The link between traumatic experiences and the development of addiction has been well-documented. Edward Khantzian, who originated the self-medication hypothesis of substance abuse, writes that “human emotional suffering and pain” and an “inability to tolerate [one’s] feelings” are at the root of addiction. People may use alcohol, drugs, or gambling to numb or control distress, low self-esteem, anxiety, or depression.

But there is virtually no empirical research on the potential link between trauma and overwork or work addiction. While a 2015 study on women survivors of intimate partner violence and a 2013 study on survivors of childhood sexual abuse both indicate that these populations may be inclined toward workaholic behaviors, there is no research on why trauma survivors might turn to work to cope with their feelings.

But a number of researchers and clinicians—and people who self-identify as workaholics or overachievers—believe the connection between trauma and overwork is likely. Some believe coping with trauma is at the very heart of a work addiction.

While the term has been used loosely in recent articles, a workaholic isn’t just someone who works a lot or delays taking vacation. Instead, they work so much that they neglect other areas of their life (like relationships, sleep, or health), and they may become unhappy and obsessive in the process. While there is no scholarly consensus, researchers typically define workaholics with at least three of the following four characteristics: working to the extent that one neglects self-care or one’s personal life; experiencing little enjoyment of work; working more than is expected or than the circumstances demand; and displaying controlling behaviors, like not delegating or trusting others.

Chanel Dubofsky, a 37-year-old writer who splits her time between New York and Massachusetts, believes she’s had overachieving tendencies from a young age. It started when her mother was diagnosed with cancer when Dubofsky was 7 years old, and worsened when her mother relapsed twice—when Dubofsky was 13 and 17. She recalls being in middle school and “waking up in the middle of the night with these super headaches that wouldn’t go away” until she finished her homework.

Dubofsky says her friends in high school enabled this working style. They used to have an informal competition around “who was getting less sleep.” Dubofsky adds: “[My workaholism] was particularly aggressive the college semester when my mom died.” Even after her mother’s death, Dubofsky enrolled in 20 credits’ worth of classes when most people took 12 or 15, staying up all night to do homework, and sleeping in until noon. She managed to get As in her classes, even the morning ones she often skipped because she was too tired, and only later did she tell professors about her recent loss. “I only know there were expectations for how someone in grief was supposed to behave and I wasn’t fulfilling any of them.”

Mental-health research indicates that grief may take many forms—like anger, guilt, depression, or a lack of productivity at work—and that there is no right way to mourn. However, there are unhealthy responses to grief, including making major life changes (like moving or quitting a job before the grief is managed) or trying to minimize or avoid your feelings.

It can be healthy to use work tasks to calm down when stressed, if someone does so in moderation, especially if they find purpose and meaning through their work. But people with traumatic stress or PTSD might be prone to channeling—or avoiding—their unresolved feelings through overwork, and they tend to get so lost in work that they don’t notice physical pain or other discomforts, explains Bryan Robinson, a psychotherapist in private practice and author of Chained To The Desk.

A 29-year-old nonprofit worker in New York, who asked that her name not be included to protect her privacy, identifies as a trauma survivor and workaholic. “For me, working all the time and being in constant motion is one way to avoid thinking about how I’m feeling,” she says. Rebekah Reysen, a researcher on staff at The University of Mississippi who coauthored an article on workaholism in teachers, adds that overworking can be a way to escape: “People can run toward something as they run away from something else.”

Nancy, a New York City-based journalist and documentary filmmaker, saw her overwork tendencies most at play when she collaborated with an abusive partner on a project: “I put all the anger and frustration into the project itself to compensate for how I wasn’t taking care of myself emotionally.”

Some have proposed that workaholics may turn to work when other areas of life feel out of control. Dubofsky explains: “Work is often the place that I go when my anxiety is very bad and I’m not able to soothe myself.” Control also came up for Nancy: “When everything else is out of control or insane and traumatic, then it’s like going to that one place where you can take charge and feel confident.”

Robinson explains how the unpredictability of trauma can lead to control-seeking: “When [a traumatic event] happens over and over again, after a while, your system tells you that anything can be a threat.” Robinson, who identifies as a recovering workaholic, explains how concrete work tasks helped him assert control and achieve a sense of stability: “[Through work] I could predict something. It makes you feel like you know what’s going to happen.”

Working as a way to assert control may be particularly relevant for people who experience hypervigilance, a symptom of PTSD and severe anxiety which can include “being easily startled” or “feeling tense or ‘on edge,’” according to the National Institute of Mental Health. The hypervigilant mind scans for potential threats in a repetitive, distressing way. Working extreme hours may help manage elevated fears or make people feel prepared for disaster (real or imagined). Explains Reysen: “It is difficult for the mind to focus on more than one task at once, so being engrossed in a work project can help temporarily replace those thoughts with something procedural, more easily controllable.”

Controlling tendencies may also mean that workaholics struggle to share the workload. Robinson explains how delegating may bring up that dreaded uncertainty: “When delegating, you’re afraid that it’s not going to get done or get done as well. [If you do it yourself], you’re making sure the outcome is more predictable.” For survivors of trauma, feeling like they know what’s going to happen, even if it’s a false sense of security, can be calming.

Robinson also believes that being accustomed to stress leads workaholics to bite off more than they can chew: “I think it’s because their internal system is used to overload. Multitasking gets their adrenaline going and the heart racing.” This activation may temporarily deliver someone from their deeper distress.

How does someone come to learn that work and overwork can save them from overwhelming situations or feelings? Robinson believes the aspect of early trauma most connected to work addiction is parentification, which one article defines as “when children are expected to provide instrumental or emotional caregiving within the family system that overtaxes their developmental capacity.” If a child’s household experiences volatility (like financial insecurity, physical or sexual abuse, or feuding adults), Robinson believes kids learn to “grab onto something that gives them a sense of stability.” This can include taking care of a sick adult or younger siblings, mediating between parental conflict, or overachieving in school.

Dubofsky’s mother’s battle with cancer catapulted her into adult responsibilities: “I knew when all her doctors’ appointments were, I knew all these times. I was often more her parent than her kid. This hypervigilance parlayed into school: “How can I prepare for this even more?’”

Scholars are not aligned on whether workaholism is a true addiction, and it is not listed in the DSM-5, the U.S. standard used to classify mental disorders. The field of study on the subject is still nascent, though Robinson thinks that workaholism should be considered on the spectrum alongside other addictions: “It’s a true addiction, and our society is in denial,” he says. Reysen suspects that workaholics can experience the same gratification and withdrawal cycles as other addicts: “You’re compelled to work but don’t necessarily feel joyous. You’re not getting a lot of satisfaction but feel like you have to do it.” When the benefits from work don’t last long, workaholics add more to their plate. As Reysen describes it: “You need more and more of it to get the same results.”

Nancy echoed the sentiment of work as drug, though for her it may function more like an anxiety-reduction drug than a stimulant: “It almost feels like I use work ... I’m calming myself down, I’m not crying, and within a few hours, this task of writing or transcribing will be done.”

The withdrawal symptoms are real for people who can’t relax without feeling guilt or anxiety. Dubofsky says she can’t take time off “without psychological repercussions,” and the New York nonprofit worker describes relaxing as “very hard” and “stressful” because “self-care sometimes feels to me like an excuse for not doing work.”

Still, Malissa Clark, a workaholism researcher, doesn’t think the term should be added to the DSM: “People can exhibit workaholic tendencies even if it’s not severe enough to be a clinical [problem]. It can still be detrimental.”

Recognizing workaholism as a clinical problem may also be complicated by how much American culture values work. It’s common for Americans not to use all their vacation days, and Reysen adds: “Work is one of those activities that society applauds, even when people work excessively and sacrifice their health, relationships, and other facets of their lives.” A workaholic may go unnoticed or even receive praise, raises, or promotions for their unhealthy habits.

Further complicating the difference between hard work and overwork is the fact that most people have to work in order to survive, and some have no choice but to work long hours. And many people derive a huge part of their identity from work. Reysen explains: “Work engagement can bring accomplishments and feelings of self-worth… It can be a way of self-regulating, connecting with other people, making a contribution to society, and enhancing one's self-esteem in a big way.”

As the New York nonprofit worker put it: “Work is a huge part of who I am... My purpose in life is very work-driven, and my sense of self worth is also very work-driven.”

And as far as coping mechanisms go, working a lot is certainly more socially acceptable than drinking, for example. Nancy sees workaholism as a partly hidden experience: “There won’t be any hangover after. [Workaholism] seems on the outside like not completely damaging, but it is when you don’t also take care of yourself.” In fact, the demonstrated consequences from sustained workaholism include declining physical and emotional health, family and marital strife, trouble sleeping, and more. There is also the reality that modern technology allows constant connectivity, making it challenging for anyone, let alone a workaholic, to disengage from work.

Then how can a workaholic heal, especially considering that they likely can’t go “cold turkey”? In his private practice, Robinson says the most important thing is learning to sit still and be in the moment instead of being impatient. “I teach [workaholics] to be able to be present. And that brings up a lot of anxiety. As they practice over time, the brain starts to realize that they can be calm and quiet and that it’s okay.” This skill of “grounding” is the same one Robinson would offer a trauma survivor or someone with PTSD—people who are used to waiting for the other shoe to drop, so to speak. When a workaholic is also a trauma survivor, learning to be present may help address unresolved emotions which they used work to avoid. With the ability to feel grounded in place, people can find healthy ways to engage with work and create concrete boundaries around it.

Some workaholics find community through Workaholics Anonymous, a 12-step program that exists in about 20 countries and 32 U.S. states. This social support may be especially beneficial if a workaholic is also a trauma survivor. Reysen explains: “The key is to not be isolated and to still engage in social activities. The survivor does not have to talk about the trauma; it is therapeutic to be around other people who make a positive impact on one's life.” Nontraditional therapies, like yoga and meditation, have shown some promise in treating PTSD, and may be helpful in training the brain to face underlying anxiety instead of distracting or soothing it with work.

The difference between working hard and working compulsively may be blurred in the cases of trauma survivors, warranting closer attention from researchers and clinicians. Through talk therapy, 12-step programs, or support groups, the goal is not to stigmatize workaholics but to examine their underlying motivations. Integrating a trauma-aware lens can ensure that support systems and treatment programs grapple with how work may have been a response to trauma for some. As Dubofsky explains: “[Work] was my survival mechanism—working really hard saved me from going into a really dark place.”