Whilst stress is a natural part of life and not an illness, stress-related exhaustion disorder is a clinical condition which has clearly defined diagnostic criteria. For a person who meets these criteria this means that they have suffered from mental and physical exhaustion for at least two weeks and that this exhaustion cannot be restored through rest and recuperation alone. One of the biggest factors for exhaustion disorder is prolonged work-related stress (more than six months). However, factors from a person’s entire life situation also need to be considered as for some the stressful circumstances may lie more in the private domain.
Even though someone may feel physically exhausted and cannot do as much as normal, stress-related exhaustion disorder is primarily a mental disorder. It can mean that you are mentally tired, have difficulties dealing with everyday tasks, only have short bursts of energy and a disproportionate need for rest after performing an activity. It is common that multi-tasking is no longer possible and that planning skills, making decisions and the ability to follow the thread in a conversation also take a hit. Forgetting what you were talking about mid-sentence, having trouble finding familiar words or involuntarily swapping words for others are also common. It may be arduous remembering names, places, dates, where you have put something, where the car is parked and so on. When forced to perform a task under time pressure, memory and concentration issues often become dramatically worse.
Emotional exhaustion is also not unusual. This may mean that your patience runs out quickly and that you can emotionally explode at the slightest provocation. Life becomes an emotional rollercoaster where you may become more easily moved, grumpy or irritated. Anything that involves even a hint of placing a demand on you can create anxiety and mental blockage. This could be anything from keeping an appointment, sudden changes in plans to being questioned on something by your employer. Some describe this as feeling like having a “stress allergy”.
In addition to suffering from diffuse stress symptoms such as chest pain, palpitations, stomach issues etc it is common to have an increased sensitivity to sound, light and even odours. Supermarkets, crowds, noisy children, people talking on their mobile phones, loud music and other unwelcome noises become unbearable.
Sleep disturbance is almost always included in the clinical picture. This can be experienced by finding it hard to fall asleep in the evenings, that sleep is restless and superficial and/or that you wake up far too early and are unable to fall back asleep. On the contrary, some people go through a phase when they sleep far too much, i.e., regularly over 9 hours a day. This is not uncommon during the time immediately following a stress-induced crash. Some people get stuck in a long-lasting pattern of sleeping too much, a pattern which does not result in recuperation. Besides being a common symptom, it is believed that chronic sleep disturbance can also be a strong contributing factor to exhaustion disorder.
For the diagnostic criteria to be considered fulfilled, the symptoms should be seen to cause a clear suffering or impaired function in work or other social contexts. These symptoms cannot be attributed to or caused by drug use, medications or other illnesses. It is also important that the difficulties cannot be better described by another diagnosis such as depression or anxiety.
In the table below you can read the diagnostic criteria for stress-related exhaustion disorder from the National Board for Health and Welfare (Socialstyrelsen).
Physical and mental symptoms of exhaustion for at least two weeks. The symptoms have developed as a result of one or more identifiable stress factors which have been present for at least six months.
Significantly reduced mental energy dominates the picture, which is evident in decreased ability for taking initiative, decreased endurance or need for extended recovery time in connection with mental strain.
At least four of the following symptoms have been present virtually every day during the same two-week period: