Driven Women & Trauma: Why Your Success and Your Suffering Are Connected

Last reviewed: July 2026 by Annie Wright, LMFT

RELATIONAL TRAUMA • June 18, 2026

LAST UPDATED: JULY 2026

The Award She Couldn’t Feel

It’s a Tuesday in late afternoon, the kind of overcast October light that makes the glass conference room feel colder than it is, and Keiko is holding a small brass award she was handed forty minutes ago in front of two hundred people. She’s 47, a chief operating officer at a mid sized medical device company, East Asian American, in the navy blazer she keeps at the office for these occasions. The award is heavier than it looks. She turns it over, reads her own name etched into the base, and feels, precisely, nothing.

“I kept waiting for it to land,” she told me the following week, sitting very upright on the edge of the couch, coat still folded over her lap, as if she might need to leave at any moment. “Everyone was clapping. My husband texted a photo to our kids. And I stood there thinking about the slide deck I still had to fix before Thursday. I felt like a fraud for not feeling anything, and then a fraud for even being here, in therapy, complaining about winning an award. Do you know how that sounds?”

I did know how it sounds, because I’ve heard some version of it many times. What I noticed wasn’t the achievement, which was genuinely impressive, but the speed with which she moved past it, her hand returning to the seam of her coat, smoothing it flat. There’s a particular ache I’ve come to recognize, and it isn’t the ache of failure. It’s the ache of arriving somewhere you worked years to reach and finding the person who was supposed to feel it isn’t home.

So let me say the thing I want you holding for the rest of this piece, because the older version of this article got it wrong. Keiko’s success does not prove she was wounded. Plenty of women win awards and feel clean pride, nothing hidden underneath. Ambition isn’t a symptom. Drive isn’t a diagnosis. If you take one thing from me today, take that.

And, for some women, and I’d come to believe Keiko was one, the drive and the difficulty do turn out to share a root system. Not because achievement is trauma, but because the same early environment that shaped the striving also shaped a nervous system that struggles to rest. That’s the careful claim, and it’s the one worth staying with. It asks a better question than “what’s wrong with me.” It asks, “what was this drive originally for?”

What Do We Actually Mean by Trauma Here?

Before we go further, I want to clean up the language, because the internet has made “trauma” mean everything and therefore nothing. When I use the word carefully, I’m pointing at something specific: repeated relational experiences in childhood that shaped how safe a person feels being seen, resting, or needing things from other people. That’s different from a single frightening event, and from the casual way we call a hard meeting traumatic.

It helps to know what the formal diagnostic world does and doesn’t recognize, because a lot of popular writing blurs this badly. Complex post traumatic stress disorder became a formal diagnosis in the World Health Organization’s ICD-11 in 2018. It is not in the DSM-5, the manual used across most of the United States. That gap matters, and I’ll return to it.

Here’s the caution I want to hand you directly. You’ll see phrases like “complex relational trauma” and “developmental trauma” used online as if they were codified diagnoses. They aren’t. They’re clinical constructs, useful for thinking, not entries in the manual. Developmental trauma disorder was proposed for the DSM-5 and rejected, in part because the evidence base was judged too thin. I mention this not to dismiss the lived reality, but so that no one hands you a term as though it were a verdict.

The most authoritative plain language source here is quietly excellent. Sadie E. Larsen, PhD, writing for the U.S. Department of Veterans Affairs National Center for PTSD, states flatly that CPTSD “is currently a diagnosis listed in the International Classification of Diseases 11th Revision (ICD-11) but not in the Diagnostic and Statistical Manual 5th Revision (DSM-5),” and that “a specific type of trauma is not required.” When a client shows me an article insisting she has a diagnosis based on her childhood story alone, I send her this VA page as a corrective.

Why spend a section on definitions? Because precision is a form of respect. If I overclaim, telling you your ambition is a trauma response when the evidence can’t carry that, I’ve traded the truth for a comforting story, and you deserve the truth. So we’ll keep our language at “associated with,” “linked to,” and “risk factor for,” which is where the science lives. That leaves room for the parts of your drive that are cleanly yours.

Does Childhood Adversity Rewire the Brain for Vigilance?

This is the question I get asked most, usually phrased as “so is it all in my wiring?” The honest answer: adversity can shape the threat monitoring system, and we have to be careful not to leap from that to a tidy story about ambition. Let me show you where the evidence stops.

A 2024 neuroimaging study led by Farah Harb and colleagues, published in Biological Psychiatry: Global Open Science, followed adult injury survivors and found childhood abuse was associated with increased resting connectivity between the amygdala, the brain’s threat alarm, and the precuneus, a region tied to self referential attention. That connectivity statistically mediated the effect of childhood abuse on anxiety symptoms six months after a later trauma. The authors interpret it, cautiously, as a possible “attentional vigilance for threat.”

Notice what that study says and, more importantly, what it doesn’t. It links early abuse to anxiety and threat vigilance after adult trauma. It does not say vigilance becomes ambition. Nobody has shown that, and I won’t imply it. The line that troubled me most in the older draft was “the hypervigilance became ambition,” stated as fact. It’s an evocative metaphor, not a finding, and printing it as one does readers a disservice.

What I can say responsibly, from the room rather than the lab, is a three layer translation I offer clients often. The clinical layer: a threat sensitized nervous system tends to over prepare. The plain layer: you might find it almost impossible to stop working until everything is airtight. The felt layer: that 11 p.m. compulsion to reread one more email, not because it’s due, but because part of you can’t put down the scanning. That’s real. It’s just not proof of anything about your worth.

Keiko described exactly this in our fourth session. “I don’t feel driven, exactly,” she said, turning the same coat seam between two fingers. “I feel like if I stop, something I can’t name is going to catch up with me.” That sentence is worth a hundred brain scans, because it names the felt truth without overclaiming the mechanism. Her body had learned to stay ahead of a threat. The award, the title, the airtight decks were, in part, how staying ahead looked in her life.

Widen the lens, because context helps. The Centers for Disease Control and Prevention reports that among U.S. high school students, roughly three in four report at least one adverse childhood experience, and one in five report four or more, with rates highest among girls. Adversity is common, and it’s gendered. The CDC frames these experiences as things that “can increase the risks” of later difficulty, not as causes, and never suggests adversity produces achievement. Neither do I.

How Does This Pattern Show Up in Driven Women?

Let’s get concrete, because abstraction is where honesty hides. In my clinical work I see a handful of early environments that show up repeatedly in the histories of driven women who feel this particular emptiness. I name them as patterns I observe, not a diagnostic checklist.

The first is conditional approval, where warmth arrived reliably only when a child performed. The second is parentification, where a child became the emotional manager of the household. The third is a home where a parent used the child’s achievements as a mirror for their own standing. None of these is destiny. Each is a soil in which a certain kind of striving can grow, alongside genuine gifts, real competence, and often real love, the part the old article missed.

On parentification specifically, the research is refreshingly honest about how two sided it is. A 2025 scoping review by Iza Berkes and Bea Piko, published in the International Journal of Mental Health Promotion, calls parentification a “double edged sword.” It’s linked to real risks, depression, anxiety, low self esteem, and also, in some studies, to higher academic achievement and stronger coping. Outcomes depend on the type, the culture, and the child’s own experience. The same childhood role can produce both the ache and the competence.

Let me introduce a second woman, because the pattern wears more than one face. Nandita is 42, a South Asian American litigation partner, the first woman of color to make partner in her practice group. She came to me because of Sunday nights. “I lose Sundays,” she said in our second session, arriving in workout clothes she clearly hadn’t worked out in, a cold matcha sweating on the table between us. “I tell myself I’ll rest, and then by two in the afternoon I’ve reopened my laptop, and by evening I hate myself for it, and I can’t tell if I’m ambitious or just scared.”

What struck me about Nandita, rotating the matcha cup a slow quarter turn, was how cleanly she could see the pattern and how little that seeing changed it. “I know it’s not rational,” she said. “Knowing has never once stopped me.” That gap, between insight and the body’s actual behavior, is one of the most important things I’ve learned to respect. You can understand a pattern completely and still be run by it. Her competence was real. It was also how she’d learned to feel safe in rooms not built for her.

Here’s the framework I’ve come to name for clients who fit this shape, offered as a lens, not a law. I call it the earned safety loop. A child learns that being useful, excellent, or needed reliably produces safety and connection. The strategy works, so it repeats. The adult keeps producing safety the only way she trusts, through output, and that output does buy real things, respect, income, standing. What it can’t buy is the felt sense of being safe when she’s doing nothing at all. That’s the loop. Naming it is where loosening starts.

If you recognize yourself in Keiko or Nandita, please hear the absolution in this too. You didn’t choose the loop. A younger version of you built the smartest strategy available with the materials she had, and it worked well enough that you’re reading this from a life that looks, from the outside, like a success story. That younger self doesn’t need correcting. She needs to be thanked, then gently relieved of a job she’s done far too long.

Is Overwork a Real Thing, or Am I Just Committed?

Many women ask me this with a defensive edge, and I understand why. The wellness internet has pathologized ambition so thoroughly that any hard worker now wonders if she’s sick. So let me be precise, because the distinction matters here.

Compulsive overwork is a measurable, common phenomenon worth separating from ordinary commitment. A 2023 systematic review and meta analysis by Frida B. Andersen and colleagues, published in Frontiers in Psychology and pooling 53 studies across 71,625 participants in 23 countries, put the prevalence of workaholism at roughly 15 percent, about one in seven working adults. The authors define it as “a compulsive and extreme need to work” that crowds out family, friends, and rest. That review reported no gender difference in prevalence, a useful check against assuming this is a “woman thing.”

That workaholism is largely unrelated to self esteem is the antidote to overclaiming. I won’t tell you your overwork means you’re wounded. It might. It might also mean you’re a perfectionist under a system that rewards it. The perfectionism thread is where the parenting research gets genuinely strong, and it’s the most solid empirical anchor in this piece. Thomas Curran of the University of Bath and Andrew P. Hill of York St John University, in a 2022 meta analysis in the American Psychological Association’s Psychological Bulletin, found that perceived parental expectations had a large association with socially prescribed perfectionism, and perceived parental criticism did too. Large, in a field where small effects are the norm.

Read the caution the authors themselves print: they assume causality runs parent to child, but note “it may be in reverse” or “reciprocal and mutually reinforcing,” and that cross lagged studies are still needed. That’s a scientist refusing to overclaim about her strongest finding, and it’s a model for how I talk about your life. High expectation, critical early environments are strongly linked to a punishing, approval hungry perfectionism. Linked. Not proven to cause. Nandita, whose father framed every A minus as a near miss, heard that finding and cried, because it named the water she’d been swimming in.

I keep that line of Estés near me because it names something the data can’t. There’s a difference between working from a handmade, chosen life and working from an image you’re afraid to let slip. The research tells us overwork tracks with perfectionism and carries costs. Estés tells us what it feels like to have swapped the soulful process for the polished image. Both are true.

Both/And: Can My Success Be Real and My Suffering Be Real?

Both/And is the frame I return to more than any other in this work, and here it does the most important job in the piece. The old cultural script wants a single answer. Either your success is authentic and you should stop complaining, or it’s a trauma response and doesn’t count. Both are lies, and they’re the same lie wearing different clothes. The truth is Both/And, and it’s roomier than either.

Your success is real. The award Keiko couldn’t feel was still earned; the company runs better for decisions she genuinely made. And her difficulty resting is also real, and it doesn’t cancel the achievement, and the achievement doesn’t cancel it. They can share a root and still be two different plants. Holding both at once isn’t a consolation prize. It’s simply the more accurate description of what’s happening.

I watched this land for Keiko about three months in, on another Tuesday, rain streaking the office window behind her. She’d stopped bringing her coat onto her lap by then. “I’ve been waiting for someone to tell me it’s one or the other,” she said slowly. “That I’m either fine and ungrateful, or broken and my whole career is fake. And you keep refusing to pick.” I said I refused because both were true, and picking would mean lying to her. She laughed, a real one, and said, “That’s the most annoying kind of honest.” Collapsing her story into “it’s all trauma” would have made her distrust her own desires; “I’m just tired” would have talked her out of the healing that eventually helped.

The proverbial foundation under a house is my metaphor for the family of origin. If the foundation you were built on had a crack, a room where love had a price, that doesn’t mean the house is worthless or has to be torn down. It means you can go down into the basement, look honestly at the crack, and do the repair work now, as the adult who owns the place. Fixing the Foundations™ is the name I give that work, and it never requires pretending the house you built above it isn’t real or beautiful. It’s both. It’s always both.

The Systemic Lens: Whose Load Are You Actually Carrying?

The Systemic Lens is the section I refuse to skip, because a purely individual story about driven women and overwork is quietly unfair. Locate the whole problem inside a woman’s childhood and you let the load bearing fault lines in the wider terrain off the hook. Start with the most concrete number I know. An OECD report, drawing on International Labour Organization estimates, finds women globally perform 76 percent of unpaid care work, more than three times what men do, and that over recent decades the gender gap narrowed by only seven minutes per day. Seven minutes, across decades. That report also notes 606 million women were outside the paid labor force specifically because of unpaid care.

Sit with what that means. When you can’t stop, part may be an old adaptation from childhood, and part is that you’re holding more than your share of a load the culture never redistributed. Those aren’t competing explanations. They stack. The woman on a call with her camera off so no one sees her cutting vegetables for a dinner she’ll eat standing up isn’t disorganized. She’s doing two jobs, one of which the terrain still refuses to count, and that knot between her shoulder blades is what a body does absorbing costs the system decided were too expensive.

A cultural trend layers on top of the structural one. In an earlier meta analysis, the same Curran and Hill drew on more than 41,000 college students to show perfectionism has risen steadily across generations since the late 1980s, with young people increasingly perceiving that others demand more of them. So the pressure you feel to be flawless isn’t only personal history. It’s the weather of a competitive, meritocratic culture that has genuinely gotten harsher.

I keep the family of origin story and the systemic story in separate rooms on purpose, and I want you to as well. The proverbial crack in the foundation is about your particular home and history. The fault lines in the terrain are about the ground everyone stands on. Confuse the two and you’ll blame yourself for a systemic problem or blame the system for a personal wound. Both leave you stuck. Naming which is which is where agency returns.

What Does Honest Healing Look Like From Here?

I want to end with hope that can survive scrutiny, because false hope is a slower disappointment. Here’s what the evidence supports.

First, the established treatments work, and it’s worth knowing which they are. The American Psychological Association’s updated Clinical Practice Guideline for the treatment of PTSD in adults, approved in February 2025 and drawing on 15 systematic reviews, strongly recommends cognitive processing therapy, prolonged exposure, and trauma focused cognitive behavioral therapy, and suggests EMDR, cognitive therapy, and narrative exposure therapy. If you’re going to spend your money and your vulnerable hours, spend them where the evidence is.

Second, the honest caveat, and I’d rather you hear it from me than discover it later. There is not yet an established, separate treatment guideline for ICD-11 complex PTSD. The International Society for Traumatic Stress Studies, in a 2024 position paper, states plainly that “there are no clinical studies to date” comparing treatments for PTSD versus CPTSD, and declined to issue separate recommendations. Established trauma therapies are “likely to be helpful,” but the CPTSD specific evidence is still indirect. Anyone selling a proprietary “achievement trauma cure” as established is ahead of the science.

Third, a sobering, clarifying finding. Marylène Cloitre, a leading trauma researcher, notes in a 2025 World Psychiatry commentary that even with the best evidenced therapies, only about 40 to 50 percent of people no longer meet PTSD criteria at treatment’s end, and childhood onset trauma tends to respond less completely. I share this not to discourage you but to inoculate you against the fantasy that healing is a single clean arc. It’s iterative, often slower when it started earlier in life, and still worth doing.

So what does this look like on a real Tuesday? For Keiko, months after that first session, she came in on a bright, cold morning and set that same brass award on the table between us, having brought it deliberately. She turned it over, read her own name, and this time went quiet for a different reason. “I felt it this week,” she said. “Not because anything changed out there. Because I stopped needing it to save me.” She didn’t say she was finished, and I don’t think finished is the right frame anyway. Whether the crack in her foundation ever fully closes, I honestly can’t tell you. What I can tell you is that she can sit in her own success now and feel the weight of it, brass and all, in her actual hands.

This article was researched and drafted with AI assistance, then reviewed, edited, and approved by Annie Wright, LMFT. See our Editorial Policy for details. Keiko and Nandita are fictionalized composite clients built from recurring patterns across many real clinical relationships, not depictions of specific individuals; identifying details have been changed throughout to protect confidentiality. If you find a factual error or a clinical inaccuracy, write to support@anniewright.com.

Warmly,
Annie.