Le burn-out est-il une entité nosographique distincte ?

Abstract

Although it has largely been studied since the 1970s, it remains controversial to accurately define what the concept of burnout encompasses. Indeed, burnout is not consensually defined and, although some consider that it is a work-related illness, there is no clear diagnostic criteria. This problem is intensified by the fact that some studies present methodological limitations, thus impeding an appropriate characterization of burnout. As a consequence of this lack of agreement, burnout is not acknowledged as a work-related illness, which minimizes the pain of those individuals who are suffering from it. The present paper will review findings that can help to disentangle whether burnout should be considered as a medical diagnosis. Cultural differences concerning the consideration of burnout as a medical condition will be pointed out and the distinctiveness of burnout compared to depression, adjustment disorder or other stress related symptoms will be highlighted. Moreover, we will explain why considering that burnout belongs to broader diagnostic categories implies that the weight of employees’ discomfort mainly relies on personal causes and therefore weakens the role of existing working conditions. This paper will also summarize clinical, psychological and biological evidences for and against the inclusion of burnout as a medical condition, before embedding them in a wider social, political and economic context. More specifically, we will explain why burnout is intimately related to the political and economic situation of a country: when society promotes cost-effectiveness, it increases stress and psychological pressure, which makes a burnout more likely to appear. Furthermore, if burnout is recognized as a work-related disease, the consequences for organizations will be that they will have to pay for additional health care charges. Finally, more effective prevention techniques could be developed, and more appropriate care could be provided to patients, but only if an agreement on diagnostic criteria was obtained and if reliable assessment tools were developed. As long as these issues are not addressed, treatments specifically targeting burnout symptoms will be further delayed although it is a serious clinical condition associated with physical and psychological symptoms impairing patients’ quality of life. In conclusion, we suggest that burnout should be considered as a medical condition despite the economic and political impediments. Nevertheless, up to now, several methodological limitations preclude to reliably establish a pathological cut-off and to delineate burnout from other mental illnesses.