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In psychology, codependency is a theory that attempts to explain imbalanced relationships where one person enables another person's self-destructive behavior [1] such as addiction, poor mental health, immaturity, irresponsibility, or under-achievement. [2]
Definitions of codependency vary, but typically include high self-sacrifice, a focus on others' needs, suppression of one's own emotions, and attempts to control or fix other people's problems. [3]
People who self-identify as codependent are more likely to have low self-esteem, but it is unclear whether this is a cause or an effect of characteristics associated with codependency. [4]
The term codependency most likely developed in Minnesota in the late 1970s from co-alcoholic, when alcoholism and other drug dependencies were grouped together as "chemical dependency". [5] [6] In Alcoholics Anonymous, it became clear that alcoholism was not solely about the addict, but also about the enabling behaviors of the alcoholic's social network. [7] The term codependent was first used to describe persons whose lives were affected through their involvement with a person with a substance use disorder, resulting in the development of a pattern of coping with life that was not healthy as a reaction to that other person's substance abuse. [8]
In 1986, psychiatrist Timmen Cermak wrote Diagnosing and Treating Co-Dependence: A Guide for Professionals. In that book and an article published in the Journal of Psychoactive Drugs , Cermak argued unsuccessfully for the inclusion of codependency as a separate personality disorder in the Diagnostic and Statistical Manual of Mental Disorders III-R (DSM-III-R). [9]
Melody Beattie popularized the concept of codependency in 1986 with the book Codependent No More, which sold eight million copies, [10] with updated editions released in 1992 and 2022. [11] Drawing on her personal experience with substance abuse and caring for someone with it, she also interviewed people helped by Al-Anon. Beattie's work formed the groundwork of a twelve-step organisation called Co-Dependents Anonymous, founded in 1986, [12] although the group does not endorse any definition of or diagnostic criteria for codependency. [13]
Codependency has no established definition or diagnostic criteria within the mental health community. [14] [15] It has not been included as a condition in any edition of the DSM or ICD.
The concept of codependency carries three different levels of meaning: [16]
Discussion of codependency tends to regard the disorder, although there is no agreement that codependency is a disorder at all, or how such a disorder might be defined or diagnosed. [9] : 723 It has no established definition or diagnostic criteria within the mental health community, [14] [15] and it has not been included as a condition in any edition of the DSM or ICD.
The Medical Subject Heading utilized by the United States National Library of Medicine describes codependency as "A relational pattern in which a person attempts to derive a sense of purpose through relationships with others." [20]
Mental Health America considers codependency to be a synonym for "relationship addiction", and to refer to people with low-self esteem who seek vicarious fulfilment in a dysfunctional family member. [21]
In her self-help book, Melody Beattie proposed that, "The obvious definition [of codependency] would be: being a partner in dependency. This definition is close to the truth but still unclear." Beattie elaborated, "A codependent person is one who has let another person's behavior affect him or her, and who is obsessed with controlling that person's behavior." [22]
Therapist and self-help author Darlene Lancer asserts that "A codependent is a person who can’t function from his or her innate self and instead organizes thinking and behavior around a substance, process, or other person(s)." Lancer includes all addicts in her definition. She believes a "lost self" is the core of codependency. [23]
Co-Dependents Anonymous, a self-help organization for people who seek to develop healthy and functional relationships, "offer[s] no definition or diagnostic criteria for codependence," [24] but provides a list of "patterns and characteristics of codependence" that can be used by laypeople for self-evaluation. [25] [26]
According to theories of codependency as a psychological disorder, the codependent partner in a relationship is often described as displaying self-perception, attitudes and behaviors that serve to increase problems within the relationship instead of decreasing them. It is often suggested that people who are codependent were raised in dysfunctional families or with early exposure to addiction behavior, resulting in their allowance of similar patterns of behavior by their partner. [27]
In an early attempt to define codependency as a diagnosable disorder, [9] psychiatrist Timmen Cermak proposed, "Co-dependence is a recognizable pattern of personality traits, predictably found within most members of chemically dependent families, which are capable of creating sufficient dysfunction to warrant the diagnosis of Mixed Personality Disorder as outlined in DSM III." [28] Cermak listed the traits he identified in self-suppressing, supporting partners of people with chemical dependence or disordered personalities, and proposed a DSM-style set of diagnostic criteria. His proposal placed codependence within the framework of Mixed Personality Disorder, which is used to describe individuals who do not qualify for a single Personality Disorder diagnosis, but who have traits of several Personality Disorders. [29]
Efforts to define and measure codependency include the Spann–Fischer Codependency Scale, proposed in 1990. That scale is predicated upon a definition of codependency as "a dysfunctional pattern of relating to others with an extreme focus outside of oneself, lack of expression of feelings, and personal meaning derived from relationships with others." [30]
As part of an effort to unify a definition of codependency, a 1994 review found that the definitions included in surveyed articles suggested "an excessive reliance on other people for approval and for a sense of identity and purpose." [31] [32] A 2004 study found that definitions typically include high self-sacrifice, a focus on others' needs, suppression of one's own emotions, and attempts to control or fix other people's problems. [32]
Codependent relationships are often described as being marked by intimacy problems, dependency, control (including caretaking), denial, dysfunctional communication and boundaries, and high reactivity. There may be imbalance within the relationship, where one person is abusive or in control or supports or enables another person's addiction, poor mental health, immaturity, irresponsibility, or under-achievement. [33]
Under this conception of codependency, the codependent person's sense of purpose within a relationship is based on making extreme sacrifices to satisfy their partner's needs. Codependent relationships signify a degree of unhealthy "clinginess" and needy behavior, where one person does not have self-sufficiency or autonomy. One or both parties depend on their loved one for fulfillment. [34]
Codependency may occur within the context of relationships with people with diagnosable personality disorders.
In the dysfunctional family, the child learns to become attuned to the parent's needs and feelings instead of the other way around. [33] Parenting is a role that requires a certain amount of self-sacrifice and giving a child's needs a high priority. A parent can be codependent toward their own child. [39] Generally, a parent who takes care of their own needs (emotional and physical) in a healthy way will be a better caretaker, whereas a codependent parent may be less effective or may even do harm to a child. Codependent relationships often manifest through enabling behaviors, especially between parents and their children. Another way to look at it is that the needs of an infant are necessary but temporary, whereas the needs of the codependent are constant. Children of codependent parents who ignore or negate their own feelings may become codependent. [40]
With no consensus as to how codependency should be defined, and with no recognized diagnostic criteria, mental health professionals hold a range of opinions about the diagnosis and treatment of codependency. [41] Caring for an individual with a physical addiction is not necessarily a pathology. The caregiver may benefit from assertiveness skills and the ability to place responsibility for the addiction on the other. [42]
Individuals who struggle with codependency may benefit from psychotherapy, including cognitive behavioral therapy and mindfulness practices. [43]
Many self-help guides have been written on the subject of codependency. [44] Self-help groups such as Co-Dependents Anonymous (CoDA), Al-Anon/Alateen, Nar-Anon, and Adult Children of Alcoholics (ACoA), which are based on the twelve-step program model of Alcoholics Anonymous, or Celebrate Recovery, a Christian twelve-step, Bible-based group, also provide support for recovery from codependency. [45]
As codependency is not a diagnosable mental health condition, there is no medical consensus as to its definition, [14] and no evidence that codependency is caused by a disease process, [46] the term becomes easily applicable to many behaviors and has been overused by some self-help authors and support communities. [47] In an article in Psychology Today , clinician Kristi Pikiewicz suggested that the term codependency has been overused to the point of becoming a cliché, and labeling a patient as codependent can shift the focus on how their traumas shaped their current relationships. [48]
Some scholars and treatment providers assert that codependency should be understood as a positive impulse gone awry, and challenge the idea that interpersonal behaviors should be conceptualized as addictions or [49] diseases, as well as the pathologizing of personality characteristics associated with women. [50] A study of the characteristics associated with codependency found that non-codependency was associated with masculine character traits, while codependency was associated with negative feminine traits, such as being self-denying, self-sacrificing, or displaying low self-esteem. [51]
Computer addiction is a form of behavioral addiction that can be described as the excessive or compulsive use of the computer, which persists despite serious negative consequences for personal, social, or occupational function. Another clear conceptualization is made by Block, who stated that "Conceptually, the diagnosis is a compulsive-impulsive spectrum disorder that involves online and/or offline computer usage and consists of at least three subtypes: excessive gaming, sexual preoccupations, and e-mail/text messaging". Computer addiction is not currently included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an official disorder. The concept of computer addiction is broadly divided into two types, namely offline computer addiction, and online computer addiction. Offline computer addiction is normally used when speaking about excessive gaming behavior, which can be practiced both offline and online. Online computer addiction, also known as Internet addiction, gets more attention in general from scientific research than offline computer addiction, mainly because most cases of computer addiction are related to the excessive use of the Internet.
Histrionic personality disorder (HPD) is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive attention-seeking behaviors, usually beginning in early adulthood, including inappropriate seduction and an excessive desire for approval. People diagnosed with the disorder are said to be lively, dramatic, vivacious, enthusiastic, extroverted and flirtatious.
Antisocial personality disorder, often abbreviated to ASPD, is a mental disorder defined by a chronic pattern of behavior that disregards the rights and well-being of others. People with ASPD often exhibit behavior that conflicts with social norms, leading to issues with interpersonal relationships, employment, and legal matters. The condition generally manifests in childhood or early adolescence, with a high rate of associated conduct problems and a tendency for symptoms to peak in late adolescence and early adulthood.
Hypersexuality is a medical condition that causes unwanted or excessive sexual arousal, causing people to engage in or think about sexual activity to a point of distress or impairment. It is controversial whether it should be included as a clinical diagnosis used by mental healthcare professionals. Nymphomania, satyromania and sex maniac were terms previously used for the condition in women and men, respectively.
Dependent personality disorder (DPD) is a personality disorder characterized by a pervasive psychological dependence on other people. This personality disorder is a long-term condition in which people depend on others to meet their emotional and physical needs. Dependent personality disorder is a cluster C personality disorder, which is characterized by excessive fear and anxiety. It begins prior to early adulthood, and it is present in a variety of contexts and is associated with inadequate functioning. Symptoms can include anything from extreme passivity, devastation or helplessness when relationships end, avoidance of responsibilities, and severe submission.
Pornography addiction is the scientifically controversial application of an addiction model to the use of pornography. Pornography use may be part of compulsive behavior, with negative consequences to one's physical, mental, social, or financial well-being. While the World Health Organization's ICD-11 (2022) has recognized compulsive sexual behaviour disorder (CSBD) as an "impulsive control disorder". CSBD is not an addiction, and the American Psychiatric Association's DSM-5 (2013) and the DSM-5-TR (2022) do not classify compulsive pornography consumption as a mental disorder or a behavioral addiction.
Sexual addiction is a state characterized by compulsive participation or engagement in sexual activity, particularly sexual intercourse, despite negative consequences. The concept is contentious; as of 2023, sexual addiction is not a clinical diagnosis in either the DSM or ICD medical classifications of diseases and medical disorders, which instead categorize such behaviors under labels such as compulsive sexual behavior.
Melody Beattie is an American author of self-help books on codependent relationships.
Co-Dependents Anonymous (CoDA) is a twelve-step program for people who share a common desire to develop functional and healthy relationships. Co-Dependents Anonymous was founded by Ken and Mary Richardson and the first CoDA meeting attended by 30 people was held October 22, 1986 in Phoenix, Arizona. Within four weeks there were 100 people and before the year was up there were 120 groups. CoDA held its first National Service Conference the next year with 29 representatives from seven states. CoDA has stabilized at about a thousand meetings in the US, and with meetings active in 60 other countries and dozens online that can be reached at www.coda.org.
In psychotherapy and mental health, enabling is the encouragement of some behaviour, especially if said behaviour is either particularly positive or dysfunctional.
The Spann–Fischer Codependency Scale is a 16-item self-report instrument that has been proposed as a measure of co-dependency. The scale is based upon a definition of codependency as "a dysfunctional pattern of relating to others with an extreme focus outside of oneself, lack of expression of feelings, and personal meaning derived from relationships with others." Codependency has no established definition within the mental health community, and is not a recognized diagnosis as a mental health disorder.
Love addiction is a proposed model of pathological passion-related behavior involving the feeling of falling and being in love. A medical review of related behaviors in animals and humans concluded that current medical evidence does not have definitions or criteria on an addiction model for love addiction, but there are reported similarities to substance dependence, such as euphoria and desire in the stimuli, as well as anhedonia and negative levels of mood when away from the stimuli, intrusive thoughts on it, and disregard for adverse consequences. There has never been a reference to love addiction in the Diagnostic and Statistical Manual of Mental Disorders (DSM), a compendium of mental disorders and diagnostic criteria published by the American Psychiatric Association.
Personality disorders (PD) are a class of mental health conditions characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture. These patterns develop early, are inflexible, and are associated with significant distress or disability. The definitions vary by source and remain a matter of controversy. Official criteria for diagnosing personality disorders are listed in the sixth chapter of the International Classification of Diseases (ICD) and in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).
Personal boundaries or the act of setting boundaries is a life skill that has been popularized by self help authors and support groups since the mid-1980s. Personal boundaries are established by changing one's own response to interpersonal situations, rather than expecting other people to change their behaviors to comply with your boundary. For example, if the boundary is to not interact with a particular person, then one sets a boundary by deciding not to see or engage with that person, and one enforces the boundary by politely declining invitations to events that include that person and by politely leaving the room if that person arrives unexpectedly. The boundary is thus respected without requiring the assistance or cooperation of any other people. Setting a boundary is different from issuing an ultimatum, though ultimatums can be a part of setting boundaries.
Emotional blackmail was popularized by psychotherapist Susan Forward about controlling people in relationships and the theory that fear, obligation and guilt (FOG) are the transactional dynamics at play between the controller and the person being controlled. Understanding these dynamics is useful to anyone trying to extricate themself from the controlling behavior of another person and deal with their own compulsions to do things that are uncomfortable, undesirable, burdensome, or self-sacrificing for others.
Schema therapy was developed by Jeffrey E. Young for use in the treatment of personality disorders and other chronic conditions such as long-term depression, anxiety, and eating disorders.
BPDFamily.com is an online support group for the family members of individuals with borderline personality disorder (BPD). The group is one of the first "cyber" support groups to be recognized by the medical providers and receive professional referrals.
Timmen Cermak is an American psychiatrist known for his work on codependent personality types. He is in private practice in San Francisco and Marin County with a focus on addictions.