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Exhaustion Syndromes: Concepts and Definitions

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Burnout, Fatigue, Exhaustion

Abstract

Johanna Doerr und Urs Nater investigate the different ways in which medically unexplained fatigue-like symptoms have been treated, focussing on difficulties in differentiating between different conditions. They begin by relating the development and variations of the neurasthenia diagnosis, investigating the overlap of this diagnosis with depression diagnoses. Following this a comparison is made with East Asian diagnostic practises regarding medically unexplained fatigue, and the changes that have occurred in this context. The focus of the essay then switches to the second half of the twentieth century, to the developments of diagnoses of chronic fatigue syndrome and of myalgic encephalomyelitis. Diagnostic criteria for the various conditions are examined and found seriously to overlap, with arguments made as to why one diagnosis may be given rather than another. At this point, the previously discussed conditions, and depression, are all considered in the light of criteria commonly given for burnout. The conclusion is reached that differential diagnoses for similarly presenting fatigue conditions is at best an inexact science, and may lack medically stable grounds.

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Notes

  1. 1.

    T. Pawlikowska et al., ‘Population Based Study of Fatigue and Psychological Distress’, BMJ 308 (1994), 763–6.

  2. 2.

    W. T. Riley et al., ‘Patient-Reported Outcomes Measurement Information System (PROMIS) Domain Names and Definitions Revisions: Further Evaluation of Content Validity in IRT-Derived Item Banks’, Quality of Life Research 19 (2010), 1311–21 (1318).

  3. 3.

    R. Schwarz, O. Krauss, and A. Hinz, ‘Fatigue in the General Population’, Onkologie 26 (2003), 140.

  4. 4.

    A. J. Dittner, S. C. Wessely, and R. G. Brown, ‘The Assessment of Fatigue: A Practical Guide for Clinicians and Researchers’, Journal of Psychosomatic Research 56 (2004), 157–70.

  5. 5.

    W. T. Riley et al., ‘Patient-Reported Outcomes Measurement Information System (Promis) Domain Names and Definitions Revisions: Further Evaluation of Content Validity in Irt-Derived Item Banks’, Quality of Life Research 19 (2010), 1318.

  6. 6.

    K. Fukuda et al., ‘The Chronic Fatigue Syndrome: A Comprehensive Approach to Its Definition and Study. International Chronic Fatigue Syndrome Study Group’, Annals of Internal Medicine 121 (1994), 953–9; L. A. Jason et al., ‘A Community-Based Study of Prolonged Fatigue and Chronic Fatigue’, Journal of Health Psychology 4 (1999), 9–26.

  7. 7.

    A. Barsevick et al., ‘I’m So Tired: Biological and Genetic Mechanisms of Cancer-Related Fatigue’, Quality of Life Research 19 (2010), 1419–27.

  8. 8.

    F. Bethoux, ‘Fatigue and Multiple Sclerosis’, Annales de Réadaptation et de Médecine Physique 49 (2006), 355–60.

  9. 9.

    J. Barroso, ‘A Review of Fatigue in People with HIV Infection’, Journal of the Association of Nurses in AIDS Care 10 (1999), 42–9.

  10. 10.

    Edward Shorter, ‘Chronic Fatigue in Historical Perspective’, in Chronic Fatigue Syndrome – Ciba Foundation Symposium 173, ed. Gregory R. Bock and Julie Whelan (Chichester, England: John Wiley, 1993), pp. 6–16.

  11. 11.

    Karin Johannisson, ‘Modern Fatigue: A Historical Perspective’, in Stress in Health and Disease (Weinheim, Germany: Wiley-VCH Verlag, 2006), pp. 3–19.

  12. 12.

    S. S. Leone et al., ‘Two Sides of the Same Coin? On the History and Phenomenology of Chronic Fatigue and Burnout’, Psychology and Health 26 (2011), 449–64.

  13. 13.

    This book chapter is based on an updated literature search for a German review paper which we published in 2013: J. M. Doerr and U. M. Nater, ‘Erschöpfungssyndrome – Eine Diskussion verschiedener Begriffe, Definitionsansätze und klassifikatorischer Konzepte’, Psychotherapie, Psychosomatik, Medizinische Psychologie 63 (2013), 69–76.

  14. 14.

    George Beard, ‘Neurasthenia, or Nervous Exhaustion’, Boston Medical and Surgical Journal 3 (1869), 217–21.

  15. 15.

    George Beard, A Practical Treatise on Nervous Exhaustion (Neurasthenia), third edition (New York: 5 Cooper Union, 1894).

  16. 16.

    Edward Shorter, ‘Chronic Fatigue in Historical Perspective’, in Chronic Fatigue Syndrome – Ciba Foundation Symposium 173, ed. by Gregory R. Bock and Julie Whelan (Chichester, England: John Wiley, 1993), pp. 6–16 (p. 12).

  17. 17.

    World Health Organization, The ICD-10 Classification of Mental and Behavioural Disorders – Clinical Descriptions and Diagnostic Guidelines (1992), pp. 19; pp. 134–5.

  18. 18.

    V. Starcevic, ‘Neurasthenia: Cross-Cultural and Conceptual Issues in Relation to Chronic Fatigue Syndrome’, General Hospital Psychiatry 21 (1999), 249–55 (251).

  19. 19.

    American Psychiatric Association, DSM-5 Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (Arlington, VA: American Psychiatric Publishing, 2013), pp. 309–15.

  20. 20.

    B. Bankier, M. Aigner, and M. Bach, ‘Clinical Validity of ICD-10 Neurasthenia’, Psychopathology 34 (2001), 221–36.

  21. 21.

    American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, third edition (Washington: American Psychiatric Association, 1980).

  22. 22.

    J. Zielasek et al., ‘Assessing the Opinions and Experiences of German-Speaking Psychiatrists Regarding Necessary Changes for the 11th Revision of the Mental Disorders Chapter of the International Classification of Disorders (ICD-11)’, European Psychiatry 25 (2010), 437–42.

  23. 23.

    S. X. Liu, ‘Neurasthenia in China: Modern and Traditional Criteria for Its Diagnosis’, Culture, Medicine and Psychiatry 13 (1989), 163–86.

  24. 24.

    P. Cheung, ‘Adult Psychiatric Epidemiology in China in the 80s’, Culture, Medicine and Psychiatry 15 (1991), 479–96.

  25. 25.

    A. Kleinman, ‘Neurasthenia and Depression: A Study of Somatization and Culture in China’, Culture, Medicine and Psychiatry 6 (1982), 117–90.

  26. 26.

    S. Lee and A. Kleinman, ‘Are Somatoform Disorders Changing with Time? The Case of Neurasthenia in China’, Psychosomatic Medicine 69 (2007), 846–9 (848).

  27. 27.

    Chinese Medical Association, Chinese Classification of Mental Disorders, ed. Hunan Medical University (Changsha, China, 1990).

  28. 28.

    K. Kitanishi et al., ‘Diagnostic Consideration of Morita Shinkeishitsu and DSM-III-R’, Psychiatry and Clinical Neurosciences 56 (2002).

  29. 29.

    T. Y. Lin, ‘Neurasthenia Revisited: Its Place in Modern Psychiatry’, Culture, Medicine and Psychiatry 13 (1989), 105–29.

  30. 30.

    T. Suzuki, ‘The Concept of Neurasthenia and Its Treatment in Japan’, Culture, Medicine and Psychiatry 13 (1989).

  31. 31.

    Lin, ‘Neurasthenia Revisited’, 112.

  32. 32.

    P. Y. Schwartz, ‘Why Is Neurasthenia Important in Asian Cultures?’, Western Journal of Medicine 176 (2002), 257–8.

  33. 33.

    N. E. Soto and S. E. Straus, ‘Chronic Fatigue Syndrome and Herpesviruses: The Fading Evidence’, Herpes 7 (2000), 46–50.

  34. 34.

    N. D. Compston, ‘An Outbreak of Encephalomyelitis in the Royal Free Hospital Group, London, in 1955’, Postgraduate Medical Journal 54 (1978), 722–4.

  35. 35.

    World Health Organization, The ICD-10 Classification of Mental and Behavioural Disorders – Clinical Descriptions and Diagnostic Guidelines (1992), p. 233.

  36. 36.

    Ibid., p. 130.

  37. 37.

    G. P. Holmes et al., ‘Chronic Fatigue Syndrome: A Working Case Definition’, Annals of Internal Medicine 108 (1988), 387–9.

  38. 38.

    K. Fukuda et al., ‘The Chronic Fatigue Syndrome: A Comprehensive Approach to Its Definition and Study. International Chronic Fatigue Syndrome Study Group’, Annals of Internal Medicine 121 (1994).

  39. 39.

    B. M. Carruthers et al., ‘Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols’, Journal of Chronic Fatigue Syndrome 11 (2003), 7–36.

  40. 40.

    B. M. Carruthers et al., ‘Myalgic Encephalomyelitis: International Consensus Criteria’, Journal of Internal Medicine 270 (2011), 327–38.

  41. 41.

    Fukuda et al., ‘The Chronic Fatigue Syndrome’.

  42. 42.

    Board on the Health of Select Populations Institute of Medicine, ‘Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness’ (2015).

  43. 43.

    C. Heim et al., ‘Childhood Trauma and Risk for Chronic Fatigue Syndrome: Association with Neuroendocrine Dysfunction’, Arch Gen Psychiatry 66 (2009), 72–80; and U. M. Nater, C. Heim, and W. C. Reeves, ‘The Role of Stress in Chronic Fatigue Syndrome’, International Journal of Medical and Biological Frontiers 16 (2010), 869–84.

  44. 44.

    R. Patarca, ‘Cytokines and Chronic Fatigue Syndrome’, Annals of the New York Academy of Sciences 933 (2001), 185–200; and N. G. Klimas and A. O’Brien Koneru, ‘Chronic Fatigue Syndrome: Inflammation, Immune Function, and Neuroendocrine Interactions’, Current Rheumatology Reports 9 (2007), 482–87.

  45. 45.

    Institute of Medicine, ‘Beyond Myalgic Encephalomyelitis’.

  46. 46.

    P. D. White, ‘Chronic Fatigue Syndrome: Right Name, Real Treatments’ (2015), online at: http://www.medscape.com/viewarticle/841289 (accessed August 2015).

  47. 47.

    L. A. Jason et al., ‘Unintended Consequences of Not Specifying Exclusionary Illnesses for Systemic Exertion Intolerance Disease’, Diagnostics 5 (2015), 272–86.

  48. 48.

    P. D. White, ‘Chronic Fatigue Syndrome: Right Name, Real Treatments’.

  49. 49.

    P. D. White and others, ‘Comparison of Adaptive Pacing Therapy, Cognitive Behaviour Therapy, Graded Exercise Therapy, and Specialist Medical Care for Chronic Fatigue Syndrome (Pace): A Randomised Trial’, Lancet, 377 (2011). One of the most prominent critics of PACE is David Tuller, who points out various flaws in the study. See D. Tuller, ‘Trial by Error: The Troubling Case of the Pace Chronic Fatigue Syndrome Study’, (2015).

  50. 50.

    L. Petrison, ‘Evaluating a Proposed Name to Replace ‘ME/CFS’: A Community Survey Project Conducted by Lisa Petrison, Ph.D.’ (2015).

  51. 51.

    L. A. Jason et al., ‘Reflections on the Institute of Medicine’s Systemic Exertion Intolerance Disease’, Polskie Archiwum Medycyny Wewnetrznej 125 (2015), 576–81 (579).

  52. 52.

    World Health Organization, pp. 99–102.

  53. 53.

    N. Afari and D. Buchwald, ‘Chronic Fatigue Syndrome: A Review’, American Journal of Psychiatry 160 (2003), 221–36 (p. 225).

  54. 54.

    U. M. Nater et al., ‘Psychiatric Comorbidity in Persons with Chronic Fatigue Syndrome Identified from the Georgia Population’, Psychosomatic Medicine 71 (2009), 557–65.

  55. 55.

    A. J. Cleare et al., ‘Contrasting Neuroendocrine Responses in Depression and Chronic Fatigue Syndrome’, Journal of Affective Disorders 34 (1995), 283–9; L. V. Scott and T. G. Dinan, ‘Urinary Free Cortisol Excretion in Chronic Fatigue Syndrome, Major Depression and in Healthy Volunteers’, Journal of Affective Disorders 47 (1998), 49–54; and U. M. Nater et al., ‘Attenuated Morning Salivary Cortisol Concentrations in a Population-Based Study of Persons with Chronic Fatigue Syndrome and Well Controls’, Journal of Clinical Endocrinology and Metabolism 93 (2008), 703–9.

  56. 56.

    James P. Griffith and Fahd A. Zarrouf, ‘A Systematic Review of Chronic Fatigue Syndrome: Don’t Assume It’s Depression.’, Journal of Clinical Psychiatry 10 (2008), 120–8.

  57. 57.

    B. K. Bennett et al., ‘Characterization of Fatigue States in Medicine and Psychiatry by Structured Interview’, Psychosomatic Medicine 76 (2014), 379–88.

  58. 58.

    World Health Organization, p. 233.

  59. 59.

    Fukuda et al., ‘The Chronic Fatigue Syndrome’; B. M. Carruthers et al., ‘Myalgic Encephalomyelitis: International Consensus Criteria’, Journal of Internal Medicine 270 (2011); and Board on the Health of Select Populations Institute of Medicine (2015), ‘Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness’.

  60. 60.

    A. Sharpley et al., ‘Do Patients with “Pure” Chronic Fatigue Syndrome (Neurasthenia) Have Abnormal Sleep?’, Psychosomatic Medicine 59 (1997), 592–6; and B. K. Bennett et al., ‘Characterization of Fatigue States in Medicine and Psychiatry by Structured Interview’, Psychosomatic Medicine 76 (2014).

  61. 61.

    D. B. Greenberg, ‘Neurasthenia in the 1980s: Chronic Mononucleosis, Chronic Fatigue Syndrome, and Anxiety and Depressive Disorders’, Psychosomatics 31 (1990), 129–37; R. Arcari and H. D. Crombie, ‘Mark Twain and His Family’s Health: Livy Clemens’ Neurasthenia in the Gilded Age and Chronic Fatigue Syndrome of Today’, Connecticut Medicine 67 (2003), 293–6.

  62. 62.

    V. Starcevic, ‘Neurasthenia: Cross-Cultural and Conceptual Issues in Relation to Chronic Fatigue Syndrome’, General Hospital Psychiatry 21 (1999).

  63. 63.

    A. Farmer et al., ‘Neuraesthenia Revisited: ICD-10 and DSM-III-R Psychiatric Syndromes in Chronic Fatigue Patients and Comparison Subjects’, British Journal of Psychiatry 167 (1995), 503–6.

  64. 64.

    C. Maslach, W. Schaufeli, and M. P. Leiter, ‘Job Burnout’, Annual Review of Psychology 52 (2001), 397–422.

  65. 65.

    H. J. Freudenberger, ‘Staff Burn-Out’, Journal of Social Issues 30 (1974), 159–65.

  66. 66.

    A. Weber and A. Jaekel-Reinhard, ‘Burnout Syndrome: A Disease of Modern Societies?’, Occupational Medicine (London) 50 (2000), 512–17.

  67. 67.

    C. Maslach and Susan E. Jackson, ‘The Measurement of Experienced Burnout’, Journal of Occupational Behaviour 2 (1981), 99–113; and C. Maslach, W. Schaufeli, and M. P. Leiter, ‘Job Burnout’, Annual Review of Psychology 52 (2001).

  68. 68.

    Anja Gerlmeier, ‘Stress und Burnout bei IT-Fachleuten – Auf der Suche nach Ursachen. Stress and Burnout in It Professionals – Searching for the Causes’, in Burnout in der IT-Branche. Ursachen und betriebliche Prävention (Kroening: Asanger, 2011), 53–89; and Kate Goodger et al., ‘Burnout in Sport: A Systematic Review’, The Sport Psychologist 21 (2007), 127–51.

  69. 69.

    W. Schaufeli and T. W. Taris, ‘The Conceptualization and Measurement of Burnout: Common Ground and Worlds Apart’, Work and Stress 19 (2005), 256–62.

  70. 70.

    R. Bianchi, I. S. Schonfeld, and E. Laurent, ‘Burnout-Depression Overlap: A Review’, Clinical Psychology Review 36 (2015), 28–41.

  71. 71.

    Wilmar Schaufeli et al., ‘Maslach Burnout Inventory – General Survey’, in The Maslach Burnout Inventory – Test Manual, third edition, ed. Christina Maslach, Suzan Jackson, and Michael Leiter (Palo Alto: Consulting Psychologists Press, 1996); W. Schaufeli et al., ‘On the Clinical Validity of the Maslach Burnout Inventory and the Burnout Measure’, Psychology and Health 16 (2001), 565–82; and W. Schaufeli and T. W. Taris, ‘The Conceptualization and Measurement of Burnout: Common Ground and Worlds Apart’, Work and Stress 19 (2005).

  72. 72.

    T. S. Kristensen et al., ‘The Copenhagen Burnout Inventory: A New Tool for the Assessment of Burnout’, Work and Stress 19 (2005), 192–207.

  73. 73.

    R. Bianchi, I. S. Schonfeld, and E. Laurent, ‘Is It Time to Consider the “Burnout Syndrome” a Distinct Illness?’, Front Public Health 3 (2015), 158.

  74. 74.

    World Health Organization, p. 244; and A. Weber and A. Jaekel-Reinhard, ‘Burnout Syndrome: A Disease of Modern Societies?’, Occupational Medicine (London), 50 (2000).

  75. 75.

    T. Friberg, ‘Burnout: From Popular Culture to Psychiatric Diagnosis in Sweden’, Culture, Medicine and Psychiatry, 33 (2009), 538–58.

  76. 76.

    A. Hillert and M. Marwitz, ‘Burnout: Eine kritische Analyse mit therapeutischen Implikationen’, Ärztliche Psychotherapie 4 (2008), 235–41.

  77. 77.

    R. Bianchi, I. S. Schonfeld, and E. Laurent, ‘Burnout-Depression Overlap: A Review’, Clinical Psychology Review 36 (2015).

  78. 78.

    L. Hallsten, ‘Burning Out: A Framework’, in Professional Burnout: Recent Developments in Theory and Research, ed. W. Schaufeli, C. Maslach, and T. Marek (Washington, DC: Taylor and Francis, 1993), pp. 95–113.

  79. 79.

    K. Ahola et al., ‘The Relationship between Job-Related Burnout and Depressive Disorders – Results from the Finnish Health 2000 Study’, Journal of Affective Disorders 88 (2005), 55–62.

  80. 80.

    Ibid.; and S. Toker and M. Biron, ‘Job Burnout and Depression: Unraveling Their Temporal Relationship and Considering the Role of Physical Activity’, Journal of Applied Psychology 97 (2012), 699–710.

  81. 81.

    B. Reime and I. Steiner, ‘Burned-Out or Depressive? An Empirical Study Regarding the Construct Validity of Burnout in Contrast to Depression’, Psychotherapie, Psychosomatik, Medizinische Psychologie 51 (2001), 304–7.

  82. 82.

    Bianchi, Schonfeld, and Laurent. ‘Is It Time to Consider the “Burnout Syndrome” a Distinct Illness?’.

  83. 83.

    M. J. Huibers et al., ‘Fatigue, Burnout, and Chronic Fatigue Syndrome among Employees on Sick Leave: Do Attributions Make the Difference?’, Occupational and Environmental Medicine 60 (Suppl. 1) (2003), 26–31.

  84. 84.

    S. S. Leone et al., ‘The Temporal Relationship between Burnout and Prolonged Fatigue: A 4-Year Prospective Cohort Study’, Stress and Health 25 (2009), 365–74; and U. Bultmannand et al., ‘Measurement of Prolonged Fatigue in the Working Population: Determination of a Cutoff Point for the Checklist Individual Strength’, Journal of Occupational Health Psychology 5 (2000), 411–16.

  85. 85.

    O. S. Lian and H. Bondevik, ‘Medical Constructions of Long-Term Exhaustion, Past and Present’, Sociology of Health and Illness 37 (2015), 920–35.

  86. 86.

    S. Gupta, ‘More Treatment, More Mistakes’, New York Times 31 July 2012, p. 23.

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Authors and Affiliations

  1. University of Marburg, Marburg, Germany

    Johanna M. Doerr & Urs M. Nater

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  1. Johanna M. Doerr
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  2. Urs M. Nater
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Correspondence to Johanna M. Doerr .

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  1. Institute of Sociology, University of Hamburg, Hamburg, Germany

    Sighard Neckel

  2. School of European Culture and Languages, University of Kent, Canterbury, United Kingdom

    Anna Katharina Schaffner

  3. Institute of Sociology, Goethe University Frankfurt, Frankfurt, Germany

    Greta Wagner

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Doerr, J.M., Nater, U.M. (2017). Exhaustion Syndromes: Concepts and Definitions. In: Neckel, S., Schaffner, A., Wagner, G. (eds) Burnout, Fatigue, Exhaustion. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-52887-8_4

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