In Reply

Our review article has stimulated a lively and controversial discussion, which underlines the relevance and current importance of the subject.

Breitenbürger correctly points to a series of circumstances and conditions that may increase burnout symptoms, among others, in doctors as a professional group. As far as possible therapeutic approaches are concerned, we mentioned in our article a general approach not limited to any specific school (p 786). The personal experiences with psychoanalytically oriented psychotherapy as described by Wankelmuth could easily be subsumed here.

In response to Wolf, we wish to point out that the primary objective of our article was not to provide a comprehensive explanation of the neurobiological causes of burnout, which at this point in time would be premature owing to a scarcity of data. We wish to point out, however, that the first author of the article, with his working group, conducted studies of the function of the autonomic nervous system in affective disorders on the basis of heart rate variability some considerable time ago (see among others [1–3]). The literature review for the cited health technology assessment (4) was concluded on 14 August 2009; the studies mentioned by Wolf were published in 2011 and were therefore not included.

Volderholzer’s and Hillert’s comment, that the experience of burnout is primarily a subjective experience of disturbance in affected patients, does not contradict our argument, which is implied in the section on the history of the term burnout. However, this does not release us from the challenge of trying to objectivize and operationalize the phenomenon as much as possible. Admittedly, we settled on the title’s “fashionable diagnosis” intending to provoke and probably erred on the side of conciseness.

The letter by Wehling et al introduces an additional, interesting perspective—namely, that of medical sociology. The example of burnout serves excellently for studying the medicalization and development of an illness identity. However, this should not be confused with the status of an illness identity in the medical sense.

We welcome the fact that the German Association for Psychiatry and Psychotherapy (Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde, DGPPN) has issued an invitation to a capital symposium on burnout and has set up a task force regarding the subject.

DOI: 10.3238/arztebl.2012.0340b

Prof. Dr. med. Wolfgang P. Kaschka

ZfP Südwürtemberg,

Klinik für Psychiatrie und Psychotherapie I der Universität Ulm

wolfgang.kaschka@zfp-zentrum.de

Dr. rer. pol. Dieter Korczak

Institut für Grundlagen- und Programmforschung, München

Dr. med. Karl Broich

Bundesinstitut für Arzneimittel und Medizinprodukte

Conflict of interest statement
Professor Kaschka has receved expenses for continuing medical educational events from Servier Deutschland, Bristol Myers Squibb, and Merz Pharmaceuticals.

The other authors declare that no conflicts of interest exist.