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How Childhood Emotional Neglect Creates Workaholism in Adult Women: A Trauma Therapist’s Honest Guide

RELATIONAL TRAUMA • April 12, 2026

The Inbox at Midnight

It’s 12:14 a.m., and Simone is sitting up in bed with her laptop balanced on her knees, the blue light the only light in the room. Her husband fell asleep an hour ago. She told herself she’d just check one thing. Now she’s answered nine emails, restructured a slide for tomorrow’s board meeting, and started drafting a message she doesn’t technically need to send until Thursday.

Simone is 44, a partner at a mid-size architecture firm in Atlanta, the kind of woman other people describe as unstoppable. She hasn’t taken a real day off in longer than she can accurately remember. Not because anyone’s forcing her. Her firm has an unlimited PTO policy. Her business partner has told her twice, in front of other people, to go home. She just can’t seem to make her hands stop moving.

“I tell myself I’ll stop at midnight,” she told me in our second session. “Then it’s midnight and I think, just one more thing. And then it’s one, and I think, well, I’m already up.” She laughed when she said it, but it wasn’t really a laugh. “My husband asked me last week what I’m running from. I didn’t have an answer. I still don’t.”

What brought Simone into therapy wasn’t a work problem, or not only a work problem. It was a body that had started sending signals she couldn’t explain away: jaw pain from clenching in her sleep, a racing heart on Sunday afternoons for no clear reason, a kind of low, constant hypervigilance she couldn’t switch off even in her own living room. A friend had told her, gently, that she couldn’t remember the last time Simone had seemed like she was actually resting rather than just not working for a few minutes.

In my work with driven women over more than fifteen years and thousands of clinical hours, I’ve come to recognize this particular presentation almost on sight. It rarely announces itself as a childhood problem. It looks like dedication, like drive, like someone who simply cares more than everyone else. But underneath a significant number of these cases is something quieter and older: childhood emotional neglect, and the way it can, over decades, reroute a person’s entire relationship with rest, worth, and work. It shares a great deal of territory with what I’ve written about elsewhere as relational trauma, and it frequently travels alongside perfectionism and a persistent, quiet inner critic that never quite clocks out either.

What Is Childhood Emotional Neglect?

Childhood emotional neglect is one of the most underrecognized sources of adult suffering I encounter in my clinical work. It doesn’t leave visible marks. It isn’t defined by what someone did to a child. It’s defined by what didn’t happen. By the emotional experiences that were consistently absent.

That distinction matters, and it’s also exactly why so many driven women never identify it in their own histories. If your parents didn’t hit you, didn’t scream at you, kept you clothed and fed and enrolled in decent schools, the question “was I neglected?” can feel absurd. But emotional neglect operates in the negative space of a childhood. In the feelings that weren’t named, the distress that wasn’t soothed, the parts of you that never found a mirror in the eyes of the people who were supposed to know you best. A large recent study following adults with documented histories of childhood emotional neglect found measurably higher rates of adult psychiatric difficulty, even in the absence of any single, nameable traumatic incident, which matches what I see clinically far more often than a dramatic origin story does (PMID: 42427090).

What I see clinically is a pervasive undercurrent of emptiness in these women, a real difficulty naming their own emotions in the moment, and a powerful, well-earned drive toward self-sufficiency that quietly blocks the very connection they’re hungry for. Not because they don’t want closeness. Because somewhere along the way, their nervous systems concluded that needing anyone openly wasn’t safe or reliable. This is also, frequently, where a habit of chronic people-pleasing gets built, and where the idea of ever setting boundaries starts to feel almost dangerous, since it once meant risking the only currency that seemed to buy attention at all.

These children become what I think of, in my own clinical shorthand, as the ones who are “no trouble.” Competent early. Praised for maturity that was never actually age-appropriate. In women specifically, this pattern tends to resolve, in adult life, into exactly the kind of relentless output that our culture rewards without asking any questions about where it came from. Which is part of why it hides in plain sight for so long, sometimes for an entire career.

What Is Workaholism, Really?

Workaholism is a word that gets its edges worn smooth by overuse. People say it about themselves the way they’d say they love coffee too much. But there’s a real clinical picture underneath the casual use, and it looks nothing like simply working hard or caring about your career.

The term itself comes from Wayne Oates, a psychologist and writer who in the 1970s coined “workaholic” to describe his own compulsive relationship to work, modeled deliberately on the language of alcoholism. Wayne Oates was making a specific point: a behavior society applauds can still function like an addiction underneath, complete with tolerance, escalation, and withdrawal. Fifty years later, that framing still holds up. What Oates described sits close to what I’d now call a chronic dysregulation of the nervous system, one that uses productivity rather than substances as its regulating agent.

What’s critical to understand about workaholism in driven women is the gap between what’s visible externally and what’s happening internally. From the outside, it looks like exceptional commitment. From the inside, for many of the women I work with, it feels like barely keeping something at bay. A recent analysis of workaholism and work engagement found the two can look similar on the surface, in hours worked and output produced, while diverging sharply in what predicts burnout over time, with the compulsive, can’t-stop quality of workaholism carrying a risk that pure engagement doesn’t (PMID: 41102903). Loving your work and being unable to put it down are not the same condition, even when they produce identical calendars.

How Worth Becomes Output: The Mechanism

In my work with clients, the path from childhood emotional neglect to adult workaholism tends to follow a recognizable arc. It doesn’t require dramatic abuse or an obviously failing parent. It only requires a childhood in which emotional attunement was consistently missing, and a nervous system that built the best substitute architecture it could manage.

Here’s how it tends to unfold. A child’s emotional world goes unnoticed often enough that she stops expecting it to be noticed. Meanwhile, she discovers, before she can put words to it, that her performance gets a response even when her feelings don’t. A good grade brings a parent to attention. An achievement produces a flicker of warmth nothing else reliably produces. Excellence becomes the closest available substitute for connection that was supposed to come free.

Over years, that contingency hardens into something closer to a physical belief than an intellectual one: I’m only worth something when I’m producing something. Not earned once and settled. Earned again, every day, indefinitely. The moment output stops, in this internal logic, worth stops too.

This tracks with what a large analysis of childhood emotional maltreatment and adult psychosocial functioning found: adults with histories of chronic emotional neglect showed measurable difficulty with self-concept and emotional regulation well into adulthood, patterns that didn’t require a single dramatic incident to take hold, just sustained absence over time (PMID: 42166821). The absence itself is the mechanism. Not a wound with a clear edge, but an erosion with none.

A child raised without reliable attunement doesn’t just feel unseen in the moment. She builds an operating system around the absence. Produce, and something like connection approaches. Go still and simply feel, and nothing comes. By the time she’s an adult with a demanding career, the operating system doesn’t look like a wound anymore. It looks like ambition, exactly what her industry is asking of her.

How This Shows Up in driven women

Simone remembers the exact moment she thinks it started. “I was nine,” she told me. “I got the highest score in my class on a math test, and my dad, who barely looked up from the newspaper most days, looked up. He said, ‘That’s my girl.’ Twice. I remember thinking, I need to find a way to make that happen again.” She paused. “I think I’ve been nine years old at every job I’ve ever had.”

What makes this pattern so hard to catch in driven women is that it doesn’t look like a problem from any conventional angle. It looks like the profile companies want to hire, promote, and hold up as a model. The woman who’s first in and last out. The one who never seems to need reminding, managing, or checking in on. Nobody stages an intervention for the executive who answers emails from her hospital bed. In some of the more severe cases I’ve supported, what’s underneath resembles complex PTSD more than a simple stress response, with the compulsive working operating as one of several long-running coping strategies.

For many of my clients, rest itself becomes the tell. Not laziness, not disinterest in slowing down, but a specific, bodily inability to tolerate unstructured time without a rising sense of dread. One client, a surgeon, described it to me this way: “I tried to just sit on my porch for ten minutes. I lasted about four. Then I started planning my next paper in my head and I felt better. Is that bad?” She asked it seriously, like a diagnostic question, because to her, functioning without producing had become a foreign state.

Simone described something similar about her Sundays. “I used to take the whole day off,” she said. “Now a full Sunday makes me so anxious I’d honestly rather work. I don’t know when that changed. I don’t know if I even noticed it happening.” That shift, from rest as restorative to rest as exposure, is one of the clearest markers I look for clinically. It’s rarely dramatic. It just quietly accumulates until a woman realizes she can’t remember what an unstructured afternoon used to feel like.

None of this means these women aren’t genuinely gifted, genuinely motivated by real interest in their fields. Many are. What I’m describing runs alongside real skill and real passion, not instead of it. That’s precisely what makes it so hard for the women living inside it to separate the two threads, and it’s exactly where we’re headed next.

Both/And: Your Drive Is Real and It’s Also a Wound

I want to be careful here, because getting this wrong does real harm. You are not imagining your ambition. You are not performing your drive for an audience. The driven women I see in my practice, the ones who’ve built surgical careers, companies, and legal practices from nothing, are genuinely talented and genuinely motivated by things that are real and meaningful to them. Reducing all of it to trauma would be reductive, and it would also be false.

AND. The compulsive piece is also real. The inability to stop, the dread of rest, the sense that worth evaporates the second the work pauses. That’s real too. These two things don’t cancel each other out. They coexist, often in the same hour of the same workday.

What I’ve seen over and over is that women in this pattern often genuinely can’t tell the difference between the two threads, because they’ve rarely been still long enough to find out. Which parts of the professional self are authentically hers, and which parts are scaffolding built over an old wound. Learning to separate the two is, in my experience, one of the most meaningful pieces of this work.

Marta, a 47-year-old surgeon I worked with for close to two years, put it about as well as anyone I’ve heard. “I always thought if I stopped, I’d find out there was nothing underneath,” she said, somewhere around month eight of our work together. “What I actually found is that there’s quite a lot there. It’s just not what I expected.” What she found in the stillness she slowly learned to tolerate was a person with real preferences, real pleasures, real grief, none of which had been accessible to her at full speed.

The invitation here isn’t to abandon ambition. It’s to let the drive become genuinely hers. Rooted in desire instead of dread, in curiosity instead of compulsion, in the actual adult in the room rather than the nine-year-old who learned that a look up from the newspaper was the closest thing available to being loved. Part of getting there involves real, unglamorous self-compassion work, learning to speak to herself the way she’d speak to a client or a friend rather than the way productivity culture taught her to speak to herself.

The Systemic Lens: Why Our Culture Loves This Particular Wound

This pattern isn’t only personal. It’s patterned, and the pattern has a structural home. We can’t talk honestly about workaholism in driven women without naming the culture that has been remarkably well-suited, whether by design or by accident, to keeping this particular wound invisible.

Think about the profile of the ideal “top performer” in most professional cultures right now: always reachable, endlessly productive, willing to set personal needs aside for organizational ones, able to suppress emotional complexity in service of function, deriving her sense of self from her professional output rather than from harder-to-measure sources. Those aren’t only professional virtues. They’re close to a description of the exact psychological profile that childhood emotional neglect tends to produce.

There’s a specifically gendered layer to this too. Many of the driven women I work with grew up absorbing a very particular message: that their emotional needs were an inconvenience, and the acceptable correction was cheerful, capable, low-maintenance competence. The woman who never complains, never asks for too much, earns her place instead of simply claiming it. She becomes the one who apologizes for needing help, who can’t let anyone see her struggle, who works twice as hard as the person beside her to justify, preemptively, her own presence in the room.

She’s also, frequently, the one who gets promoted. Her wound is, in a very literal sense, someone else’s productivity. The two systems fit together so smoothly that it can take decades before anyone questions whether there’s a wound underneath at all, or whether this is simply what excellence is supposed to look like.

Odessa, a 51-year-old operations director I worked with several years ago, named it plainly in one of our later sessions. “Every performance review I’ve ever gotten has praised the exact thing that’s killing me,” she said. “Reliable. Always available. Never drops the ball. Nobody in twenty-two years has once asked why I never drop it.” Research into workplace loneliness has found that employees who present as highly self-sufficient and low-maintenance are frequently the least likely to be checked on by supervisors or colleagues, precisely because they read as needing nothing (PMID: 42216618). The reward for never dropping the ball is often that no one ever asks whether you’re allowed to.

You’re not broken, and you’re not imagining how rigged this particular equation is. A system that rewards self-erasure will keep rewarding it for as long as women keep supplying it. That’s not a personal failing. That’s a structural inheritance, and naming it as such doesn’t excuse the system. It just makes clear that healing here has to happen on more than one level.

What Healing Actually Looks Like

By the time most of the women I work with reach this point, they aren’t just tired. They’re at the edge of something with a real clinical name.

Recovery from this pattern isn’t about working less. That’s the first thing I clarify with almost every client who arrives convinced the goal is fewer hours. The goal isn’t less output. The goal is loosening the equation between output and worth, so that eventually you can choose how you work rather than being driven by what you’d feel like without it.

This matters because “just work less” advice, without the underlying clinical work, tends not to hold. Women told to simply take more time off often fill it with productive activity anyway, or feel enough anxiety that they use it as proof they’re “not someone who can rest,” and return to the old pattern with fresh shame stacked on top. Real change usually requires learning, often for the first time, how to set actual boundaries around work, ones that hold even when no one else is enforcing them.

What I’ve seen work, across the clients I’ve supported through this, requires movement on a few levels at once. First, naming what’s actually happening, not “I work too much” but “I have a belief, installed a long time ago, that my worth depends on my output, and that belief is running my nervous system.” That reframe alone moves the problem from a behavior to be corrected into a wound to be tended, which changes everything about how the work proceeds.

Second, there’s a nervous-system layer that insight alone doesn’t touch. Because the compulsion is wired in somatically, understanding it intellectually rarely loosens its grip on its own. The body needs repeated, felt experience that stillness is safe, not just an argument that it should be. This tends to be slow work: tolerating small doses of unstructured time and discovering, again and again, that nothing catastrophic happens.

A recent look at the mechanisms linking childhood adversity to adult outcomes found that self-regulation capacity, not willpower or insight alone, was the strongest predictor of whether adults could shift long-held compulsive coping patterns, which matches almost exactly what I see across years of clinical work with this population (PMID: 42253147). You can understand your pattern completely and still need years of practice before your body believes it.

There’s also grief in this work that can’t be optimized or scheduled around. Mourning the childhood that didn’t happen, the attunement that wasn’t there, the plain permission to simply be that was never granted. That grief has to be felt, often for the first time, usually in the company of someone who can offer the steadiness the original environment couldn’t.

I think about that line often, because it names exactly what’s beautiful and exactly what’s dangerous about this pattern in the same breath. Work made visible as love is a gift when it comes from genuine desire. It becomes something else entirely when it’s the only language a person has left for saying I matter.

Simone is about fourteen months into her work with me now. She still checks her phone more than she’d like. But two Sundays ago, she told me, she left it in a drawer for four hours and went for a walk instead, and nothing fell apart. “I kept waiting for the floor to disappear,” she said. “It didn’t. I don’t totally trust that yet. But I noticed it.” That’s usually where this work actually lives. Not in a dramatic before and after, but in the noticing, repeated enough times that the nervous system slowly starts to believe it.

What I’ve watched happen, over years and with many different women, is that healing this pattern doesn’t make anyone less capable or less driven. If anything, the ones who do this work become more effective, because they’re no longer spending enormous energy managing an internal alarm system underneath everything else they do. What they lose is the terror. What they keep is the skill. And they gain, often for the first time in their adult lives, the capacity to actually rest in it, and to relate to workaholism itself as a pattern with a history rather than a fixed identity.

If you recognize yourself in any of this, I want you to hear something plainly: what you’re carrying has a name, and it has a path through it that doesn’t require you to want less or become someone else. You don’t have to have already earned the right to ask for help with it. You’re allowed to start exactly where you are, mid-project, mid-email, mid-midnight, and simply put the laptop down and see what happens next.

Related Reading

Oates, Wayne E. Confessions of a Workaholic: The Facts about Work Addiction. World Publishing Co., 1971. The book that introduced the term “workaholic” into clinical and popular language, written by the psychologist who coined it.

Freudenberger, Herbert J. Burn-Out: The High Cost of High Achievement. Anchor Press, 1980. The foundational text on burnout as a distinct clinical phenomenon, written by the psychologist who named it.

Merola et al. Childhood emotional neglect and psychiatric outcomes in adulthood. (PMID: 42427090)

Peter et al. Childhood emotional maltreatment and adult psychosocial functioning. (PMID: 42166821)

Matsuyama et al. Workaholism and work engagement: distinguishing the mechanisms. (PMID: 41102903)

Mauno et al. Antecedents and outcomes of workplace loneliness. (PMID: 42216618)

Christensen et al. Mechanisms linking childhood adversity to adult self-regulation and coping. (PMID: 42253147)

Continue exploring: overfunctioning as a survival pattern, how anxious attachment often runs alongside compulsive achievement, and the broader landscape of attachment styles that shape how driven women relate to rest and to work.

About the Author

Annie Wright, LMFT

LMFT · Relational Trauma Specialist · W.W. Norton Author

Helping driven women finally feel as good as their resume looks.

Annie Wright is a licensed psychotherapist (LMFT #95719) and trauma-informed executive coach with over 15,000 clinical hours. She works with driven women, including Silicon Valley leaders, physicians, and entrepreneurs, in repairing the psychological foundations beneath their impressive lives. She is licensed to practice across 15 U.S. jurisdictions, including Colorado (telehealth only), including California, Colorado (telehealth only), Connecticut, District of Columbia, Florida, Illinois, Maine, Maryland, New Hampshire, New Jersey, New York, Texas, Utah, Virginia, and Washington. Annie is the founder and former CEO of Evergreen Counseling, a multimillion-dollar trauma-informed therapy center she built, scaled, and successfully exited. A regular contributor to Psychology Today, her expert commentary has appeared in Forbes, Business Insider, Inc., NBC, and The Information. She is currently writing her first book with W.W. Norton.

Work With Annie

Warmly, Annie.

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