Using Liberal Criteria to Identify Burnout Poses the Risk of Pathologizing Normal Adaptive States.

Abstract

To the Editor: In a recent study, Dyrbye and colleagues1 used the Maslach Burnout Inventory to assess burnout and categorized participants with either an emotional exhaustion score ≥ 27/54 or a depersonalization score ≥ 10/30 as cases of burnout. In our view, these inclusion criteria are excessively liberal and pose the risk of pathologizing normal fluctuations in daily levels of stress, fatigue, or motivation.2 The (arbitrary)3 cutoff scores used by the authors to categorize burnout correspond to symptoms experienced on average a few times a month for emotional exhaustion and once a month for depersonalization. Identifying cases of burnout based on these relatively low symptom frequencies is questionable given that (1) burned out individuals are supposed to be “constantly overwhelmed, stressed and exhausted”4 and (2) the state of burnout is regarded as the final stage of an adaptation breakdown, by contrast with transient, nonmorbid (job) stress.3,5 In view of these definitional elements, and pending consensual diagnostic criteria for burnout, the use of conservative cutoff scores associated with high symptom frequencies has been recommended when seeking to isolate cases of burnout.5 The authors’ approach contrasts with such recommendations. Remarkably, the authors made their inclusion criteria even more liberal by identifying burnout based on either emotional exhaustion or depersonalization. Importantly, because emotional exhaustion is consensually viewed as the core of burnout,3,5 considering it a non-necessary criterion for burnout is problematic. Our concerns regarding the categorization of burnout have implications for the interpretation of the study findings. The authors observed that only a third of their participants “with burnout” sought help for emotional/mental health problems. Following our line of reasoning, these results may reflect the fact that many participants categorized as burned out were actually healthy. Renzo Bianchi, MA, MS, PhD Adjunct instructor, Laboratoire de Psychologie (EA 3188), University of Franche-Comté, Besançon, France; [email protected] Marie Lavaux, MA Neuropsychologist, Association pour le Développement de la Neuropsychologie Appliquée, Besançon, France. Romain Brisson, MA, MS Adjunct instructor, Laboratoire C3S (EA 4660), University of Franche Comté, Besançon, France.