Occupational hazards: The relationship between workaholism, ADHD, and psychiatric disorders

A few weeks ago, my colleagues and I received a lot of media coverage around the world for our latest study on workaholism that was published in the journal PLoS ONE. The study involved researchers from the University of Bergen (Norway) and Yale University USA) and is probably the largest ever study done on the topic as it included 16,426 working Norwegian adults. Our study got a lot of press attention because we examined the associations between workaholism and a number of different psychiatric disorders.

We found that workaholics scored higher on all the psychiatric symptoms than non-workaholics. For instance we found that among those we classed as workaholics (using the Bergen Work Addiction Scale that we published in the Scandinavian Journal of Psychology four years ago and which I talked about in a previous blog), we found that:

  • 32.7% met ADHD (attention-deficit/hyperactivity disorder) criteria (12.7 per cent among non-workaholics).
  • 25.6% met OCD (obsessive-compulsive disorder) criteria (8.7 per cent among non-workaholics).
  • 33.8% met anxiety criteria (11.9 per cent among non-workaholics).
  • 8.9% met depression criteria (2.6 per cent among non-workaholics).

These were all statistically significant differences between workaholics and non-workaholics.

I think a lot of people wondered why we looked at the relationship between workaholism and ADHD to begin with. Firstly, research has consistently demonstrated that Attention-Deficit/Hyperactivity Disorder (ADHD) increases the risk of various chemical and non-chemical addictions. ADHD is prevalent in 2.5–5% of the adult population, and is typically manifested by inattentiveness and lack of focus, and/or impulsivity, and excessive physical activity. Individuals with ADHD may often stop working due to their disorder, and may have trouble in getting work health insurance as they are regarded as a risk group. For this reason, we thought that individuals with ADHD may compensate for this by over-working to meet the expectations required to hold down a job. Although this is a contentious issue, there are a number of reasons why ADHD may be relevant to workaholism.

Firstly, we argued that the inattentive nature of individuals with ADHD causes them to spend time beyond the typical working day (i.e., evenings and weekends) to accomplish what is done by their fellow employees within normal working hours (i.e., the compensation hypothesis). In addition, as they may have a hard time concentrating while at work due to environmental noise and distractions (especially office work in open landscape environments), they might find it easier to work after co-workers have left their working environment or work from home. Their attentive shortcomings may also cause them to overly check for errors on the tasks given, since they often experience careless mistakes due to their inattentiveness. This may cause a cycle of procrastination, work binges, exhaustion, and – in some cases – a fear of imperfection. Although ADHD is associated with lack of focus, such individuals often have the ability to hyper-focus once they find something interesting–often being unable to detach themselves from the task.

Secondly, we argued that the impulsive nature of individuals with ADHD causes them to say ‘yes’ and taking on many tasks without them thinking ahead, and taking on more work than they can realistically handle–eventually leading to workaholic levels of activity. Thirdly, we also argued that the hyperactive nature of individuals with ADHD and the need to be constantly active without being able to relax, causes such individuals to keep on working in an attempt to alleviate their restless thoughts and behaviors. Consequently, work stress might act as a stimulant, and they may choose active (and often multiple) jobs with high pressure, deadlines and activity (e.g., media, sales, restaurant work) – where they have the opportunity to multitask and constantly shift between tasks (e.g., Type-A personality behavior).

In line with this, Type-A personality has often been associated – and sometimes used inter-changeably – with workaholism in previous research. This line of reasoning also relates to the workaholic type portrayed by Dr. Bryan Robinson (in his 2014 book Chained to the desk: A guidebook for workaholics, their partners and children, and the clinicians who treat them), in which he actually denoted “attention-deficit workaholics” (who tend to start many projects but become bored easily and need to be stimulated at all times). His description of the “relentless” type also corresponds well with ADHD symptoms (i.e., unstoppable in working fast and meeting deadlines, often with many projects going on simultaneously). In other words, these types may utilize work pressure to obtain focus, constantly seeking stimulation, crisis, and excitement – and therefore like risky jobs.

Finally, people with ADHD are often mistaken as being lazy, irresponsible, or unintelligent because of their difficulties with planning, time management, organizing, and decision-making. Feeling misunderstood might cause individuals with ADHD to push themselves to prove these misconceptions as wrong – and resulting in an excessive and/or compulsive working pattern. Such individuals are often intelligent, but may feel forced or motivated to start up their own business (i.e., entrepreneurs), as they find it troubling to adjust to standard work schedules or organizational boundaries. Previous research has highlighted that workaholism is prevalent among entrepreneurs and the self-employed. Often failing in other aspects of life (e.g., family), work for such individuals may become even more important to them (e.g., self- efficacy). This is why we hypothesized that ADHD symptoms will be positively associated with workaholism in our study (and that is what we found).

Obsessive-Compulsive Disorder (OCD) is another underlying psychiatric disorder that increases the likelihood of developing an addiction. Full-blown OCD occurs in approximately 2-3% of children and adults, and is commonly manifested by intrusive thoughts and repetitive behaviors of checking, obsessing, ordering, hoarding, washing, and/or neutralizing. It has been suggested that addictive behaviors might represent a coping and/or escape mechanism of OCD symptoms, or as an OCD-behavior that eventually becomes an addiction in itself. Previous workaholic typologies such as those described by Dr. Kimberly Scotti and her colleagues in the journal Human Relations have incorporated the ‘compulsive-dependent’ and ‘perfectionistic’ workaholic types, and some empirical studies have demonstrated that obsessive-compulsive traits are present among workaholics. The OCD tendency of having the need to arrange things in a certain way (i.e., a strong need for control) and obsessing over details to the point of paralysis – may predispose workers with such traits to develop workaholic working patterns. Again we found in our study that OCD symptoms were positively related to workaholism.

It has also been reported that other psychiatric disorders such as anxiety and depression may also increase the risk of developing an addiction. Approximately 30% of people will suffer from an anxiety disorder in their lifetime, and 20% will have at least one episode of depression. These conditions often occur simultaneously, as most people who are depressed also experience acute anxiety. Consequently, anxiety and/or depression can lead to addiction, and vice versa. A number of studies have previously reported a link between anxiety, depression, and workaholism. Furthermore, we know that workaholism (in some instances) develops as an attempt to reduce uncomfortable feelings of anxiety and depression. Working hard is praised and honored in modern society, and thus serves as a legitimate behavior for individuals to combat or alleviate negative feelings – and to feel better about themselves and raise their self-esteem. This is why we hypothesized that there would be a positive association between anxiety, depression, and workaholism (and that is what we found). In relation to our study’s findings as a whole, the lead author of our study (Dr. Cecilie Andreassen) told the world’s media:

“Taking work to the extreme may be a sign of deeper psychological or emotional issues. Whether this reflects overlapping genetic vulnerabilities, disorders leading to workaholism or, conversely, workaholism causing such disorders, remain uncertain…Physicians should not take for granted that a seemingly successful workaholic does not have ADHD-related or other clinical features. Their considerations affect both the identification and treatment of these disorders”.

Our findings clearly highlighted the importance of further investigating neurobiological differences related to workaholic behaviour. Finally, in line with our previous research published two years ago (also in the PLoS ONE journal) using a nationally representative sample, 7.8% of the participants in our latest study were classed as workaholics compared to 8.3% in our previous study.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Andreassen, C.S., Griffiths, M.D., Hetland, J., Kravina, L., Jensen, F., & Pallesen, S. (2014). The prevalence of workaholism: A survey study in a nationally representative sample of Norwegian employees. PLoS ONE, 9(8): e102446. doi:10.1371/journal.pone.0102446.

Andreassen, C.S., Griffiths, M.D., Hetland, J. & Pallesen, S. (2012). Development of a Work Addiction Scale. Scandinavian Journal of Psychology, 53, 265-272.

Andreassen, C.S., Griffiths, M.D., Sinha, R., Hetland, J. & Pallesen, S. (2016). The relationships between workaholism and symptoms of psychiatric disorders: A large-scale cross-sectional study. PLoS ONE, 11(5): e0152978. doi:10.1371/journal. pone.0152978.

Griffiths, M.D. (2005). Workaholism is still a useful construct. Addiction Research and Theory, 13, 97-100.

Griffiths, M.D. (2011). Workaholism: A 21st century addiction. The Psychologist: Bulletin of the British Psychological Society, 24, 740-744.

Griffiths, M.D. & Karanika-Murray, M. (2012). Contextualising over-engagement in work: Towards a more global understanding of workaholism as an addiction. Journal of Behavioral Addictions, 1(3), 87-95.

Karanika-Murray, M., Duncan, N., Pontes, H. & Griffiths, M.D. (2015). Organizational identification, work engagement, and job satisfaction. Journal of Managerial Psychology, 30, 1019-1033.

Karanika-Murray, M., Pontes, H.M., Griffiths, M.D. & Biron, C. (2015). Sickness presenteeism determines job satisfaction via affective-motivational states. Social Science and Medicine, 139, 100-106.

Orosz, G., Dombi, E., Andreassen, C.S., Griffiths, M.D. & Demetrovics, Z. (2016). Analyzing models of work addiction: Single factor and bi-factor models of the Bergen Work Addiction Scale. International Journal of Mental Health and Addiction, in press

Quinones, C. & Griffiths, M.D. (2015). Addiction to work: recommendations for assessment. Journal of Psychosocial Nursing and Mental Health Services, 10, 48-59.

Quinones, C., Griffiths, M.D. & Kakabadse, N. (2016). Compulsive Internet use and workaholism: An exploratory two-wave longitudinal study. Computers in Human Behavior, 60, 492-499.

Robinson, B.E. (2014). Chained to the desk: A guidebook for workaholics, their partners and children, and the clinicians who treat them. New York: New York University Press.

Scotti, K.A., Moore, K.S., & Miceli, M.P. (1997). An exploration of the meaning and consequences of workaholism. Human Relations, 50, 287–314.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: Journal of Science and Healing, 10, 193-195.

Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

About drmarkgriffiths

Professor MARK GRIFFITHS, BSc, PhD, CPsychol, PGDipHE, FBPsS, FRSA, AcSS. Dr. Mark Griffiths is a Chartered Psychologist and Professor of Behavioural Addiction at the Nottingham Trent University, and Director of the International Gaming Research Unit. He is internationally known for his work into gambling and gaming addictions and has won many awards including the American 1994 John Rosecrance Research Prize for “outstanding scholarly contributions to the field of gambling research”, the 1998 European CELEJ Prize for best paper on gambling, the 2003 Canadian International Excellence Award for “outstanding contributions to the prevention of problem gambling and the practice of responsible gambling” and a North American 2006 Lifetime Achievement Award For Contributions To The Field Of Youth Gambling “in recognition of his dedication, leadership, and pioneering contributions to the field of youth gambling”. His most recent award is the 2013 Lifetime Research Award from the US National Council on Problem Gambling. He has published over 600 research papers, four books, over 130 book chapters, and over 1000 other articles. He has served on numerous national and international committees (e.g. BPS Council, BPS Social Psychology Section, Society for the Study of Gambling, Gamblers Anonymous General Services Board, National Council on Gambling etc.) and is a former National Chair of Gamcare. He also does a lot of freelance journalism and has appeared on over 2000 radio and television programmes since 1988. In 2004 he was awarded the Joseph Lister Prize for Social Sciences by the British Association for the Advancement of Science for being one of the UK’s “outstanding scientific communicators”. His awards also include the 2006 Excellence in the Teaching of Psychology Award by the British Psychological Society and the British Psychological Society Fellowship Award for “exceptional contributions to psychology”.

Posted on June 10, 2016, in Addiction, Compulsion, Drug use, Obsession, Obsessive-Compulsive Disorder, Psychiatry, Psychology, Work, Workaholism and tagged , , , , , , , , , , , , , , , , , , . Bookmark the permalink. Leave a comment.

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