Codependency

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Codependency is a descriptive term that attempts to explain imbalanced relationships where one person enables another person's self-destructive behavior such as addiction, poor mental health, immaturity, irresponsibility, or under-achievement. There is no established definition for codependency within the mental health community, which has led to criticism that the term has been overused.

Those who may be called codependent typically exhibit high self-sacrifice, a focus on others' needs, suppression of their own emotions, and attempts to control or fix other people's problems. Codependency is not limited to married, partnered, or romantic relationships, as co-workers, friends, and family members can also form codependent relationships.

Definitions

Codependency carries three potential levels of meaning. First, it can describe a didactic 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. Second, it can describe a psychological concept, a shorthand means of describing and explaining unhealthy human behavior. 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.

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 entity might be defined or diagnosed. In fact, codependency has no established definition or diagnostic criteria within the mental health community. It has not been included as a condition in any edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD).

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

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.

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."

"Mental Health America" describes codependency as "an emotional and behavioral condition that affects an individual’s ability to have a healthy, mutually satisfying relationship." They also suggest that it is an addictive behavior that can be learned:

Co-dependency is a learned behavior that can be passed down from one generation to another. ... It is also known as “relationship addiction” because people with codependency often form or maintain relationships that are one-sided, emotionally destructive and/or abusive.

In her self-help book, Melody Beattie proposed:

The obvious definition [of codependency] would be: being a partner in dependency. This definition is close to the truth but still unclear. ... 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.

Another self-help author, Darlene Lancer, asserted that a "lost self" is the core of codependency. She includes all addicts in her definition:

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).

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

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.” 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.

"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." Application of the concept of codependency was driven by the self-help community. Codependency is not limited to married, partnered, or romantic relationships, as co-workers, friends, and family members can be codependent as well.

Marriage and Family Therapist Robin Norwood's Women Who Love Too Much (1985), aimed to help women who were addicted to men who offered little love in return. It sold two and a half million copies.

Psychiatrist Timmen Cermak found that the condition could affect people close to people with any mental disorder, not just addiction. In 1986, he wrote Diagnosing and Treating Co-Dependence. In that book, and his 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.

Melody Beattie popularized the concept of codependency in 1986 with her book Codependent No More which sold eight million copies, with updated editions released in 1992 and 2022. 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 underpinning of a twelve-step organization called Co-Dependents Anonymous, founded in 1986.

Psychotherapist Darlene Lancer wrote Codependency for Dummies in 2012, with a second edition released in 2015. She also wrote Conquering Shame and Codependency: 8 Steps to Freeing the True You in 2014. These books detail her understanding of the condition she developed over many years of delivering marriage and family therapy.

Assessing Codependency

Over the years a number of scales have been developed which assess various aspects of codependent relationships. The Composite Codependency Scale (CCS) is a 19-item measure designed to assess the codependent traits common to these scales. Based on reviewing several widely used definitions of codependency, four core codependent behaviors were identified: external focusing (focusing one's attention on the behaviors, opinions, and expectations of others); self‐sacrifice (neglecting one's own needs to focus on meeting the needs of others); interpersonal control (an entrenched belief in one's capacity to fix other people's problems and control their behavior); and emotional suppression (the deliberate suppression, or limited conscious awareness, of one's own emotions until they become overwhelming).

A comparison of scores on the CCS was made between participants attending Codependents Anonymous (CoDA) and those from the general population, it was found that higher codependency scores were significantly associated with higher levels of depression, anxiety, stress, and familial dysfunction, as well as lower levels of narcissistic tendencies and self-esteem.

Recovery

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.

It has been suggested 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.

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. 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 based on the twelve-step program model of Alcoholics Anonymous. Co-Dependents Anonymous (CoDA) identified patterns that occur in codependency and recovery from it, which are helpful to those seeking to change from codependence to healthy relationships.

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, bully, or behaviors that might reflect conflict addiction. 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 victim-hood, 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.

Theories

Codependency is a descriptive term that attempts to explain imbalanced relationships where one person enables another person's self-destructive behavior, such as addiction, poor mental health, immaturity, irresponsibility, or under-achievement.

Under 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.

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.

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. The mood and emotions of the codependent are often determined by how they think other individuals perceive them (especially loved ones). This perception is self-inflicted and often leads to clingy, needy behavior which can hurt the health of the relationship.

Personality disorders

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

• Borderline personality disorder – there is a tendency for loved ones of people with borderline personality disorder (BPD) to slip into "caretaker" roles, giving priority and focus to problems in the life of the person with BPD rather than to issues in their own lives. The codependent partner may gain a sense of worth by being perceived as "the sane one" or "the responsible one."
• Narcissistic personality disorder – Narcissists, with their ability to get others to "buy into their vision" and help them make it a reality, seek and attract partners who will put others' needs before their own. A codependent person can provide the narcissist with an obedient and attentive audience. Among the reciprocally interlocking interactions of the pair are the narcissist's overpowering need to feel important and special and the codependent person's strong need to help others feel that way.

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. 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.

Codependent relationships often manifest through enabling behaviors, especially between parents and their children. 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.

Criticism

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

Some scholars and treatment providers assert codependency should be understood as a positive impulse gone awry, and challenge the idea that interpersonal behaviors should be conceptualized as addictions or diseases. It has been noted that this conceptualization pathologizes personality characteristics associated with women, such as being self-denying and self-sacrificing, behaviors integral to parenting, specifically motherhood.

Human beings are relational beings, and relationships are complicated; they are not simple, and they are not always dysfunctional. While identification of certain unhealthy relationships as codependent has been helpful, particularly in dealing with those close to someone addicted to drugs or alcohol, the lack of clear defining criteria risks inappropriate overuse of the term and excessive focus on the self as the source of the problem.

References

ISBN links support NWE through referral fees

• Beattie, Melody. Codependent No More: How to Stop Controlling Others and Start Caring for Yourself. Hazelden, 1986. ISBN 978-0894864025
• Cermak, Timmen L. Diagnosing and Treating Co-Dependence: A Guide for Professionals Who Work With Chemical Dependents, Their Spouses, and Children. Hazelden, 1998. ISBN 978-0935908329
• CoDA. Co-Dependents Anonymous. CoDA Resource Publishing, 1995. ISBN 978-0964710504
• Crompton, Simon. All About Me: Loving a Narcissist. Collins, 2007. ISBN 978-0007247950
• Davis, Lennard J. Obsession: A History. University of Chicago Press, 2009. ISBN 978-0226137841
• Gomberg, Edith S. Current Issues in Alcohol/Drug Studies. Routledge, 2019. ISBN 978-1138881815
• Irving, Leslie. Codependent Forevermore, The Invention of Self in a Twelve Step Group. University of Chicago Press, 1999. ISBN 978-0226384719
• Lancer, Darlene. Codependency for Dummies. John Wiley & Sons, Inc., 2012. ISBN 978-1118095225
• Lancer, Darlene. Conquering Shame and Codependency: 8 Steps to Freeing the True You. Hazelden Publishing, 2014. ISBN 1616495332
• Moos, Rudolf H., John W. Finney, and Ruth C. Cronkite. Alcoholism Treatment: Context, Process, and Outcome. Oxford University Press, 1990. ISBN 978-0195043624
• Norwood, Robin. Women Who Love Too Much. Jeremy P. Tarcher, Inc., 1985. ISBN 978-0874773552
• Oakley, Barbara, Ariel Knafo, Guruprasad Madhavan, and David Sloan Wilson (eds.). Pathological Altruism. Oxford University Press, 2011. ISBN 978-0199738571
• Rice, John Steadman. A Disease of One's Own. Routledge, 1998. ISBN 978-0765804549
• Sadock, Benjamin J., Virginia A. Sadock, and Pedro Ruiz (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry. Philadelphia: Lippincott Williams & Wilkins, 10th ed., 2017. ISBN 1451100477
• Shohov, Serge P. (ed.). Advances in Psychology Research Vol. 34. Nova Science Pub Inc, 2004. ISBN 978-1594540790

External links

All links retrieved January 7, 2024.

• Co-Dependency Mental Health America
• Signs of Codependency WebMD
• What Is Codependency? Very Well Mind
• Codependency Psychology Today
• Codependency: Signs, Causes, and Help Help Guide
• Codependency: What Are The Signs & How To Overcome It Positive Psychology
• What Is Codependency? Very Well Health
• Codependency by Darlene Lancer

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