Development Of a Chronic Stress Diagnosis

This study discusses a novel diagnosis, “stress- related exhaustion disorder”, which was introduced in Sweden in 2005. An International Classification of Diseases 10(th) 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; (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 healthcare and social insurance benefits, and diagnostic bias.