By Dr Daniel S. Cohen · Updated: 28 April 2026
Summary
Burnout is one of the most common reasons for consultation in the expat population in Madrid: international professionals in banking, consulting, diplomacy, technology or research who arrive exhausted, irritable and emotionally distant after months or years trying to perform in a new cultural and work environment.
It is neither a sign of weakness nor a generational “fad”: it is a well-characterised clinical picture, with a predictable trajectory, specific risk factors in the expat population and effective therapeutic options. Detecting it early prevents its evolution into established depression or anxiety disorders.
What is burnout
Burnout was clinically conceptualised by Christina Maslach in the 1980s as a psychological work-related syndrome that appears as a response to chronic stress at work. The WHO included it in the ICD-11 as an occupational phenomenon —not a mental illness in itself—, recognising its work-related origin while differentiating burnout from conditions such as depression or anxiety.
In clinical practice, burnout is not just “being tired”. It is a stable, persistent picture that disrupts global functioning and frequently coexists with or evolves into other mental disorders if not addressed.
The three dimensions of burnout
Maslach’s model defines three dimensions that appear together:
- Emotional exhaustion. A sense of being consumed, lacking energy, “empty” at the end of the day and at the start of the next. It is the most visible dimension and usually the first to appear.
- Cynicism or emotional detachment. A progressive distancing from work, colleagues, clients or patients emerges. The person begins to treat others in a cold, mechanical or sarcastic way, as a defensive attempt to protect themselves from the wear and tear.
- Lack of efficacy and personal accomplishment. A sense of not delivering, not adding value, that effort “is not worth it”. It often coexists with low professional self-esteem, even when objective performance is maintained.
Burnout is clinically diagnosed when these three dimensions are sustained over time and produce a functional impact on the person.
Why expats are an at-risk population
The literature describes several factors that make the expat particularly vulnerable:
- Loss of social network and routines. Moving to another country means rebuilding friendships, support systems, leisure and cultural references from scratch. A large part of everyday emotional support disappears overnight.
- Perceived isolation. It is one of the strongest predictors of psychological distress in the expat population, even more than workload itself. Up to 86 % of international expats report having felt emotionally isolated or “disconnected” at some point.
- Cultural shock and language barrier. Adapting to new social codes (at work, in leisure, with public services) consumes significant cognitive resources. Even when the language is mastered, cultural nuances and implicit expectations require sustained effort.
- Pressure to “make the move worth it”. Those who accept an expat assignment —and often the family who follows— live under the implicit pressure that the move “must have been worthwhile”. Acknowledging difficulties is experienced as a personal and professional failure.
- Conflicts in the couple and binational family. The adaptation process is rarely symmetrical between members of a couple. Frequently one adapts faster while the other remains emotionally “anchored”, generating additional tension.
- Distance from the usual healthcare network. The expat frequently postpones clinical consultation due to unfamiliarity with the local healthcare system, language difficulties or doubts about international insurance coverage.
Early signs
Burnout does not appear overnight. It usually settles in over months, with signs the patient and their environment tend to normalise at first.
At work:
- Persistent tiredness that does not improve with weekend rest.
- Increasing procrastination, difficulty concentrating on background tasks.
- Cynicism, sarcasm or emotional coldness towards colleagues and clients.
- A sense of “not getting there” despite high objective effort.
Physically:
- Insomnia (especially sleep-onset insomnia or early waking).
- Tension headaches, neck and lower-back muscular pain.
- Digestive issues, palpitations, chest tightness.
- Increased consumption of caffeine, alcohol or anxiolytics.
Emotionally and socially:
- Increasing irritability with partner, children or close relations.
- Progressive isolation, avoidance of social events that used to be enjoyable.
- Loss of motivation for personal projects outside work.
- A sense of “being trapped”, of not being able to stop without everything falling apart.
When several of these signs persist for weeks or months, the picture deserves clinical evaluation.
Differences between burnout, depression and anxiety
The three pictures partially overlap and often coexist, but they have relevant clinical differences:
- Burnout is contextual. Its origin is at work and improves —at least initially— when away from the work environment. Depression, on the other hand, persists even outside the work context.
- Depression is transversal. It affects enjoyment, sleep, appetite, self-esteem and life meaning in general, not just the professional sphere.
- Generalised anxiety centres on anticipation and worry. Burnout adds the components of chronic exhaustion and emotional detachment, not only hypervigilance.
In practice, untreated burnout frequently evolves into established depression or anxiety disorders. Differentiating them is key because treatment differs: burnout responds best to psychotherapeutic and organisational interventions; depression and anxiety may also require pharmacological treatment when the picture is moderate or severe.
Frequent comorbidities
Burnout rarely appears alone. The most common comorbidities are:
- Depressive disorders. Especially when the picture has evolved for more than six months without intervention.
- Anxiety disorders (generalised anxiety, panic attacks, social anxiety).
- Sleep disorders, particularly chronic insomnia.
- Problematic substance use, especially alcohol as a “switch-off” tool at the end of the day.
- Adjustment disorders, common in the first 6-12 months of expatriation.
- Parental burnout, an emerging variant: exhaustion shifts to the parental role, particularly in expat families with reduced support networks.
Identifying comorbidity changes the treatment plan.
How evaluation works in consultation
Evaluation includes:
- Detailed psychiatric interview, exploring the work context, the adaptation trajectory, personal and family history, and the presence of comorbidity.
- Differential diagnosis with depression, anxiety disorders, sleep disorders and substance use.
- Validated standardised questionnaires (such as the Maslach Burnout Inventory) as a support, not as a stand-alone diagnosis.
- Exploration of the work environment: working hours, autonomy, team support, role clarity, perceived values.
- Exploration of the personal environment: social network in Madrid, couple dynamics, relationship with the family of origin, planning of returns to the country of origin.
- Basic medical assessment when there are persistent physical symptoms, to rule out other causes.
Treatment
Burnout treatment is psychotherapeutic in first line and, when significant comorbidity appears, also pharmacological.
- Psychotherapy. Cognitive-behavioural therapy and structured mindfulness-based programmes are the approaches with the strongest evidence. They work on cognitive distortions, perfectionism, time management, emotional regulation and rebuilding boundaries between professional and personal life.
- Pharmacological treatment. It is not prescribed for burnout itself, but it is when burnout coexists with depression, clinical anxiety or chronic insomnia that does not respond to behavioural measures. The indication, dose and duration are decided by a psychiatrist on an individualised basis.
- Organisational interventions. The evidence is clear: burnout is not resolved through individual change alone. When possible, the patient and clinician work together to identify realistic workplace adjustments (workload, deadlines, autonomy, role clarity) and to address the conversation with their company or direct manager.
- Rebuilding social network and cultural support. Particularly important for expats: community activities, links with associations of their linguistic community, periodic returns to the country of origin, integration into local networks.
- Specific interventions in the expat setting. Psychoeducation on the typical phases of the expatriation process, normalisation of cultural shock, joint work with the partner when there is a mismatch in adaptation.
In clinical practice, coordinated work between psychiatrist and psychotherapist within the same approach clearly improves outcomes compared to fragmented care, especially when there is comorbidity.
Common myths
- “Burnout is just tiredness, holidays will fix it.” False. Holidays bring temporary relief, but the picture reappears on return if the work-related and personal factors have not been changed.
- “It’s weakness or lack of character.” False. The people most at risk of burnout are frequently the most committed, perfectionist and with the strongest sense of responsibility.
- “If I don’t have depression, I don’t need help.” False. Untreated burnout frequently evolves into established depression or anxiety disorders. Treating it early prevents it from becoming chronic.
- “It’s the others’ problem; I can take it.” False. Denial is part of the picture: the person with burnout tends to minimise their symptoms and postpone consultation until the functional decline is obvious.
- “If I quit the job, it’s solved.” Partially. Changing job may help short-term, but without therapeutic work on the patterns that led to burnout (perfectionism, difficulty saying no, time management, expectations), the cycle repeats in the next role.
When to consult
Some signs warrant a professional evaluation without delay:
- Persistent tiredness that does not improve with weekend rest or short holidays.
- Insomnia sustained for several weeks.
- Unusual irritability or emotional coldness with partner, children or close relations.
- Increased consumption of alcohol or other substances to “switch off”.
- A growing sense that work “no longer makes sense”, even though objectively nothing has changed.
- Physical symptoms with no clarified medical cause (headaches, palpitations, persistent muscular pain).
If you recognise yourself in several of these situations, it makes sense to consult early with a psychiatrist or a team experienced clinically in burnout and the expat population. Early detection —before the picture evolves into clinical depression or anxiety— clearly improves prognosis.
If you also consult in your native language, therapeutic work progresses faster. For more information on multilingual clinical care in Madrid, you can read the guides on psychiatry in English in Madrid and psychiatry in French in Madrid.
Conclusion
Burnout is common, especially in the expat population in Madrid, and it is fully treatable when diagnosed in time. The clinical challenge is not identifying exhaustion —which is the visible part— but recognising the dimensions of cynicism and loss of efficacy, intervening before comorbidities appear and working both on individual patterns and on the work and social context. Coordinated work between psychiatrist, psychotherapist and other disciplines within the same approach significantly improves prognosis.
Clinical references
- WHO. ICD-11: Burn-out, an occupational phenomenon. Access
- Maslach C, Leiter MP. Understanding the burnout experience. World Psychiatry. Access
- Bader B, Schuster T. Stress of working abroad: systematic review. Access
- Expatriation stressors and well-being of accompanying partners. 2024. Access
- Effectiveness of Workplace Mental Health Programs in Reducing Burnout. 2024. Access
- Burnout, depression, anxiety in physicians and postgraduate trainees. Front Public Health 2025. Access
About the author: Dr Daniel S. Cohen. Psychiatrist in Madrid, specialist in child and adolescent psychiatry and adult psychiatry. Medical Director of Clínica Colev. Registration No. 28/4003040 (ICOMEM). Consultations in English, French, Hebrew and Spanish. View professional profile.