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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.

Can you feel the force? The psychopathology of ‘Star Wars’

A few days ago, my friend and colleague Dr. Andrew Dunn sent all the psychology staff members a paper published in the December 2015 issue of Australasian Psychiatry by Susan Friedman and Ryan Hall entitled ‘Using Star Wars’ supporting characters to teach about psychopathology’. As a fan of Star Wars and science fiction more generally, I immediately read the paper and thought it would be a good topic to write a blog about.

It turns out that Friedman and Ryan have written a series of papers in psychiatric journals over the last year arguing that many of the characters in the Star Wars movies have underlying psychopathologies and that because of the films’ popularity, the films could be used to teach students about various psychiatric disorders. The authors asserted that supporting characters in Star Wars can be used to teach about a wide variety of psychiatric conditions which are not commonly so accessible in one story, including [attention deficit hyperactivity disorder] ADHD, anxiety, kleptomania, and paedophilia”. I have to admit that in my own teaching I often use characters and/or storylines from film and television to explain psychological phenomena to my own students (and have also published articles and papers demonstrating the utility of using such sources in both teaching and research contexts – see ‘Further reading’ below). Therefore, I was intrigued to read what psychiatric disorders had been attributed to which Star Wars characters.

In the Australasian Psychiatry paper, it is argued that Jar Jar Binks has attention deficit hyperactivity disorder (ADHD):

“Jar Jar frequently overlooks details and makes careless mistakes…His difficulty in sustaining his attention is evident…His difficulty in following instructions almost results in him being put to death…trainees can determine whether [the examples provided] are related to inattention, hyperactivity or impulsivity”.

More controversially, Friedman and Ryan make the case for Qui-Gon Jinn showing paedophilic grooming behaviour.

“In Phantom Menace, Qui-Gon engages in many behaviours with young Anakin Skywalker the same way a paedophile would with a child victim. Anakin seems to fit a pattern which Qui-Gon has of cultivating prepubescent, fair-complexioned boys with no strong male family ties…Anakin’s mother has no power or relations with authority, which decreases the likelihood that either she or Anakin would report the paedophile, or potentially be believed by others…Qui-Gon develops a relationship with Anakin, noting his special features and abilities: he often gives compliments to the child…He fosters a relationship where secrets are kept…and the child is slowly isolated from others…After trust is gained, there is a gradual increase in physical intimacy. In the movies this was symbolised by Qui-Gon drawing blood samples from Anakin. A paedophile may incorporate other children or older victims into the grooming process to further lower the child’s inhibitions”.

I’m not overly convinced by the argument but it does at least lead to discussions on the topic of grooming that I could see having a place in the classroom. Friedman and Ryan also examine a whole species (the Jawas) and claim that they are by nature kleptomaniacs:

“Jawas can introduce the concepts of kleptomania and hoarding, since they ‘have a tendency to pick up anything that’s not tied down’. It is important from a diagnostic point of view to recognise that kleptomania is more than just stealing or shoplifting…To meet criteria for kleptomania, one must recurrently fail to resist the impulse to steal unneeded or non-valuable objects. Tension before committing the theft is followed by gratification or release afterwards. These characteristics of kleptomania can be inferred from the Jawas’ capture of R2D2…The gratification of stealing R2D2 is clear from the Jawas’ excited scream…As for the need or value of the stolen items and the repetitive nature of the theft, the Jawas’ sandcrawler is filled with droids in various states of dysfunction…Although on a desert planet almost anything might have value, the Jawas seem to take this to extremes given the number of broken droids in their possession which do not even appear to be in good enough shape to use as spare parts”.

Elsewhere in the paper is a table listing many Star Wars characters along with “potential concept discussions” related to the characters’ behaviours in the films. This includes (amongst others) Darth Vader (borderline personality disorder, post-traumatic stress disorder), Jabba the Hutt (psychopathy and antisocial personality disorder), Boba Fett (Oedipal issues – Hamlet type), Yoda (dyslexia, malingering), Luke Skywalker (prodromal schizophrenia), Princess Leia (histrionic personality disorder), Padme Amidala (postnatal delirium, postnatal depression), Obi-Wan Kenobi (major depression in old age, pseudo-dementia), and C3PO (obsessive-compulsive personality disorder).

However, given my own research interests, the character that most interested me in Friedman and Ryan’s list was the claim that Lando Calrissian might be a pathological gambler. According to one of the Wiki entries:

“Lando Calrissian was a human male smuggler, gambler, and card player who became Baron Administrator of Cloud City, and, later, a general in the Rebel Alliance. [He] was born on the planet Socorro…During his youth, he became a smuggler and a gambler, playing a card game known as sabbacc. Calrissian was able to make a living by illegally acquiring and redistributing rare or valuable goods. However, due to Calrissian’s penchant for gambling, he and his business partner Lobot were in deep with the wrong people”.

Gambling does make the occasional appearance in Star Wars films – particularly in bar scenes. In describing Calrissian to Han Solo, Princess Leia notes “he’s a card player, gambler, scoundrel. You’d like him“. Qui-Gon Jinn notes in The Phantom Menace that “Whenever you gamble my friend, eventually you’ll lose”. The Star Wars Wiki on gambling notes that it involves the betting of credits or possessions in wagers or games like sabbacc. For example, Lando Calrissian bet the Millennium Falcon in a game of sabacc with Han Solo, and lost. Gambling was rampant on Tatooine [the home planet of Luke Skywalker]”. The Star Wars Wiki on sabacc also notes that there are several variants of the game and that Calrissian lost the Millenium Falcon to Han Solo while playing ‘Corellian Spike’ and that Solo kept the two golden dice that were used while gambling. A profile article on Calrissian in the Washington Post describes him as a “suave gambler” rather than a pathological gambler.

There is no doubt that Calrissian liked to gamble but there is little evidence from the film that it was pathological. However, other articles (as well as older and newer fiction) about him claim that he is. For instance, in an online article by Shane Cowlishaw discussing the personality disorders of Star Wars characters, the following is claimed: 

“He may have ended up leading the final assault on the Death Star, but Lando perhaps was only successful due to being a pathological gambler. Having lost the Millennium Falcon to Han Solo in a bet, conned the Bespin Gas Mine out of somebody and gambling on a deal to betray Han and Chewbacca to the Empire, it is clear he can’t help himself. Lando gambles with the lives of other rebels, albeit successfully, be demanding that the spaceship not abort their mission when Admiral Ackbar orders everyone to retreat from the unexpectedly operational Death Star. A perfect character to debate whether pathological gambling is an addiction or an impulse-control disorder, apparently”

It’s also worth mentioning that Calrissian will also be making an appearance in upcoming Marvel comics. In an interview with writer Charles Soule (who will be scripting the new stories), it is evident that the crux of his character will focus on the gambling part of his personality – but more on the problem side:

“I focused on the whole gambler archetype for Lando; more specifically, the sort of lifelong card player who never really knows when to walk away from the table. He’s always chasing his losses, hoping that if he makes a big enough bet, he can get ahead with just one good hand. It’s tweaked a bit here—the idea is that Lando had something happen to him in his past that put him way behind, and now he’s just trying to get back to even. This isn’t really a financial thing, although that’s part of it – it’s more like a moral thing. Like a life debt. I don’t hit it too hard in this story—it’s all background—but the shading is there…Lando gets into crazy, extreme situations because they’re his version of making big bets at the card table. If he can make it through his next adventure, maybe he can just retire and live a quiet life. It never really works out, though. One step forward, two steps back. That’s Lando Calrissian…It’s a story about a hyper-charismatic, ultra-smooth guy who gets into huge jams constantly, and tends to get out of them through a combination of luck and charm. He’d never punch his way out of a fight; he’d rather buy everyone a few drinks and leave on good terms. Assuming he hasn’t gambled away all his money, that is”.

However, there is also the 2013 novel Scoundrels written by Timothy Zahn featuring Calrissian, Han Solo, and Chewbacca and includes the short story Winner Lose All based on Calrissian’s love of gambling but here, there is nothing to suggest the behaviour is pathological. There is also a fictional online interview with Calrissian that puts forward the idea that he was a professional gambler rather than a pathological gambler:

“Basically I was born to a normal middle class family and found I had a talent for gambling. I traipsed across the universe as a professional gambler, but occasionally need more money so I hired out as mercenary and treasure hunter. Eventually I won the Millennium Falcon, but didn’t know how to fly it. So I paid Han Solo to teach me, he won the ship from me in a game of Sabbac. I won it back but, it like taking your best friend’s girl so I gave it back to him. When I wound up on Cloud City I won my title of Barron Administrator in a card game. The rest is they sat history”.

Finally, on a more academic note, Calrissian also makes an appearance as one of the ‘Gambler’ archetypes the book Archetypes in Branding: A Toolkit for Creatives and Strategists by Margaret Hartwell and Joshua Chen. The book is a novel approach to brand development and includes a deck of 60 archetype cards with the aim of revealing a brand’s motivation and why it attracts certain customers. The authors hope that the book will be used repeatedly to inform and enliven brand strategy. This again suggests that Calrissian’s gambling is not seen as pathological (otherwise he wouldn’t have been included in the book as a brand to be modelled upon).

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

Further reading

Cowlishaw, S. (2015). Star Wars characters and their personality disorders. Stuff, July 8. Located at: http://www.stuff.co.nz/entertainment/film/70017741/Star-Wars-characters-and-their-personality-disorders

Friedman, S. H., & Hall, R. C. (2015). Using Star Wars’ supporting characters to teach about psychopathology. Australasian Psychiatry, 23(4), 432-434.

Friedman, S. H., & Hall, R. C. (2015). Teaching psychopathology in a galaxy far, far away: The light side of the force. Academic Psychiatry, 39(6), 719-725.

Griffiths, M.D. (1996). Media literature as a teaching aid for psychology: Some comments. Psychology Teaching Review, 5(2), 90.

Griffiths, M. (2004). An empirical analysis of the film ‘The Gambler’. International Journal of Mental Health and Addiction, 1(2), 39-43.

Griffiths, M.D. (2010). Media and advertising influences on adolescent risk behaviour. Education and Health, 28(1), 2-5.

Hall, R. C., & Friedman, S. H. (2015). Psychopathology in a galaxy far, far away: The use of Star Wars’ dark side in teaching. Academic Psychiatry, 39(6), 726-732.

Hartwell, M. & Chen, J.C. (2012). Archetypes in Branding: A Toolkit for Creatives and Strategists. How Design Books.