There are more than 45 million (yes, million) unpaid caregivers in the United States selflessly and lovingly caring for and assisting parents, children, family members, friends or even neighbors who require intensive levels of support. They may be doing so a few hours a day, a couple of days a week, or in some cases, around-the-clock.

While words cannot truly justify the value they provide – and their incredible sacrifices – many of these amazing individuals are at risk for an often unrecognized condition called caregiver burnout. Caregiver burnout can cause stress, present physical, mental and emotional challenges, and even compromise the quality of care someone is providing their loved one (in addition to themselves!). We recently took a more in-depth look behind some characteristics and warnings signs of caregiver burnout (click here for a refresher).

For the second part of our series on the topic, let’s now talk about how caregiver burnout develops – including some warning signs and causes.

What Causes Caregiver Burnout?

While the origin of caregiver burnout can vary person-by-person, here are some common causes:

1. The workload: Being a caregiver, whether for your parents or friends, is hard work. It can take an incredible toll, both emotionally and physically, and consume a great deal of time, attention and energy. The more overwhelming the workload becomes, the more likely someone may experience symptoms of caregiver burnout.
2. Unrealistic expectations: Some caregivers may expect their role to be magical of sorts, thinking that just because they are caring for a loved one automatically means that person will get better. While that can happen, it’s never a guarantee. Sometimes a loved one may face an even sharper decline in health, or their condition may not improve, leaving the caregiver to blame themselves or question what they’re doing wrong. This can understandably be a deflating feeling.
3. Lack of control: Frustration can build up when a caregiver perceives an absence of control. This could mean a lack of money, specific resources or anything else that is preventing them from doing their job as best they can. In these cases, the caregiver will often continually strive to do more or have the mindset that the way they are providing care is leaving a lot to be desired.
4. Unreasonable demands: Caregivers will often place unnecessary demands on themselves or others. Sometimes they are aware of it; other times, they may not be. Some examples might be “well, my mother isn’t getting any better so maybe I should work two more hours per day,” when in reality, they are already putting in significant time. Or a sibling or close family member scrutinizes them, offering their own opinions or questioning the way things are done. These demands, whether intentional or not, can build up over time and make the heavy load of being a caregiver even heavier.
5. Role confusion: When someone is thrust into the role of caregiver – and they put that hat on – it’s difficult to take it off. This is especially true if the caregiver either lives with their loved one or spends hours a day with them. Going home for the evening and transitioning from the role of caregiver to the job of a mother or spouse can be incredibly challenging. Sometimes the line between these different hats can become blurry.
6. Perfectionism: Caregivers tend to possess more perfectionist qualities, such as fixating on what is not getting done or the areas they feel they could improve upon. They may question every single move instead of focusing on what has already happened and how they can best manage that. Perfectionism can often distract caregivers from what they need to be doing.
7. Unspoken and neglected feelings: Caregivers can feel isolated at times. Remember, that person is not only responsible for caring for their family member or friend; they have to care for themselves too. But when attending to their own needs, caregivers often don’t have anyone to turn to or talk with. Emotions and feelings can bottle up very quickly. This type of repression can prevent them from completing certain tasks or functioning in their role as best they can. They can become tired easily. They can become forgetful or chronically late. They can often react in emotionally inappropriate ways, over seemingly small things.

Risk Factors for Caregiver Burnout

Now that we’ve talked about common causes of caregiver burnout, let’s outline some areas that may make someone more susceptible to it:

1. The level of physical exertion: Caretaking isn’t only emotionally and mentally challenging. It can be physically grueling too, whether it’s lifting a parent out of the bathtub, moving them into chairs or helping them get into a car. Caregivers are generally at a much higher risk for physical injuries, such as muscle strains, skeletal injuries or other serious signs of discomfort.
2. The severity of the care recipient’s behavioral problems: Caregivers experience many ups-and-downs, with no visibility into what’s ahead. This may be especially true when caring for someone with Alzheimer’s disease or dementia, which can be very fluid conditions. That person may be pleasant and appreciative one moment, then combative or confused the next. Cognitive issues place a lot of stress on the caregiver, especially when they’re trying to do their best to help – but it’s not received on the other end.
3. Caregivers who have poor or neglected self-care: There is a downside to the selfless quality caregivers possess. While they are making sacrifices with their own time, energy and resources, caregivers should not sacrifice their own well-being. But the sad reality is it happens often. Inadequate diets, lack of exercise, poor stress management or not creating enough time for themselves will quickly place them on the track for burnout.
4. Socioeconomic issues: Caregivers with higher incomes have more resources, whether it’s the ability to hire additional support, access more comprehensive healthcare or provide certain equipment to ease any physical burdens they encounter. Lacking financial resources can make a caregiver susceptible to burnout.
5. Co-residing or spousal caregivers: When you are caregiving for a spouse or someone living with you, you’re at more risk for burnout. It’s tough to see someone you love and spend time around constantly in pain or declining health. Sometimes, caregivers in these situations may feel trapped or unable to escape the intense feelings and emotions they experience in their role.
6. Duration: The longer someone has been a caregiver, the higher the risk for burnout. A longer duration could mean an extended period of time or the total number of hours per day (a full-time basis, for instance).
7. A lack of a support system: Even the best of caregivers can’t do their job alone. Some level of support, whether from another family member or community organization, is required. If no one is around to help them, burnout can quickly become a reality. Remember: being a caregiver can be incredibly isolating.
8. Substance abuse: Caregivers can often cope with their frustration, exhaustion and loneliness in a maladaptive way. Sadly, many caregivers are at a higher risk of falling into substance abuse issues.

When thinking about these common causes and risk factors, one theme radiates: being a caregiver is not an easy job. And while someone may “sign up” or volunteer to become one, they often don’t understand the magnitude of the challenges they can face, particularly when it comes to caregiver burnout.

Are you concerned you – or someone close to you – may have caregiver burnout? Our counseling services can help support you.

And stay tuned to our blog in the coming weeks. Next up: some proactive tips for both preventing and overcoming caregiver burnout.

Janice D. MacKenzie, LICSW is a Licensed Independent Clinical Social Worker for Catholic Charities New Hampshire’s Counseling Services, with 20 years of experience in the field of mental health. Janice provides counseling services to teens, adults and couples through a strengths-based, cognitive- behavioral and client-centered approach to therapy. She can be reached at jmackenzie@nh-cc.org.