Classification<unk>  is not recognized as a distinct mental disorder in the current revision (dating from 2013) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Its definitions for Adjustment Disorders, and Unspecified Trauma- and Stressor-Related Disorder in some cases reflect the condition. The Royal Dutch Medical Association, however, defines<unk> " as a subtype of adjustment disorder. In The Netherlands<unk>  is included in handbooks and medical staff are trained in its diagnosis and treatment. Regarding the International Classification of Diseases (ICD), the ICD-10 edition (current 1994–2021) classifies "burn-out" as a type of non-medical life-management difficulty under code Z73.0. It is considered to be one of the "factors influencing health status and contact with health services" and "should not be used" for "primary mortality coding". It is also considered one of the "problems related to life-management difficulty". The condition is further defined as being a "state of vital exhaustion," which historically had been called neurasthenia. The ICD-10 also contains a medical condition category of "F43.8 Other reactions to severe stress," which sometimes has also been labeled neurasthenia. The Swedish National Board of Health and Welfare defines neurasthenia as more serious than<unk> . Swedish sufferers of severe<unk>  have been treated as having neurasthenia. This category is in the same group as adjustment disorder and posttraumatic stress disorder, other conditions caused by excessive stress that continue once the stressors have been removed. A new version of the ICD, ICD-11, was released in June 2018, for first use in January 2022. The new version has an entry coded and titled "QD85<unk> ". The ICD-11 describes the condition this way:<unk>  is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and 3) reduced professional efficacy.<unk>  refers specifically to phenomena in the<unk>  context and should not be applied to describe experiences in other areas of life. This condition is classified under "Problems associated with employment or unemployment" in the section on "Factors influencing health status or contact with health services." The section is devoted to reasons other than recognized diseases or health conditions for which people contact health services. In a statement made in May 2019, the WHO said "Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an<unk>  phenomenon. It is not classified as a medical condition." The ICD's browser and coding tool both attach the term "caregiver<unk> " to category "QF27 Difficulty or need for assistance at home and no other household member able to render care." QF27 thus acknowledges that<unk>  can occur outside the work context. The ICD-11 also has the medical condition "6B4Y Other specified disorders specifically associated with stress," which is the equivalent of the ICD-10's F43.8. Instruments In 1981, Maslach and Jackson developed the first widely used instrument for assessing<unk> , namely, the MBI. Consistent with Maslach's conceptualization, the MBI operationalizes<unk>  as a three-dimensional syndrome consisting of emotional exhaustion, depersonalization, and reduced personal accomplishment. Other researchers have argued that<unk>  should be limited to fatigue and exhaustion. Exhaustion is considered to be<unk> 's core. There are, however, other conceptualizations of<unk>  that differ from the conceptualization suggested by Maslach and adopted by the WHO. Shirom and Melamed with their Shirom-Melamed<unk>  Measure (SMBM) conceptualize<unk>  in terms of physical exhaustion, cognitive weariness, and emotional exhaustion. An examination of the SMBM's emotional exhaustion subscale, however, indicates that the subscale more clearly embodies Maslach's concept of depersonalization than her concept of emotional exhaustion. Demerouti and Bakker, with their Oldenburg<unk>  Inventory, conceptualize<unk>  in terms of exhaustion and disengagement. There are still other conceptualizations as well that are embodied in these instruments: the Copenhagen<unk>  Inventory, the Hamburg<unk>  Inventory, Malach-Pines's<unk>  Measure, and more. Kristensen et al. and Malach-Pines (who also published as Pines) advanced the view that<unk>  can also occur in connection to life outside of work. For example, Malach-Pines developed a<unk>  measure keyed the role of spouse. In 1999, Wilmar Schaufeli and Arnold Bakker released the Utrecht Work Engagement Scale (UWES). The UWES measures vigour, dedication and absorption; positive counterparts to the values measured by the MBI. In 2010, researchers from Mayo Clinic used portions of the MBI, along with other comprehensive assessments, to develop the Well-Being Index, a nine-item self-assessment tool designed to measure<unk>  and other dimensions of distress in healthcare workers specifically. The core of all of these conceptualizations, including that of Freudenberger, is exhaustion. Alternatively,<unk>  is also now seen as involving the full array of depressive symptoms (e.g., low mood, cognitive alterations, sleep disturbance). Marked differences among researchers' conceptualizations of what constitutes<unk>  have underlined the need for a consensus definition. A new instrument, the<unk>  Depression Inventory (ODI), quantifies the severity of work-attributed depressive symptoms and establishes provisional diagnoses of job-ascribed depression. Subtypes In 1991, Barry A. Farber in his research on teachers proposed that there are three types of<unk> : * "wearout" and "brown-out," where someone gives up having had too much stress and/or too little reward * "classic/frenetic<unk> ," where someone works harder and harder, trying to resolve the stressful situation and/or seek suitable reward for their work * "underchallenged<unk> ," where someone has low stress, but the work is unrewarding. Farber found evidence that the most idealistic teachers who enter the profession are the most likely to suffer<unk> . Caregiver<unk> <unk>  affects caregivers. Relationship with other conditions A growing body of evidence suggests that<unk>  is etiologically, clinically, and nosologically similar to depression. In a study that directly compared depressive symptoms in burned out workers and clinically depressed patients, no diagnostically significant differences were found between the two groups; burned out workers reported as many depressive symptoms as clinically depressed patients. Moreover, a study by Bianchi, Schonfeld, and Laurent (2014) showed that about 90% of workers with very high scores on the MBI meet diagnostic criteria for depression. The view that<unk>  is a form of depression has found support in several recent studies. Some authors have recommended that the nosological concept of<unk>  be revised or even abandoned entirely given that it is not a distinct disorder and that there is no agreement on<unk> 's diagnostic criteria. A newer generation of studies indicates that<unk> , particularly its exhaustion dimension, problematically overlaps with depression; these studies have relied on more sophisticated statistical techniques, for example, exploratory structural equation modeling (ESEM) bifactor analysis, than earlier studies of the topic. The advantage of ESEM bifactor analysis, which combines the best features of exploratory and confirmatory factor analysis, is that it provides a granular look at item-construct relationships, without falling into traps earlier<unk>  researchers fell into. Liu and van Liew wrote that "the term<unk>  is used so frequently that it has lost much of its original meaning. As originally used,<unk>  meant a mild degree of stress-induced unhappiness. The solutions ranged from a vacation to a sabbatical. Ultimately, it was used to describe everything from fatigue to a major depression and now seems to have become an alternative word for depression, but with a less serious significance" (p. 434). The authors equate<unk>  with adjustment disorder with depressed mood. Kakiashvili et al., however, argued that although<unk>  and depression have overlapping symptoms, endocrine evidence suggests that the disorders' biological bases are different. They argued that antidepressants should not be used by people with<unk>  because the medications can make the underlying hypothalamic–pituitary–adrenal axis dysfunction worse. Test Major depressive disorder Atypical depression PTSD Chronic Fatigue Syndrome<unk>  Cortisol awakening response ↑ ↓ ↓ ↓ - or ↓ Adrenocorticotropic hormone (ACTH) ↑ - - or ↓ Dehydroepiandrosterone sulphate (DHEA-S) ↓ ↑ or ↓ ↓ ↑ Despite its name, depression with atypical features, which is seen in the above table, is not a rare form of depression. The cortisol profile in atypical depression, in contrast to that of melancholic depression, is similar to the cortisol profile found in<unk> . Commentators advanced the view that<unk>  differs from depression because the cortisol profile of<unk>  differs from that of melancholic depression; however, as the above table indicates,<unk> 's cortisol profile is similar to that of atypical depression. It has previously been hypothesised that Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), is caused by<unk> . It is suggested that the "burning out" of the body's stress symptom (by any of a wide range of causes) can lead to chronic fatigue. However, the very nomenclature of "Chronic Fatigue Syndrome" is viewed as problematic by both patients and healthcare professionals specialising in the condition, as it fails to encompass the wide range of non-fatigue related symptoms present in ME/CFS, or to differentiate between the so-named condition and the symptom of chronic fatigue which is present in many unrelated conditions or diseases. Furthermore, more up-to-date research has shown that ME/CFS is a
Occupational burnout
Idiopathic chronic fatigue
Social stress
Psychological resilience
Addiction vulnerability
Social isolation
Stress 
Computer addiction