Will a ‘burnout’ diagnosis help cure what ails the modern worker? | Opinion

This week, news broke that the World Health Organization (WHO) will include burnout as a medical diagnosis in the International Classification of Diseases. While hailed as a sign of progress, this decision in fact sidestepped a spirited discussion across the research about whether work-related burnout should be considered a diagnosis or a syndrome, or whether it is simply a more “acceptable” psychosocial label for Major Depression, a psychiatric condition whose characteristics overlap with those of burnout.

Burnout is characterized by three major features, according to the WHO: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and 3) reduced professional efficacy. The WHO noted that the diagnosis of burnout should not be applied to experiences outside the occupational context. Importantly, the WHO’s definition specified that burnout not be diagnosed in the context of mood, stress, or anxiety disorders.

Why, you might ask, is this distinction between diagnosis, syndrome, or misplaced label critical? Those on the side of calling burnout a syndrome argued that medicalizing burnout as a diagnosis in itself would shift the focus from an institutional or workplace problem, which some view as the cause of burnout, to the individual and their apparent medical problems. They contended that not addressing toxic environments would expose others to the risk of developing burnout.

One argument against this diagnosis is that it might lead to failure to diagnose other underlying psychiatric conditions that drive “burnout,” and that these unrecognized psychiatric disorders are potentially lethal, requiring active evidence-based treatment. For example, Major Depression is a condition in which individuals experience fatigue, similar to the “feelings of energy depletion or exhaustion” as experienced with burnout. Patients with Major Depression may experience hopelessness and helplessness, which could be mistaken for “feelings of negativism related to one’s job” and they often cannot not function at full capacity, which could be misconstrued as “reduced professional efficacy.” Thus, when screening for burnout does not also include a method for detecting cases of Major Depression, individuals with Major Depression may be misclassified as having burnout and fail to receive desperately needed, effective treatment.

One challenge on either side of the argument is the fact that there were over 140 different definitions for burnout that had been used in the research literature, making its true prevalence difficult to estimate. In fact, for the medical workforce, the reported range of burnout’s prevalence is 0-80%, although the most often cited prevalence is closer to 60%.

Still, the WHO has aided the field in important ways. First, it has cemented a definition for burnout by including it in the International Classification. This is critical because to conduct research on a notion of illness — whether a syndrome, diagnosis, or something else — a consistent definition across studies is essential. Second, it has addressed the concern about missed psychiatric conditions warranting treatment by explicitly stating that the burnout diagnosis not be made without ruling out the psychiatric conditions with which it most overlaps. Third, it has made it possible for physicians to bill for the condition, should patients seek care for its symptoms. Fourth, by defining it as a diagnosis, it has reinforced the notion that treatments or solutions should be sought to address burnout.

Surely, the debate will continue. For now, we have an important tool to further research on the seemingly rising modern malady of burnout: a consistent definition.

Maria A. Oquendo, M.D., Ph.D., is Ruth Meltzer Professor and chair of Psychiatry in the Perelman School of Medicine at the University of Pennsylvania. The opinions expressed in this article do not represent those of the University of Pennsylvania Health System or the Perelman School of Medicine.