NEW YORK (NYTIMES) - Dr Jessi Gold, a psychiatrist at Washington University in St Louis, knows she is edging towards burnout when she wakes up, feels instantly angry at her e-mail inbox and does not want to get out of bed.
It is perhaps not surprising that a mental health professional who is trying to stem the rising tide of burnout could burn out sometimes too. After all, the phenomenon has practically become ubiquitous in our culture.
In a 2021 survey of 1,500 United States workers, more than half said they were feeling burnout as a result of their job demands, and a whopping 4.3 million Americans quit their jobs in December in what has come to be known as the "great resignation".
When people think of burnout, mental and emotional symptoms such as feelings of helplessness and cynicism often come to mind. But burnout can lead to physical symptoms as well, and experts say it can be wise to look out for the signs and take steps when you notice them.
Burnout, as it is defined, is not a medical condition - it is "a manifestation of chronic unmitigated stress", explained Dr Lotte Dyrbye, a physician scientist who studies burnout at the Mayo Clinic. The World Health Organisation describes burnout as a workplace phenomenon characterised by feelings of exhaustion, cynicism and reduced efficacy.
"You start not functioning as well, you're missing deadlines, you're frustrated, you're maybe irritable with your colleagues," said researcher Jeanette Bennett, who studies the effects of stress on health at the University of North Carolina, Charlotte.
But stress can have wear-and-tear effects on the body, especially when it does not ease up after a while - so it makes sense that it can incite physical symptoms too, Dr Bennett added. When people are under stress, their bodies undergo changes that include making higher than normal levels of stress hormones such as cortisol, adrenaline, epinephrine and norepinephrine. These changes are helpful in the short term - they give us the energy to power through difficult situations - but over time, they start harming the body.
Our bodies were "not designed for the kinds of stressors that we face today", said Professor Christina Maslach, a social psychologist at the University of California, Berkeley, who has spent her career studying burnout.
Here is how to recognise burnout in your body and what to do about it.
What to look out for
One common burnout symptom is insomnia, Dr Dyrbye said. When researchers in Italy surveyed front-line healthcare workers with burnout during the first peak of the pandemic, they found that 55 per cent reported having difficulty falling asleep, while nearly 40 per cent had nightmares.
Research suggests that chronic stress interferes with the complicated neurological and hormonal system that regulates sleep. It is a vicious circle because not sleeping throws this system even more out of whack. If you have noticed you are unable to sleep at night, that could be a sign you are experiencing burnout, Dr Dyrbye said - and your sleeplessness could exacerbate the problem.
Physical exhaustion is another common sign. Dr Gold said one of her key symptoms of burnout was fatigue. "I realised I was sleeping every day after work - and I was like, 'What is wrong with me?' But it was actually burnout."
Changes in eating habits - either eating more or less than usual - can also be a sign of burnout. In the study of Italian healthcare workers, 56 per cent reported changes in food habits.
People might eat less because they are too busy or distracted, or they might find themselves craving "those comfort foods that we all like to go to when we need something to make us feel better", Dr Bennett said.
Research suggests, too, that stress hormones can affect appetite, making people feel less hungry than usual when they are under a lot of stress, and more hungry than usual when that stress alleviates.
Headaches and stomachaches can also be incited by burnout, Dr Gold said. One study of people in Sweden suffering from exhaustion disorder - a medical condition similar to burnout - found that 67 per cent reported experiencing nausea, gas or indigestion, and 65 per cent had headaches.
It is also important to note that burnout can develop alongside depression or anxiety, both of which can cause physical symptoms. Depression can cause muscle aches, stomachaches, sleep issues and appetite changes. Anxiety is linked to headaches, nausea and shortness of breath.
What to do
If you are experiencing physical symptoms that could be indicative of burnout, consider seeing your primary care doctor or a mental health professional to determine whether they are driven by stress or rooted in other physical conditions, Dr Dyrbye said. Do not just ignore the symptoms and assume they do not matter.
If it is burnout, the best solution is to address the root of the problem. Burnout is typically recognised when it is job-driven, but chronic stress can have a variety of causes - financial problems, relationship woes and caregiving burdens, among other things.
Think about "the pebbles in your shoe all the time that you have to deal with", Prof Maslach said, and brainstorm ways to remove some of them, at least some of the time. Perhaps you can ask your partner to help more with your toddler's bedtime routine, or get takeout when you are especially busy, so you do not have to plan dinner too.
Despite popular-culture coverage of the issue, burnout cannot be "fixed" with better self-care, Prof Maslach said. In fact, this implication only worsens the problem, because it lays the blame and responsibility on those with burnout and implies that they should do more to feel better, which is not the case, she added.
However, some lifestyle choices can make burnout less likely. Social support, for instance, can help, Dr Gold said. This could include talking to a therapist or meeting friends - even if over Zoom. It may also help to take advantage of mental health or exercise benefits offered by your employer. Sleeping more can help too - so if you are suffering from insomnia, talk to a doctor about possible treatments, Dr Bennett suggested.
When burnout stems from job-related woes, it may help to request better working conditions. Prof Maslach suggested brainstorming with co-workers and presenting your employer with ideas that would help - like providing quiet areas for breaks and personal phone calls, creating "no meeting" days so employees can have more time to focus, or ensuring that there is always coffee in the break room. Even small changes like these can make a dent in the risk for burnout if they fix a problem that people face at work every day.
"It's the chronic job stressors that drive people really nuts after a while - they do not have the right equipment, they do not have the things they need, they do not have enough people to do the work," Prof Maslach said.
Taking time off work could also help, but it is likely only a temporary Band-Aid, Dr Gold said. She compares it to using a bucket to empty water out of a sinking ship. "It's still sinking, right? You have to do more than just occasionally take the water out," she said.
Still, it is important to take time off regularly, Dr Dyrbye said.
Ultimately, you want to ensure you have some freedom and autonomy in your job, Dr Gold said. "Anything you can do to regain an element of control can be really helpful," she added.
That could mean doing your least favourite work activity right before your break, so you have something to look forward to during the task and time to recover from it afterwards. Or it could be trading a dreaded task with a co-worker and, in return, picking up their most hated task, which might not be so difficult for you.
Finally, while you may not want to add more to your plate, try to make a bit of time each day for something you love, Dr Dyrbye said.
Her work has found that surgeons who make time - even just 15 to 20 minutes a day - for hobbies and recreation are less likely to experience burnout than surgeons who do not.
"You have to have something outside of work that helps you destress, that helps you focus and helps you relax," she said.