occupational burnout occupational burnout according to the world health organization (who), occupational burnout is a syndrome resulting from chronic work-related stress, with symptoms characterized by "feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy". while burnout may influence health and can be a reason for people contacting health services, it is not itself classified by the who as a medical condition or mental disorder. who additionally states that "burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life." occupational burn-outother namesburn-out, exhaustion disorder, neurastheniaa person who is experiencing psychological stressspecialtypsychology symptomsemotional exhaustion, depersonalization, reduced personal accomplishment, fatiguedifferential diagnosismajor depressive disorder history according to wolfgang kaskcha, "burnout as a phenomenon has probably existed at all times and in all cultures." he notes that the condition is described in the book of exodus (18:17–18). gordon parker believes the ancient european concept of acedia refers to burnout, and not depression as many others believe. it has been suggested that the first printed use of the term "burnout" in english was in one of shakespeare's sonnets in 1599, referring to a woman's love burning out. the sonnet in question is one of shakespeare's most famous. in 1869, new york neurologist george beard used the term "neurasthenia" to describe a very broad condition caused by the exhaustion of the nervous system, which was thought to be particularly found in "civilized, intellectual communities." the concept soon became popular, and many in the united states believed themselves to have it. some came to call it "americanitis". the rest cure was a commonly prescribed treatment (though there were many others). beard yet further broadened the potential symptoms of neurasthenia over time, so that almost any symptom or behaviour could be deemed to be caused by it. don r lipsitt would later wonder if the term "burnout" was similarly too broadly defined to be useful. in 1961, graham greene published the novel a burnt-out case, the story of an architect who became greatly fatigued by his work, and who took much time to recover. in 1969, hb bradley used the term "burnout" in a criminology paper to describe the fatigued staff at a centre for treating young adult offenders. this has been cited as the first known academic work to use the term for this concept. in 1974, herbert freudenberger, an american psychologist, used the term in his academic paper "staff burn-out." the paper was based on his qualitative observations of the volunteer staff (including himself) at a free clinic for drug addicts. he characterized burnout by a set of symptoms that includes exhaustion resulting from work's excessive demands as well as physical symptoms such as headaches and sleeplessness, "quickness to anger", and closed thinking. he observed that the burned-out worker "looks, acts, and seems depressed." after the publication of freudenberger's paper, interest in the concept grew. in 1976, christina maslach noted the term being used by california lawyers working with the poor, and began to study the concept. in 1981, maslach and susan e. jackson published an instrument for assessing burnout, the maslach burnout inventory (mbi). it was the first such instrument of its kind and the most widely used burnout instrument. the two researchers described burnout in terms of emotional exhaustion, depersonalization (feeling low-empathy towards other people in an occupational setting), and reduced feelings of work-related personal accomplishment. in 2005, the swedish board of health and welfare adopted a refined conceptualisation of severe burnout it described as "exhaustion disorder." in 2015, the world health organization adopted a conceptualisation of burnout that is consistent with maslach's. it adopted a modified version of this in 2022. however, "is not itself classified by the who as a medical condition or mental disorder." also in 2015, bianchi and colleagues brought to bear evidence that the construct of burnout substantially overlaps with depression. as of 2017, nine european countries (denmark, estonia, france, hungary, latvia, netherlands, portugal, slovakia and sweden) considered burnout as being a recognised medical disorder. diagnosis classification the two main classification systems of psychological disorders are the diagnostic and statistical manual of mental disorders (dsm, used in north america and elsewhere) from the american psychiatric association (apa), and the international classification of diseases (icd, used in europe and elsewhere) from the world health organisation (who). burnout is not recognized as a distinct mental disorder in the dsm-5 (published in 2013). its definitions for adjustment disorders, and unspecified trauma- and stressor-related disorder in some cases reflect the condition. 2022's update, the dsm-5-tr, did not add a definition of burnout. as of 2017, nine european countries considered burnout as being a recognised medical disorder. these countries classify it under one or more codes of the icd. the icd-10 (current 1994–2021) classified "burn-out" as a type of non-medical life-management difficulty under code z73.0. it was considered to be one of the "factors influencing health status and contact with health services" and "should not be used" for "primary mortality coding". it was also considered one of the "problems related to life-management difficulty". the condition is further defined as being a "state of vital exhaustion," which historically had been called neurasthenia. the icd-10 also contained a medical condition category of "f43.8 other reactions to severe stress." in 2005, the swedish board of health and welfare added “exhaustion disorder” (ed; f43.8a) to the swedish version of the icd-10, the icd-10-se, representing what is typically called "burnout" in english. 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