Hitting the send button each week is like serving in tennis. With great anticipation, I always wonder what will come back at me. Last Friday, I wrote about the recent adoption of the WHO International Classification of Diseases-11 (ICD-11) and provided a number of highlights about conditions that were added, deleted, modified, and garnering lots of media attention.
I was sure that comments on Gaming Disorder would dominate your return emails. Instead, messages on Burnout flooded my inbox. Readers from around the world sent questions, comments, and personal experiences – all of which indicated that I needed to hunker down and do a better job clarifying and elaborating what is meant by Burnout in ICD-11. Here goes!
1. The syndrome of Burnout in the ICD-11. Although we all have an intuitive sense of what burnout is, the ICD-11 syndrome of Burnout is specifically defined as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: 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 ICD-11 description of Burnout is substantiated by a significant body of research, and the phenomenon of burnout in the workplace is widely recognized in many countries around the world.
2. Burnout is in the ICD-11, but it is not a mental disorder. When I have referenced the ICD-11 over the past years, I have typically focused on Chapter 6: Mental, Behavioural and Neurological Disorders. But the ICD-11 includes many other chapters focused on other health conditions. It also includes a chapter entitled, “Factors Influencing Health Status or Contact with Health Services.” Things like donating an organ, receiving a prophylactic vaccination, and Burnout are included in this chapter. Such conditions bring people into contact with health services even though they are not considered illnesses or health conditions. The placement of Burnout in this chapter verses the chapter on mental disorders reflects assumptions about the external cause of the syndrome as well as the dimensions of the symptoms. I daresay, it may also reflect some political compromise.
3. Why is Burnout getting so much attention now? We witnessed an unanticipated explosion of articles focused on Burnout when the ICD-11 was approved last month. So much so, that I also thought Burnout was elevated to the status of a disorder for the first time in ICD-11. But this is not correct. Burnout was included in the same chapter in ICD-10. So why all the hype? My impression is that the media attention has hit a certain resonance with the workforce where Burnout seems to be on the rise. Extraordinary advances in technology since ICD-10 (which was pre-internet and pre-smart phone) have propelled great increases in workforce productivity, availability, and accessibility. All well and good up to a certain point, but Burnout is a reminder that, in our technology driven 24/7 world, there is such a thing as too much of a good thing. For a Japanese take on workplace stressors and burnout risk, you might want to watch the newly released feature film, Whistleblower. The French have responded to burnout and the intrusion of work on leisure time with a national law that prohibits requiring employees to respond to emails after hours.
4. Burnout in ICD-11 is limited to the workplace. ICD-11 Burnout refers specifically to a syndrome that occurs in response to the occupational context and should not be applied to experiences in other areas of life. This is quite interesting to me since definitions of “workplace” can be debated. Does school constitute the workplace for a student? Can individuals who volunteer experience burnout or do you need to be a salaried worker? What about stay-at-home parents who are the untitled CEOs of their families?
5. Burnout and mental health in the workplace. Regardless of the chapter in which Burnout sits in the ICD-11, when people experience Burnout, they are also likely to experience symptoms of depression and anxiety. Thus, business leaders are increasingly paying attention to mental health in the workplace, beginning with concerns about excessive stress, which can lead to Burnout and mood and anxiety disorders. Of course, not all mental health problems that employees experience are caused by the work place environment. But there is no doubt that business leaders can positively impact employee health and productivity by creating workplace environments that reduce Burnout and support mental health.
Bottom line: ICD-11 Burnout occurs in the context of the workplace. It is not a mental disorder per se, but it can lead to mental health problems, especially mood and anxiety disorders. When Burnout and mental disorders are left unaddressed, they are a burden for the individuals who is suffering, and they make it more difficult for us to engage productively at work. Creating a workplace environment that reduces burnout and promotes mental health is not only the right thing to do for individual employees, it is also good for business.