Diagnosestellung beim Burnout-Syndrom
Es gibt, wie bereits erwähnt, keine einheitliche Definition des Burnout-Syndroms.
Diagnostisch wird dem Burnout-Syndrom in der ICD-10-Klassifikation psychischer Störungen „nur“ eine Z – Diagnose im Anhang zugestanden (die eigentlichen psychiatrischen Diagnosen werden mit einem F kodiert). Folge davon ist, dass keine eigentlichen diagnostischen Leistlinien vorhanden sind, die das Vorhandensein konkreter Symptome fordern.
Das Burnout-Syndrom weist aber m. E. so eindeutige, von anderen depressiven Störungsbildern meist klar unterscheidbare Symptome auf und stellt eine derart gefährliche und oft folgenschwere Störung dar, dass es unbedingt als relevante psychische Erkrankung beachtet werden müßte.
Burnout-Syndrom – typische Symptomatik:
- Anhaltende resp. zunehmende, tiefgreifende psycho-physische Erschöpfung
- Entwicklung über einen langen Zeitraum (oft über mehrere Jahre)
- Verlauf schleichend und meist über mehrere symptomatisch unterscheidbare Stadien
- besondere Häufung in Tätigkeitsfeldern, denen ein hoher Anspruch an die eigene Tätigkeit innewohnt und in denen der persönliche Erfolg entweder schwer meßbar (soziale oder künstlerisch-kreative Berufe), schwer erreichbar (andauernde Frustrierung eigener oder akzeptierter Leistungs- und Erfolgsvorgaben) oder aber nach oben hin unbegrenzbar (Manager, Selbständige) ist. (Entgrenzte Tätigkeit aufgrund disponierender Persönlichkeitsfaktoren oder aufgrund der inhaltlichen oder strukturellen Beschaffenheit des Tätigkeitsfeldes (z. B. soziale und helfende Berufe, Lehrer, Manager, Seelsorger, Künstler etc.).
- erhebliche Abhängigkeit dieser Störung von konkreten Arbeitsbedingungen und sozialen/gesellschaftlichen Zielvorgaben und Interaktionsweisen. Jede entgrenzte Tätigkeit kann zu einer Burnout-Situation führen! Entsprechend lassen sich viele Burnout-Entwicklungen durch präventive Massnahmen, d.h. einen angemessenen/menschengerechten Umgang mit Mitmenschen, Arbeitskräften und Zielvorgaben, auch und v.a. sich selber gegenüber.
- unbehandelt oder zu spät behandelt sehr häufig Grund für langanhaltende Arbeitsunfähigkeit, persistierende depressive Verstimmungen und Antriebslosigkeit bis hin zur Suizidalität sowie nicht selten auch konsekutive Suchterkrankungen
Im Online-Archiv des Deutschen Ärzteblattes schreibt Dr. med. Thomas Bergner in einem Artikel über Burn-out bei Ärzten:
„Burn-out bedeutet immer einen vielfältigen Symptomenkomplex (29) aus:
– körperlichen Symptomen wie kardialen Beschwerden, Diarrhö oder Obstipation, Kopfschmerz, Müdigkeit, Muskelverspannungen, Lustlosigkeit,
– mentalen Symptomen wie Konzentrationsschwierigkeiten, Entscheidungsschwäche, fehlenden Zielen und verminderter Belastbarkeit,
– emotionalen Auffälligkeiten, wie Nervosität, depressiven Verstimmungen, Unruhe, Pessimismus, fehlender Motivation, Kontaktverlust zu Patienten, Mitarbeitern, Kollegen und Freunden sowie innerer Leere und vermindertem Selbstwertgefühl,
– Besonderheiten im Verhalten wie anfangs Hyperaktivität, später Alkoholkonsum und anderen Süchten.“ (Quelle: https://www.aerzteblatt.de/v4/archiv/artikel.asp?id=43363)
Frau Dr. med. Martin Greif beschreibt in viamedici das Burnout-Syndrom folgendermaßen:
„Die Symptome sind vielfältig und somatisch, vegetativ und psychisch ausgeprägt: Die körperlichen Beschwerden sind unspezifisch und diffus. Betroffene klagen beispielsweise über Müdigkeit und Schlaflosigkeit und sind anfälliger für Krankheiten. Gefühlsmäßig neigen sie zu einer negativen Einstellung, empfinden eine innere Leere, Lustlosigkeit und ziehen sich zunehmend sozial zurück. Wird dieser Zustand zur Gewohnheit, beginnen die Betroffenen, bestimmte Tätigkeiten aufzugeben, gar zu vermeiden, reduzieren ihre Arbeit und sind nicht mehr so leistungsfähig wie zuvor. Gehemmt, rast- und ruhelos und tendieren sie zu größerer Ängstlichkeit, sind aber mehr und mehr mit ihrer Verfassung und Bewährung im Berufs- und Privatleben unzufrieden. Sie trauen sich nichts mehr zu und hecheln einer Überforderung nach der anderen hinterher. Ihr Verhalten und ihre Stimmung ändern sich unmerklich, zunehmend reagieren sie gereizt und mit Verzweiflung. Es fällt ihnen dann schwer, nach der Arbeit abzuschalten und sich auf das Privatleben zu konzentrieren. In der Folge sind die ganze Kraft und Kreativität geschwunden. Einen anderen Ausweg als den gesteigerten Verzehr von Genussmitteln sehen sie nicht mehr und versuchen, sich über ihre Lage hinwegzutäuschen.“ (Quelle: https://www.thieme.de/viamedici/aktuelles/artikel/burnout.html#anker4)
Die Stadien des Verlaufs beim Burnout-Syndrom:
Nicht immer verläuft der Burnout-Prozess so klar unterscheidbar in Phasen. Diese sind daher nur als Orientierungshilfe gedacht. Entscheidend für die Diagnose bleibt dagegen die aktuelle klinische Situation (anhaltende Erschöpfung, Frustration und Antriebslosigkeit) und die anamnestischen Angaben einer schleichenden Entwicklung bei hohem Arbeitspensum und hohem emotionalem Druck.
- Begeisterung und Idealismus für die Arbeit (Um ausbrennen zu können, muß man vorher einmalgebrannt haben…)
- Reduktion des Arbeitsengagements und Versuch der Kompensation beruflicher Frustrationen durch vermehrte Außenaktivitäten oder Engagement im Privatleben
- Phase des Aufbegehrens, der heftigen emotionalen Reaktionen und der Suche nach dem oder den Schuldigen, Wut und depressive Gefühle
- Unbeeinflussbares Nachlassen der Leistungsfähigkeit (Leistungsknick). Antriebsverlust, Motivationsverlust, Verlust der Krativität
- teilweise sehr lange andauerndes Stadium zunehmender Interesselosigkeit an sozialen oder geistig-kulturellen Aktivitäten, Rückzug, emotionale Einpanzerung bzw. Nivellierung, stumpfes „Funktionieren“
- Einsetzen ernster psychische oder psychosoomatischer Beschwerden, von diversen Schmerzzuständen, körperlicher Ermüdung/Kraftlosigkeit, Infektionen, Magen-Darm-Störungen, Essstörungen bis hin zu Angststörungen, Phobien, Depressionen
- Krise und Zusammenbruch (oft Zeitpunkt des erstmaligen Aufsuchens eines Facharztes)
Differentialdiagnose beim Burnout-Syndrom
Zur Differentialdiagnostik eines chronischen Erschöpfungszustandes (Burnout-Syndrom) können eine Vielzahl von medizinischen Untersuchung notwendig werden, weil „Müdigkeit“ ein unspezifisches Symptom von sehr vielen körperlichen Erkrankungen (Vitamin-, Elektrolyt-, Hormon-, Stoffwechselstörungen, Ernährungsgewohnheiten, Schlafmangel, Tumoren, Entzündungen, Infektionen, Autoimmunkrankheiten, Leber- und Nierenstörungen etc..) darstellt. Am Anfang einer Burnout-Abklärung muß also eine umfangreiche, auch körperliche und laborchemische Untersuchung stehen, um körperliche Ursachen auszuschließen!
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