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Working Yourself to Death: Long Hours Bring Risks

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July 16, 2018 -- At 35, Jennifer was single and childless. She poured herself into her work. As a physical therapist who also was director of the department at a hospital, she says she regularly put in 60 to 75 hours a week.

“I was always working,” she says. "I could avoid the emptiness in my life. I saw a full caseload of patients, often more than those who worked for me," she says. She also attended meetings, coached staff, did quality reviews and handled payroll and doctor relations.

Then came the fallout.

"My health effects were significant," she says now. Her periods disappeared. She cracked a tooth from grinding her teeth, had she had chronic abdominal pain and extreme fatigue.

She had been getting help for what she says were her other issues: excess alcohol use and overeating. She noticed she wasn't making the progress that her colleagues in those 12-step programs were. She Googled “workaholics,” found Workaholics Anonymous, joined, and began to change her habits.

That was 5 years ago. Her workweek now is calmer, saner, and capped at 40 hours. The rest of her life is falling into place, too. "I'm now in a loving relationship; we've moved in together," she says.

Jennifer now practices self-care, makes time for a massage, yoga and the gym, and has let go of “the obsession to talk about work,” she says

The turning point? She says she realized that work addiction, like the other forms of addiction, can be fatal.

"If it doesn't kill me, it will keep me miserable the rest of my life," she says she realized.

Overworking and Health Issues

Many people still look at long hour hours on the job as proof of their work ethic. Some historians trace the work ethic to the Protestant Reformation in the 1500s, when working hard was thought to align with the values of their faith.

Americans who work full time log an average of 47 hours a week, according to a 2014 Gallup poll, and some, of course, put in many more hours.

While Americans like to pride themselves on being the hardest workers around, it’s not necessarily true, according to global statistics from the Organization for Economic Cooperation and Development. Its 2014 report found that overall, Mexicans average 43 hours a week, compared with U.S. workers' 34.2 hours.

But in recent years, researchers have found that working long hours is linked with a variety of health issues, as Jennifer discovered. (Abiding by Workaholics Anonymous policy, she gives only her first name.) Among the ailments linked with long work hours are stroke, heart disease, mental health problems, diabetes, and abnormal heart rhythms.

Experts don't agree on whether all workaholics, or workers who put in long hours, are cut from the same cloth. They debate: Is it the long work hours or the mentality of the workers that affects health? Some say those who work long hours by choice because they are “engaged” in work but not compulsive may escape the health consequences. And some people, of course, must work long hours just to make ends meet.

Workaholic ‘Types’: Are Some Healthy?

The health effects of working long hours depend on the type of worker you are, says Lieke ten Brummelhuis, PhD, assistant professor of management at Simon Fraser University, Vancouver, British Columbia. She led a study, tracking 763 Dutch workers to see if she found a relationship between long work hours and things that can cause metabolic syndrome (a cluster of symptoms including high blood pressure, elevated cholesterol, and other problems). Metabolic syndrome makes heart disease and diabetes more likely.

She found it was not a simple matter of hours. The people she terms “engaged,” who liked their job and perhaps worked long hours but were not constantly worrying about it, didn't have the symptoms she tracked. "It was not really the behavior, it was the work mentality, the constant rumination about work" that had a bad effect on health, she says.

So who's who? An engaged workaholic may put in 12 hours, close their laptop, and go do something else, she says. A compulsive workaholic will put in the same 12 hours but remain anxious about some of the tasks or decisions after work hours are over.

The Key: How Does Work ‘Grip’ You?

Bryan Robinson, PhD, a psychologist in Asheville, NC, and author of the forthcoming book #Chill, says that  workaholism is about “how it grips you and takes over your life and debilitates you.”

"The research is overwhelming," he says. "In my mind, there is no question that work addiction is a compulsive disorder. It kills people. In Japan, they have a name for it: karoshi. It means death from overwork.

"A true workaholic gets high from the adrenaline and cortisol, and [without work,] they go through withdrawal," Robinson says. "We are talking about working to the extreme," he says. "It's not just when you are in the office. It's the inability to turn it off," such as thinking through a work problem while watching your kid's soccer game.

"A workaholic is someone who is on the ski slopes dreaming about being back in the office. A healthy worker is someone in the office who dreams about being on the ski slopes," Robinson says.

Working too much not only leads to health issues, he says, but relationship problems. "It has the same undergirding dynamic as alcohol, food addiction, or compulsive gambling," says Robinson, who says he is a former workaholic.

Many workaholics come from dysfunctional homes, he says. Often, those who have come from such environments feel like they need to take charge of something to overcome the chaos, he says, and that becomes part of their personality. "Work becomes the coping mechanism," Robinson says.

Healthy and Engaged Workaholics?

Chris Scruggs, 67, of San Antonio, TX, a lawyer turned pastor, works long hours but says his health is fine. When he worked at a large law firm, he regularly logged 70-hour weeks. Now, his “retirement” career is serving as a pastor, and he usually works about 55 hours. "I don't work just for work's sake," he says. In his pastoral role, he needs to respond to needs such as unexpected funeral planning or other events that come up.

He says he has natural high energy and he takes care of his health, exercises regularly, eats a healthy diet, and keeps a healthy weight. In both legal practice and being a pastor, he says, you are not in control of your time.

Brian Weinberger, 61, an attorney in Agoura Hills, CA, agrees. In professions such as medicine and the law, “we have people's lives in our hands” and often need to respond quickly to that need, whatever the hour of day. He logs 60 hours in a typical week. “I enjoy what I do, and I take it seriously,” he says. He rates his health as fairly good, but he admits the stress sometimes makes him dizzy.

Not So Fast

Another expert doesn't buy the idea that it's not the hours, it's all about mentality. In a published critique of the study by Brummelhuis, Jeffrey Pfeffer, PhD, the Thomas D. Dee II professor of organizational behavior at Stanford University, pointed out what he sees as shortcomings of the research, such as studying only workers in the Netherlands, where employees tend to work fewer hours than in the U.S. and enjoy more vacation time.

"The idea that work hours, by themselves, are not consequential for health seems problematic," writes Pfeffer, who wrote Dying for a Paycheck, a book about work and employee health. While work hours by themselves are not the single aspect that harms health, the effects of long work hours have been clear in many studies, he says.

The Studies

Several recent studies buttress Pfeffer's points Among them: 

Diabetes risk: Putting in 45 or more hours a week raises the chance of having diabetes in women, but not men, according to researchers who tracked the health and work habits of more than 7,000 Canadians between ages 35 and 74 over 12 years.

"Women who worked 45 or more hours a week had a 63% higher risk of developing type 2 diabetes over a 12-year period, compared to women working between 35 to 40," says Mahee Gilbert-Ouimet, PhD, a postdoctoral fellow at the Institute for Work and Health, Toronto, who led the study.

They found no such link in the men studied, she says, and in fact, “we see the opposite trend, though it was not statistically significant.”

She can't explain the lack of a link in men but speculates that "women might work more hours when all the household chores and family responsibilities are taken into account. We did not have the data to verify that, but it's plausible." Another factor, she says, is that most of the men working longer hours tended to have more physically demanding jobs than women had, and the activity may have protected them from getting diabetes. The chronic stress of excess work hours may make it more likely to have abnormal hormones and raise insulin resistance, which can make diabetes more likely, Gilbert-Ouimet says.

Abnormal heart rhythm: Workers putting in 55 hours or more a week, compared with 35 or 40, had a 1.4 times greater chance of having an abnormal heart rhythm known as atrial fibrillation, according to a study of more than 85,000 men and women in Denmark, Sweden, Finland, and the U.K. Having atrial fibrillation raises the odds of having a stroke. The link held even after researchers accounted for other things that make the illness more likely, such as age, sex, obesity, physical inactivity, smoking, and risky alcohol use.

Researchers say the higher risk they found is modest. They speculate that the long hours lead to an abnormal autonomic nervous system, which controls involuntary actions such as the beating of the heart.

Heart disease and stroke: Other researchers looked at 25 previously published studies involving more than 600,000 workers who were healthy at the start. Compared with working 35 to 40 hours, working 55 or more hours raised the odds of having a stroke by 33% and the chance of heart disease by 13% over a 7-year span.

Psychiatric disorders: Workaholism often happens along with mental health issues, Norwegian researchers found after looking at more than 16,000 adults. They used standard scales to find that about 8% of participants met the definition of workaholics.

Compared with non-workaholics, workaholics were more likely to have attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, and depression. Taking work to the extreme may reflect deeper emotional or psychological issues, the researchers say.

The Long View

Work environments are changing, Robinson says. "Employers are starting to say, 'We don't want workaholics,’ ” and workaholics don't give employers a better bang for the buck, he says.

In the long run, he says, workers who take and enjoy vacations and other down time -- without being chained to their phones and other devices -- are more productive and less prone to burnout and health issues. Employers, as well as workers, are beginning to believe this, he says.

WebMD Health News Reviewed by Brunilda Nazario, MD on July 16, 2018


Jennifer, physical therapist and volunteer, Workaholics Anonymous.

Chris Scruggs, lawyer turned pastor, San Antonio, TX.

Brian Weinberger, attorney, Agoura Hills, CA.

Lieke ten Brummelhuis, PhD, assistant professor in management, Simon Fraser University, Vancouver, British Columbia.

Mahee Gilbert-Ouimet, PhD, postdoctoral fellow, Institute for Work & Health, Toronto.

Bryan Robinson, PhD., psychologist, Asheville, NC; professor emeritus, University of North Carolina Charlotte; author of the forthcoming book #Chill.

BMJ Open Diabetes Research & Care: "Adverse effect of long work hours on incident diabetes in 7065 Ontario workers followed for 12 years."

European Heart Journal: "Long working hours as a risk factor for atrial fibrillation: a multi-cohort study."

Lancet: "Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published an unpublished data for 603,838 individuals."

PLOS One: "The Relationships between Workaholism and Symptoms of Psychiatric Disorders: A Large-Scale Cross-Sectional Study."

Academy of Management Discoveries: "Beyond Nine to Five: Is Working to Excess Bad for Health?"

Academy of Management Discoveries: “Work Hours and Health: A Comment on 'Beyond Nine to Five.' ”

Academy of Management Discoveries: "The Difference Between Working Long Hours and Workaholism: Response to Commentary on 'Beyond Nine to Five.'"


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