in emphasis:

• Source. Stress can come from anywhere: work, money, relationships, health or family. Burnout, in the WHO definition, relates to work.
• How it feels. Stress often involves feeling overwhelmed, worried and swamped. Burnout centres on exhaustion and a growing distance from your job.
• Your relationship with work. Feeling cynical, detached or no longer effective at work is a central part of burnout, rather than a side effect.

Some signs, such as tiredness, poor sleep and low mood, can also be part of depression. The NHS describes depression as feeling persistently sad or hopeless for weeks or months, often with a loss of interest in things you used to enjoy. If that sounds familiar, it is important to see your GP, and you can read more on my depression page. A therapist or website cannot diagnose you, but a GP can help you make sense of what is going on and rule out physical causes of tiredness.

What causes burnout and work-related stress?

The Health and Safety Executive (HSE) identifies six main areas that can lead to work-related stress if they are not managed properly:

• Demands: workload, work patterns and the working environment.
• Control: how much say you have over the way you do your work.
• Support: the encouragement and resources you get from managers and colleagues.
• Relationships: including conflict and unacceptable behaviour such as bullying.
• Role: whether you understand your role and whether roles conflict.
• Change: how change in the organisation is managed and communicated.

The HSE says employers have a legal duty to protect employees from stress at work by assessing the risk and acting on it. It can help to know this if you are thinking about raising the issue at work.

It can also be worth looking at your own patterns alongside the workload, such as finding it hard to say no, holding yourself to very high standards, or feeling that your worth depends on what you achieve. Therapy can be one place to explore this.

What helps with stress and burnout?

The NHS suggests several things that can help with stress, and many apply to burnout too:

• Talk to someone you trust, such as a friend, family member or health professional.
• Set small, achievable goals rather than trying to do everything at once.
• Try breathing exercises, such as my breathing exercise.
• Plan ahead for days or events you know will be stressful.
• Make time for yourself, including regular exercise if you can.
• Avoid relying on alcohol, cigarettes, gambling or drugs to cope.

Talking to your employer

If work is the main source of the pressure, it may help to talk to your manager, HR or an occupational health service, if there is one. Some employers also offer counselling through an employee assistance programme. If you need time off, you can self-certify for up to seven days. After that, a healthcare professional such as your GP can issue a fit note, which may say you are not fit for work or that you may be fit for work with changes such as altered hours, amended duties or a phased return.

Getting support

See your GP if you are struggling to cope, if self-help is not working, or if you have physical symptoms that worry you. In England, if you are 18 or over (16 or over in some areas), you can also refer yourself to NHS Talking Therapies without seeing a GP first.

Therapy can offer a space to step back, understand how you reached this point, and think about what needs to change, at work and in how you treat yourself. You can read more on my stress and burnout page.

If you are in crisis, call 999, go to A&E, call NHS 111, or contact Samaritans on 116 123 (free, 24/7).

If you would like to talk about how you have been feeling, you are welcome to get in touch and arrange an initial consultation. I am an integrative psychotherapist registered with the BACP, and I see adults online and in person in Farringdon, Central London.