Jarkko Kalliomäki, Gunilla Brodda-Jansen
Dept of Rehabilitation Medicine, Division of Clinical Sciences, Karolinska Institutet (KIDS), Stockholm, Sweden.
DOI: 10.2340/20030711-1000064

This study discusses a novel diagnosis, “stress-related exhaustion disorder“, which was introduced in Sweden in 2005. An International Classification of Diseases 10th revision (ICD-10) code, F43. 8A, was specified for exhaustion disorder. Since then, there has been a remarkable increase in the number of patients diagnosed with exhaustion disorder in Sweden. The scientific basis of the diagnosis, and the putative mechanisms behind its increase, are discussed. It is hypothesized that the following factors may have promoted the increase in exhaustion disorder diagnosis: (i) the widespread perception of exhaustion disorder as a medical condition with physiological impairment of the endocrine and nervous systems, caused by external stressors; (ii) provision of healthcare resources and social insurance benefits for exhaustion disorder, without having firm evidence or guidelines on its management; of exhaustion disorder; (iii) highly inclusive diagnostic criteria for exhaustion disorder that overlap with the criteria for several other diagnoses (depression, anxiety disorders, chronic pain disorders), leading to possible bias towards exhaustion disorder diagnosis. The increase in exhaustion disorder does not necessarily reflect an increased stress-related morbidity in society. It is also important to consider factors related to the concept of stress as a disease, the availability and organization of health-care and social insurance benefits, and diagnostic bias.

Many of us will experience “stress“, at least at some time in our lives. It is a common view that stress sometimes becomes so severe that it causes “burn-out” or “exhaustion”. While these concepts are frequently used in everyday language, their mechanisms are poorly understood, especially regarding whether and how stress might cause exhaustion. In a single country, Sweden, an initiative was undertaken in 2005 to introduce a novel diagnosis: “stress-related exhaustion disorder“. Since then, a remarkable increase in exhaustion disorder has taken place, and it has become a major cause of disability. The question arises as to whether this reflects a true increase in stress-related disease in the population? This paper explores this question, and proposes that there are several other factors that may explain the increase in exhaustion disorder. The analysis also highlights the risks involved in creating a novel diagnosis for which solid scientific data are lacking.