Are You Burnt Out? Or, Do You Have Chronic Fatigue? – Part II

Is your fatigue brought on by adrenal fatigue, chronic fatigue, or burnout?

Before starting treatment, make sure you know exactly which condition you’re dealing with.

In part 1 of this series, you learned the three hidden causes of burnout. By now, you probably know more than your doctor about burnout.

In today’s post, I’ll help you differentiate burnout from chronic fatigue syndrome. The two terms are often used interchangeably. But I’ll show you why these are two distinctly different medical conditions.

Let’s get going!

A brief history of burnout

Burnout is a curious term. It’s used a lot in office-spaces around North America. The term burnout is used to describe a set of symptoms (more on those in a little bit) coming about through excessive demands at work.

Burnout was originally described in the 1970s. (1) The researcher, Herbert Freudenberger, was describing a set of symptoms he noticed in both himself and his staff. It’s worth noting that Dr. Freudenberger and his staff worked at a free clinic for drug addicts. The demands of their job were incredibly high and their success rates were incredibly low. Perhaps this is part of the recipe for burnout…

Burnout isn’t isolated to the office 

The most common misconception with burnout is that it is linked with overwork. The picture that comes to mind is the stressed-out office worker. Yes, early understandings of burnout did place the condition strictly in an office setting. But new understandings of the illness show that burnout is not isolated to your office. (1)

Burnout is incredibly common in healthcare disciplines. Think doctors, nurses, and veterinarians. These three professions carry a high degree of risk for burnout. With each of the professions experiencing nearly a 50% burnout rate! (2)

Another demographic that commonly experiences burnout is new parents. It is estimated that more than 1 in 10 parents will experience burnout. (3)

There’s no industry or profession that is immune to burnout. The risk of over-work in western culture is ubiquitous. In Japan, the term Karoshi references working yourself to death. This is not a hyperbole. Japanese citizens are working so hard and in such stressful environments that heart attacks and strokes are common.

When stress levels run at this level, fatigue is imminent. The human body can only tolerate so much stress.

But since you see so many of your peers working insane hours, it’s easy to rationalize your fatigue as something else. Something like a physical illness. Something like chronic fatigue syndrome.

Here is where it becomes so important to take a step back and analyze whether stress is the main cause of your fatigue. Or, whether something more insidious is making you tired.

 Stress vs illness – they’re not the same 

Lululemon reports that stress contributes to 99% of all illness. I doubt that tagline is based on firm, scientific evidence. But it’s hard to argue.

Stress can lead to illness. This occurs from a weakening of your immune system. It’s quite common in situations of chronic stress.

Illness is a stress to your body. When you’re sick or ill, your body is undergoing a stress response. Chronic or longterm illnesses are chronic stresses that weaken your immune system which results in a lowered stress tolerance.

Burnout is caused by chronic stress. Chronic fatigue is caused by chronic illness. 

This is the difference between chronic fatigue and burnout. But this difference is not black and white. Chronic stress often leads to chronic illness. And chronic illness causes chronic stress. There’s a whole lot of overlap between these two conditions.

I’ll help you better differentiate chronic fatigue from burnout below!

How to know you’re dealing with chronic fatigue syndrome (not burnout or adrenal fatigue)

Remember, burnout doesn’t have clear diagnostic criteria. The diagnosis is based on your experience. Testing cortisol levels can help point in the direction of burnout, but it’s not used as a diagnostic test.

Chronic fatigue syndrome does have diagnostic criteria. Albeit, weak and also subjective diagnostic criteria. Below, I give you the most up to date rubric on how to diagnose chronic fatigue syndrome. It’s the same rubric used by your doctor!

1.  Do you have a substantial reduction or impairment in your ability to engage in pre-illness levels of occupation, social, or personal activities?
   • If you answered yes, this impairment needs to have occurred for more than 6 months.
   • If you answered no, you do not have chronic fatigue syndrome.
2. How long has your impairment been occurring?
   • It needs to occur for more than 6 months.
3. When did you begin to feel fatigued?
   • This cannot be lifelong. There needs to be a definitive start point.
4. Is your fatigue the result of an ongoing exercise or fitness regime?
   • If you answered yes, this is not chronic fatigue syndrome.
   • If you answered no, continue to the next question
5. Is your fatigue alleviated by rest?
   • If you answered yes, your condition is not chronic fatigue syndrome.
   • If you answered no, continue to next question.
6. Do you feel more fatigue/symptomatic after exertion?
   • If you answered no, your condition is not chronic fatigue syndrome.
   • If you answered yes, continue to next question.
7. Do you feel refreshed after sleep?
   • If you answered yes, your condition is not chronic fatigue syndrome.
   • If you answered no, continue to next question.
8. Do you suffer from one of the two symptoms?
   • A noticeable decline in cognitive abilities (ie: thinking, memory)?
   • Intolerance to standing upright?
     •  If you answered yes, you are positive for chronic fatigue syndrome.
     • If you answered no, you do not have chronic fatigue syndrome.
9. What percentage of the time do you feel fatigued?
   • You need to experience fatigue more than 50% of the time.

The hallmark difference between CFS and burnout

I’m confident someone dealing with burnout could read the above questions and be absolutely sure he/she is dealing with chronic fatigue syndrome. But there is one hallmark difference between chronic fatigue syndrome and burnout.

Rest.

Those dealing with burnout feel better with rest. Those dealing with chronic fatigue syndrome do not feel better after rest.

If you’re burnt out, it’s usually due to excessive demands at home or work  – combined with the hidden stresses I mentioned in part I. The solution is to lessen those demands. By resting, you lessen your demands. In turn, your fatigue generally improves.

With chronic fatigue syndrome, no amount of rest will improve your fatigue.

Those dealing with severe levels of burnout will often take a leave of absence from work. In my experience, this time away from the office generally improves burnout symptoms substantially.

Those with chronic fatigue have often been off work for years. CFS patients get plenty of rest. But rest doesn’t change energy levels in chronic fatigue syndrome.

One more difference between CFS and burnout

A new addition to the chronic fatigue diagnostic criteria is something known as orthostatic intolerance. This term was introduced in 2015 when chronic fatigue underwent a re-branding. As of 2015, chronic fatigue syndrome is now called systemic exertion intolerance disorder (SEID).

Orthostatic intolerance describes a condition where your symptoms worsen while standing upright and improve when you lie down. This is not at all the same condition as orthostatic hypotension.

Orthostatic hypotension is the name given to the condition of falling blood pressure after standing. Orthostatic hypotension occurs when too much blood pools in your legs or extremities. This is usually brought on by sitting. Common symptoms include lightheadedness, blurred vision, and nausea.

Orthostatic hypotension tends to pass in a few minutes. Orthostatic intolerance does not. One with orthostatic intolerance will notice a worsening of her symptoms every time she is upright. Patients with orthostatic intolerance are often resigned to spending the majority of their waking hours in a reclined position.

If you notice your fatigue and other unwanted symptoms worsen while you’re in an upright position, odds are good that you’re dealing with chronic fatigue syndrome.

A note on rest

If your burnout symptoms are new, you’ll likely feel that rest doesn’t alleviate your fatigue. Keep resting. I assure you your fatigue will improve.

If you’ve been off work for ninety days, rested for a number of hours each day, and still your fatigue is unrelenting, it’s time to look at chronic fatigue syndrome. In my experience, nearly every case of burnout I’ve treated improves within ninety days. Just be sure you’ve identified and rectified the three hidden causes of burnout – blood sugar imbalances, sleep irregularities, and chronic sources of inflammation.

For a deeper dive into fatigue’s effect on your brain, click here for our latest writings.

Ok, now you know the differences between chronic fatigue syndrome and burnout. Put this information to work for you and start reclaiming your energy tomorrow!

I’d love to hear your experiences in dealing with CFS and/or burnout.

How were you able to accurately identify which condition was causing your fatigue?

Be sure to leave your answers in the comments section below!