How many times have we heard of work-related stress or unemployment? According to theWorld Health Organization the burnout it is now officially considered a syndrome - not a disease - and has been included in the new version of the eleventh International Classification of Diseases (Icd-11) and refers only to a work context and not extended to other areas of life. The decision comes after decades of studies. Initially, the UN special agency for health had hinted that it was instead a disease after mistakenly entering it for the first vote in the list of diseases. Then he adjusted the shot and specified that burnout remains an occupational phenomenon (work-related stress) for which a cure can be sought but it is not a medical condition. WHO has also provided guidelines for doctors to diagnose this condition by ruling out other disorders that exhibit similar symptoms such asadaptation, anxiety or depression. The first to deal with burnout was the psychologist Herbert Freudenberger with a scientific article published in 1974 where he spoke about a syndrome that mainly referred to so-called helping professions such as nurses and doctors. That syndrome can be extended, more generally, to people who deal with assistance or who coming often into contact with others who experience states of distress or suffering.

What is meant by work-related or unemployment stress syndrome?

What are the symptoms to pay attention to for a correct diagnosis?

When patient should contact a specialist?

For the Journal Italian Healthcare World the psychologist-psychotherapist to these questions will answer Enza Elefante, specialist who is part of IHW platform and who works in Amsterdam and online..

Dr. Enza Elefante

Dr. Elefante, what is Burnout Syndrome?

The term burnout comes from the English verb phrase burn out, which means burnt, exhausted. Burnout syndrome is a clinical syndrome characterized by gradual depletion of the psychophysical resources of the person who is exposed in the workplace to excessive and long-lasting stressful events and who handles them in an inappropriate way.

What are the symptoms to pay attention to for a correct diagnosis?

Occupational burnout can present with different symptoms. Three are currently considered as specific:

  • emotional exhaustion: the person feels tense, without energies, emptied by the work;
  • depersonalization: distant or indifferent attitude towards the work and the people met at work;
  • reduced personal accomplishment: the person feels inadequate and experiences diminished self-esteem and self-efficacy.

Furthermore, there are other symptoms considered non-specific, for example, on a physical level, there may be sleep disturbances, gastrointestinal disorders, weight loss and/or weight gain, headache. From the behavioural point of view, there may be delay and absenteeism, isolation, abuse of psychotropic drugs, alcohol or substances. Finally, at the cognitive-affective level, apathy, irritability, frustration, reduced productivity, inability to concentrate, lack of enthusiasm, loss of motivation can be present. According to the WHO, for a certain diagnosis, the three specific symptoms must be present: a sense of exhaustion or energy weakness; increase in isolation from one's work with feelings of negativity or cynicism and reduced professional effectiveness.

When patient should contact a specialist?

When a patient experiences the symptoms and the malaise, typical of this syndrome, you could ask for psychological consultation, during which the professional will evaluate the presence or absence of burnout and eventually indicate the treatment to be carried out.

How is it treated by the specialist? What are the prevention actions?

Usually, the programs implemented, be they preventive or cure, provide for the integration between interventions aimed at the person and interventions aimed at the working context. The former has the objective of strengthening the person's internal resources, improving his ability to manage stress and tackling problems at work. In this regard, relaxation techniques can be used to reduce physiological activation, techniques based on mindfulness to increase the degree of awareness and acceptance of one's thoughts, emotions and behaviours, techniques such as cognitive restructuring or constructive conflict management to strengthen coping skills, ie the skills used to cope with stressful events. Furthermore, it is very important to increase social support from colleagues. The person can be helped to improve their social skills through assertiveness training and inclusion in support groups that encourage listening, discussion and learning of more functional ways of acting. With regard to the interventions aimed at the working context, these have the objective of improving the social climate within the organization and increasing the sense of belonging, autonomy and participation in the common objectives. One type of intervention could be the use of social and economic reward.

You work in Amsterdam and online. How long have you moved and why did you choose Holland?

I moved to the Netherlands about three months ago. A job was offered to my husband and we decide to move to Amsterdam, a town that we both love and where the quality of life is very high. In addition, Amsterdam and in general the Netherlands enable the people to develop and grow from a professional point of view. I also work with Skype. I offer this service to all people who cannot physically come to my office and particularly to all Italians who live abroad and for whom it is difficult to find a professional who speaks Italian.

What is the patient approach?

With my patients, I immediately create a therapeutic relationship based on empathy, validation, and acceptance. I try to make them feel welcome, understood, and at ease, creating a space in which they can share their suffering without being judged. I use the cognitive-behavioural approach, according to which there is a complex relationship between thoughts, emotions, and behaviours, and psychological problems are largely the product of dysfunctional beliefs that are maintained over time. Currently, Cognitive Behavioral Therapy is considered one of the most reliable and effective psychological therapies to understand and treat emotional and behavioural problems, which is corroborated by the greatest number of scientific evidence in the national and international panorama.

What is the difference compared to Italy from a professional point of view?

In Amsterdam I noticed that there is greater attention to psychological well-being, therefore the number of people asking for help from the professional is greater than in Italy. As far as clinical practice is concerned, I noticed a high incidence of problems related to living abroad, such as the difficulty in creating stable social relationships and adapting to a different culture and working environment.  

Have you followed patients suffering from work-related stress or unemployment? What is your experience?

Yes, many people I helped were affected by these problems, which are very common. The experience was really positive. After the assessment phase, during which we evaluated the characteristics of the personality and the symptom framework, we carried out a psychotherapeutic treatment to reduce the level of stress and treat the subjective factors that played a role in the onset and the maintenance of the problem, with really positive results.

What are your tips?

Burnout can be compared to a virus since it works in an invisible, penetrating continuously and without a qualified intervention, can lead to serious consequences. Therefore, if you think you are experiencing the typical symptoms of the syndrome, my advice is always to ask a specialist for help.


The psychologist Enza Elefante is part of the Network Italian Healthcare World, the first platform dedicated to Italian doctors and health professionals residing abroad. His profile can be consulted in our very useful WebApp.

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