Exhaustion disorder: scoping review of research on a recently introduced stress-related diagnosis

Abstract

Background Symptoms related to chronic stress are prevalent and entail high societal costs, yet there is a lack of international consensus regarding diagnostics and treatment. A new stress-related diagnosis, exhaustion disorder, was introduced into the Swedish version of ICD-10 in 2005. Since then, use of the diagnosis has increased rapidly. Aims To create the first comprehensive synthesis of research on exhaustion disorder to report on the current state of knowledge. Preregistration: Open Science Framework (osf.io), doi 10.17605/OSF.IO/VFDKW. Method A PRISMA-guided scoping review of all empirical studies of exhaustion disorder was conducted. Searches were run in the MEDLINE, PsycInfo and Web of Science databases. Data were systematically charted and thematically categorised based on primary area of investigation. Results Eighty-nine included studies were sorted into six themes relating to lived experience of exhaustion disorder (n = 9), symptom presentation and course (n = 13), cognitive functioning (n = 10), biological measures (n = 24), symptom measurement scales (n = 4) and treatment (n = 29). Several studies indicated that individuals with exhaustion disorder experience a range of psychiatric and somatic symptoms beyond fatigue, but robust findings within most thematic categories were scarce. The limited number of studies, lack of replication of findings and methodological limitations (e.g. small samples and scarcity of specified primary outcomes) preclude firm conclusions about the diagnostic construct. Conclusions More research is needed to build a solid knowledge base for exhaustion disorder. International collaboration regarding the conceptualisation of chronic stress and fatigue is warranted to accelerate the growth of evidence.

Characterization of exhaustion disorder and identification of outcomes that matter to patients: Qualitative content analysis of a Swedish national online survey

“…, and the proportion of women in the present study is similar to what has been found in previous clinical trials on ED(Lindsäter et al, 2022). Recruitment was largely carried out online, which likely introduces some selection bias, and even though recruited individuals represented a geographical spread that largely corresponds to population size of different Swedish regions, most participants were from larger cities.…”

“…The 10-item Perceived Stress Scale (PSS-10; Cohen et al, 1983) is the most common measure of perceived stress used in clinical trials of stress-related ill health (Estevez Cores et al, 2021;Svärdman et al, 2022) and measures how often one has perceived life as unpredictable, uncontrollable, and overloading in the past month (scale range 0-40). A higher score indicates higher level of perceived stress.…”

“…Recruitment was largely carried out online, which likely introduces some selection bias, and even though recruited individuals represented a geographical spread that largely corresponds to population size of different Swedish regions, most participants were from larger cities. Outreach might also have been limited by the comprehensiveness of the survey, as indicated by the fact that 42% of those who visited the study website did not respond to the survey.4.4 | Considerations for the development of a core outcome setMany clinical trials of ED and other stress-related conditions use an array of outcomes to measure a multitude of outcome domains, usually encompassing a burnout measure (e.g., Shirom-Melamed Burnout questionnaire(Lundgren-Nilsson et al, 2012)) as well as measures of perceived stress, depression, anxiety, insomnia, functional disability, and different assessments of sick leave/work ability(Perski et al, 2017;Svärdman et al, 2022). The abundance of different measurement scales to assess these outcomes and the lack of a standard primary outcome measure aggravates comparisons across trials and may result in overly strenuous administration for study participants with increased risk of data loss.…”

Psychometric and Structural Properties of the Karolinska Exhaustion Disorder Scale: A 1,072-Patient Study

“…A recent review of all published empirical ED studies found that research on the validity of this new diagnosis remains limited (5). The clinical picture of ED is similar to that of burnout (6, 7) and chronic fatigue (8), and the overlap with anxiety and depressive disorders is substantial (5).…”

“…A recent review of all published empirical ED studies found that research on the validity of this new diagnosis remains limited (5). The clinical picture of ED is similar to that of burnout (6, 7) and chronic fatigue (8), and the overlap with anxiety and depressive disorders is substantial (5). Amidst an international debate regarding whether burnout should be conceptualized as a medical disorder (9), ED has not been included in international versions of the ICD or the Diagnostic and Statistical Manual of Mental Disorders (DSM).…”