Codependency

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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]

Contents

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 exhibit low self-esteem, but it is unclear whether this is a cause or an effect of characteristics associated with codependency. [4] Codependency is not limited to married, partnered, or romantic relationships, as co-workers, friends, and family members can be codependent as well.

History

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] The term is most often identified with Alcoholics Anonymous and the realization that the alcoholism was not solely about the addict but also about the family and friends who constitute a network for the alcoholic. [7]

The term "codependent" was first used to describe how family members and friends might interfere with the recovery of a person affected by a substance use disorder by "overhelping." [8] Application of the concept of codependency was driven by the self-help community.

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 , DSM-III-R. [9] He found that the condition could affect people close to people with any mental disorder, not just addiction.

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]

Definition

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.

Codependency carries three potential levels of meaning. First, it can describe an instructive tool that, once explained to families, helps them normalize the feelings that they are experiencing and allows them to shift their focus from the dependent person to their own dysfunctional behavior patterns. [16] [17] [18] Second, it can describe a psychological concept, a shorthand means of describing and explaining human behavior. [16] [19] Third, it can describe a psychological disorder, implying that there is a consistent pattern of traits or behaviors across individuals that can create significant dysfunction. [16] [20]

Discussion of codependency tends to focus on the disease model of the term, although there is no agreement that codependency is a disorder at all, or how such a disease might be defined or diagnosed. [16] : 723 

In an early attempt to define codependency as a diagnosable disorder, [16] Timmen Cermak wrote, "Co-dependence is a recognisable 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." Cermak proceeded to list the traits he identified in self-suppressing, supporting partners of people with chemical dependence or disordered personalities, and to propose a DSM-style set of diagnostic criteria. [21] [22]

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." [23]

Another self-help author, psychologist 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)." [24] Lancer includes all addicts in her definition. She believes a "lost self" is the core of codependency.

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," [25] but provides a list of "patterns and characteristics of codependence" that can be used by laypeople for self-evaluation. [26] [27]

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." [28]

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. [29]

Theories

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. [30]

Relationships

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. [31]

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. [32]

Personality disorders

Codependency may occur within the context of relationships with people with diagnosable personality disorders.

Family dynamics

In the dysfunctional family, the child learns to become attuned to the parent's needs and feelings instead of the other way around. [31] 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. [36] 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. [37]

Recovery and prognosis

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. [38] Caring for an individual with a physical addiction is not necessarily a pathology. The caregiver may only require assertiveness skills and the ability to place responsibility for the addiction on the other. [39] [40] There are various recovery paths for individuals who struggle with codependency. For example, some may choose cognitive-behavioral psychotherapy, sometimes accompanied by chemical therapy for accompanying depression. There also exist support groups for codependency, 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 and Life Recovery a Christian 12 step Bible-based group. [41] Many self-help guides have been written on the subject of codependency.

It has been proposed that, in attempts to recover from codependency, people may go from being overly passive or overly giving to being overly aggressive or excessively selfish. Therapists may seek to help a client develop a balance through healthy assertiveness, which leaves room for being a caring person and also engaging in healthy caring behavior, while minimizing selfishness, bullying, or behaviors that might reflect conflict addiction. [39] [40] Developing a permanent stance of being a victim (having a victim mentality) does not constitute recovery from codependency. A victim mentality could also be seen as a part of one's original state of codependency (lack of empowerment causing one to feel like the "subject" of events rather than being an empowered actor). Someone truly recovered from codependency would feel empowered and like an author of their life and actions rather than being at the mercy of outside forces. A victim mentality may also occur in combination with passive–aggressive control issues. From the perspective of moving beyond victimhood, the capacity to forgive and let go (with exception of cases of very severe abuse) could also be signs of real recovery from codependency, but the willingness to endure further abuse would not. [39]

It is theorized that unresolved patterns of codependency may lead to more serious problems like alcoholism, drug addiction, eating disorders, sex addiction, psychosomatic illnesses, and other self-destructive or self-defeating behaviors. People with codependency may be more likely to attract further abuse from aggressive individuals (such as those with BPD or NPD), more likely to stay in stressful jobs or relationships, less likely to seek medical attention when needed and are also less likely to get promotions and tend to earn less money than those without codependency patterns. For some people, the social insecurity caused by codependency may progress into full-blown social anxiety disorders like social phobia, avoidant personality disorder or painful shyness. Other stress-related disorders like panic disorder, depression or PTSD may also be present. [42]

Controversy

Codependency is not a diagnosable mental health condition, there is no medical consensus as to its definition, [14] and there is no evidence that codependency is caused by a disease process. [43] Without clinical definition, the term is easily applicable to many behaviors and has been overused by some self-help authors and support communities. [44] 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. [45]

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 [46] diseases, as well as the pathologizing of personality characteristics associated with women. [47] 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. [48]

Efforts to define and measure codependency include the Spann-Fischer co-dependency scale, proposed in 1990. [49] Researchers have attempted to build support for the concept of codependency, and to try to build an understanding of how it develops and manifests.

See also

Related Research Articles

<span class="mw-page-title-main">Alcoholism</span> Problematic excessive alcohol consumption

Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal. Problematic use of alcohol has been mentioned in the earliest historical records, the World Health Organization (WHO) estimated there were 283 million people with alcohol use disorders worldwide as of 2016. The term alcoholism was first coined in 1852, but alcoholism and alcoholic are stigmatizing and discourage seeking treatment, so clinical diagnostic terms such as alcohol use disorder or alcohol dependence are used instead.

<span class="mw-page-title-main">Histrionic personality disorder</span> Personality disorder involving excessive emotionality and attention-seeking

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.

<span class="mw-page-title-main">Narcissistic personality disorder</span> Personality disorder

Narcissistic personality disorder (NPD) is a personality disorder characterized by a life-long pattern of exaggerated feelings of self-importance, an excessive need for admiration, and a diminished ability to empathize with other people's feelings. Narcissistic personality disorder is one of the sub-types of the broader category known as personality disorders. It is often comorbid with other mental disorders and associated with significant functional impairment and psychosocial disability.

Antisocial personality disorder is a personality disorder characterized by a limited capacity for empathy and a long-term pattern of disregard or violation of the rights of others. Other notable symptoms include impulsivity and reckless behavior, a lack of remorse after hurting others, deceitfulness, irresponsibility, and aggressive behavior.

<span class="mw-page-title-main">Dependent personality disorder</span> Personality disorder

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 may be part of compulsive sexual 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.

According to proponents of the concept, sexual addiction, also known as sex addiction, is a state characterized by compulsive participation or engagement in sexual activity, particularly sexual intercourse, despite negative consequences. The concept is contentious; neither of the two major mainstream medical categorization systems recognise sex addiction as a real medical condition, instead categorizing such behavior under labels such as compulsive sexual behavior.

Melody Beattie is an American author of self-help books on codependent relationships.

Sexual anorexia is a term coined in 1975 by psychologist Nathan Hare to describe a fear of or deep aversion to sexual activity. It is considered a loss of "appetite" for sexual contact, and may result in a fear of intimacy or an aversion to any type of sexual interaction. The term largely exists in a colloquial sense and is not presently classified as a disorder in the Diagnostic Statistical Manual.

Self-defeating personality disorder was a proposed personality disorder. As a descriptor for "Other personality disorder" it was included in the DSM-III in 1980.. It was discussed in an appendix of the revised DSM-III-R in 1987, but was never formally admitted into the manual. The distinction was not seen as clinically valuable because of its significant overlap with other personality disorders. Both the DSM-III and DSM-III-R separated the condition from sexual masochism.

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 has a positive sense of empowering individuals, or a negative sense of encouraging dysfunctional behavior.

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.

<span class="mw-page-title-main">Love addiction</span>

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 disorders 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; an ultimatum is a demand that other people change their choices so that their behavior aligns with the boundary-setter's own preferences and personal values.

Emotional blackmail and FOG are terms 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.

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.

References

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