A normal reaction then would be to go to the doctor. But that summer, the covid-19 pandemic had the world in its grip. The most I could hope for was a telehealth meeting between work meetings. So I washed my face, stuffed tissues in my nose, and logged into Slack and Zoom. I ignored what was happening to my body. I felt like I had less time to complete my work than I had to take care of myself. I didn’t even search WebMD. My health could wait, right? My deadlines could not.

Psychologists call the merging of self and work “enmeshment” – a chronic workaholism that is entrenched in the psyche by distorting our sense of self. It’s “when one’s whole identity becomes their job,” says Janna Koretz, a psychologist based in Boston who specializes in treating patients in high-pressure careers. This phenomenon can be a sign of deep-rooted trauma.

“Performance trauma usually occurs when someone has been pushed at all costs to succeed,” says Koretz. Performance trauma is not an official diagnosis i Diagnostic and Statistical Manual of Mental Disorders, Koretz is careful to point out, but rather an umbrella term that characterizes the psychological repercussions of trauma in the pursuit of achievement. “They feel they’re only worth it if they succeed. And in life . . . you don’t always feel good. Eventually something happens. And the one thing they’ve held on to and used for self-worth is gone.”

Lack of self-worth can lead to problems such as addiction, lack of sleep and eating disorders – and spiral from there. People with lower self-esteem are more likely to accept increasingly unhealthy working conditions in search of validation. In this vicious cycle, the more you work, the easier it is to tie your self-worth to your productivity. Workloads become a source of stress and a source of validation – a poison and an antidote.

When covid-19 hit and many professionals were forced to work from home, the cycle mutated. Physical barriers between self and work crumbled and career sealing permeated homes like an undetectable poisonous gas. Measures of success evolved from praise given around a conference table to purely trackable metrics: hours logged, sales made, performance metrics met. And in the rapid shift to remote work, the working week was extended. A study tracking more than 60,000 Microsoft employees found that the average length of the working week for remote workers increased 10 percent in 2020.

The insidious creep of increasing working hours becomes even more worrying when you consider how much time is spent at work. A 70-hour work week is not unusual for some professions or for people who work multiple jobs; this almost consumes the average waking life of 105 hours per week. Some managers have reported working as much as 120 hours a week. In an interview in 2019 with Glamor magazine, productive author Danielle Steelauthor of more than 210 books, said she works 20 hours a day and considers four hours a good night’s sleep.

Taking a break at work isn’t necessarily part of the culture either. According to a 2022 study, about 4 in 10 respondents said they rarely or just take breaks sometimes during the working day. Women were more than twice as likely to skip breaks as men. When you spend almost your entire waking life working, how can there be any sense of self outside of the workplace?

And yet, defining oneself as profession has been a Western tradition for centuries. Those with the last name Miller, Smith or Carpenter carry with them generational traces of a time when most people were born into their line of work. Now our careers are much more self-determined and have become consequential markers of identity. When we met someone new, we used to ask, “How are you?” Now we ask “What do you do?”

“At the beginning of my career, I think my ambition was driven by a lot of fear. I had to succeed . . . otherwise bad things were bound to happen,” says Stephanie Foo, author of What my bones know, a memoir. “It also became unhealthy; I was a workaholic, regularly putting in 70-hour weeks. In some ways, my work also became a comfort – a way to distance myself from my trauma. I didn’t have to think about my problems with relationships, or my deep sadness or anxiety, if I washed it all away with constant work and career success.”

In 2018, Foo found himself in a mental breakdown. After years of exponential career growth, from a radio producer to an acclaimed Emmy-winning journalist, Foo finally reached a breaking point. “For the first time I found myself unable to work. I was gripped by anxiety that paralyzed me and made me cry at work for hours every day. And then I was diagnosed with C-PTSD.”

Complex post-traumatic stress disorder can occur after enduring prolonged and repeated psychological trauma, often resulting in bodily harm and impaired cognition. Biomarkers such as tremors, panic attacks, sleep disturbances, and chronic fatigue, along with mental or behavioral symptoms such as frequent dissociation, blackouts, eating disorders, and inattention, are all indicators of a trauma response. And comorbidities of severe stress can cause the body to release cortisol and adrenaline (like what happened to me when I got a bloody nose), leading to increased heart rates and blood sugar levels, while suppressing the immune system, digestive system, reproductive system, and healing and growth processes . For women, the effects of severe stress can lead to irregular menstrual cycles (me too) and in some cases trigger early menopause.

Over time, stress can imprint our genes through a process called epigenetic inheritance, through changes in DNA methylation, which can change how genes are expressed. Some scientific studies have found evidence that these gene imprints can be passed on to children.

For mothers who work outside the home, there is another layer of stress. Annie Wright, a psychotherapist based in California, is a trauma specialist and has treated many ambitious women who have suffered from the increased responsibilities of being a working mother. “It wasn’t that long ago that the majority of women were mainly stay-at-home mothers or wives. But now that more and more women are surpassing men in college enrollment, (and) entering the workforce in equal numbers, there is an increase in female breadwinners,” she points out. “It can feel almost impossible to maintain the same level of performance, and that struggle can be profoundly overwhelming, sometimes even leading to an identity crisis.”

Foo, who gave birth in 2023, is writing a new book about trauma and motherhood. “I have such intense anxiety about raising my child well and not traumatizing him, but it also manifests itself as a lot of perfectionism and self-sacrifice. I don’t know how to separate how much of it is my trauma and how much of it which is our society’s brutally intense parenting standards and expectations for mothers, especially working mothers.”

Foo’s advice to working moms who feel a sense of failure while juggling an overwhelming workload applies more broadly: She recommends building friendships outside of your work circle to avoid a narrow work-centered worldview and recognizing your value in personal relationships — being a good friend , partner or parent is meaningful, even if it is not work-related. Making room for these aspects of your life can have negative effects on the momentum of your career, but for Foo, it’s worth it in the long run.

“Right now my career is taking the biggest hit,” she says. “It’s true that you really can’t have everything.”

Jazmin Aguilera can be reached at [email protected]. Follow her @jazminaguilerax.