Codependency

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Codependency is a type of dysfunctional helping relationship where one person supports or enables another person's drug addiction, alcoholism, gambling addiction, poor mental health, immaturity, irresponsibility, or under-achievement.^[1] Among the core characteristics of codependency, the most common theme is an excessive reliance on other people for approval and a sense of identity.^[1] Given its grassroots origin, the precise definition of codependency varies based on the source but can be generally characterized as a subclinical and situational or episodic behavior similar to that of dependent personality disorder.^[1] In its broadest definition, a codependent is someone who cannot function from their innate self and whose thinking and behavior is instead organized around another person, or even a process, or substance.^[2] In this context, people who are addicted to a substance, like drugs, or a process, like gambling or sex, can also be considered codependent. In its most narrow definition, it requires one person to be physically or psychologically addicted, such as to heroin, and the second person to be psychologically dependent on that behavior.^[3] Some users of the codependency concept use the word as an alternative to using the concept of dysfunctional families, without statements that classify it as a disease.^[4]

History

According to disability studies specialist Lennard J. Davis, historically, the concept of co-dependence "comes directly out of Alcoholics Anonymous, part of a dawning realization that the problem was not solely the addict, but also the family and friends who constitute a network for the alcoholic."^[5] "While not an actual diagnosis, the term “codependent” was first used to describe how family members of individuals with substance abuse issues might actually interfere with recovery by overhelping."^[6] It was subsequently broadened to cover the way "that the codependent person is fixated on another person for approval, sustenance, and so on."^[5] The concept of codependency overlaps with, but developed in the mainstream independently from, the older psychoanalytic concept of the passive dependent personality which is attaching oneself to a stronger personality.^[7] "Dependency" is well-established in psychological literature. Whereas early on psychoanalytic theory emphasized the oral character and structural basis of dependency, social learning theory considered a tendency to be acquired by learning and experience, and ethological attachment theory posited that attachment or affectional bonding is the basis for dependency. All three theories have contributed to the concept of dependent personality disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association. The definition and criteria have changed in the different versions of the DSM. In DSM-I, passive dependency personality was characterized by helplessness, denial, and indecisiveness, and was considered a subtype of passive aggressive personality. By DSM-IV, there were nine criteria with an essential feature of a pervasive or lifetime pattern of dependent and submissive behavior. The DSM-IV definition emphasized the excessive need to be taken care of, leading to submissive and clinging behavior and fear of separation.^[8]

The codependency movement may have its roots in the theories of German psychoanalyst Karen Horney. In 1941, she proposed that some people adopt what she termed a "Moving Toward" personality style to overcome their basic anxiety. Essentially, these people move toward others by gaining their approval and affection, and subconsciously control them through their dependent style. They are unselfish, virtuous, martyr-like, faithful, and turn the other cheek despite personal humiliation. Approval from others is more important than respecting themselves.^[9] Al-Anon was formed in 1951, 16 years after Alcoholics Anonymous was founded.^[10] Al-Anon holds the view that alcoholism is a family illness^[11] and is one of the earliest recognitions of codependency.

The expansion of the meaning of codependency happened very publicly.^[12] Janet G. Woititz's Adult Children of Alcoholics had come out in 1983 and sold two million copies while being on the New York Times bestseller list for forty-eight weeks.^[12] Robin Norwood's Women Who Love Too Much, 1985, sold two and a half million copies and spawned Twelve Step groups across the country for women "addicted" to men.^[12] Melody Beattie popularized the concept of codependency in 1986 with the book Codependent No More which sold eight million copies.^[13] In 1986, Timmen Cermak, M.D. wrote Diagnosing and Treating Co-Dependence: A Guide for Professionals. In the book and an article published in the Journal of Psychoactive Drugs (Volume 18, Issue 1, 1986), 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; American Psychiatric Association, 1987).^[14] Cermak's book paved the way for a Twelve-step take-off program, called Co-Dependents Anonymous.^[15] The first Co-Dependents Anonymous meeting was held October 22, 1986.^[15]

Symptoms and behaviors

Codependency does not refer to all caring behavior or feelings, but only those that are excessive to an unhealthy degree.^[16] One of the distinctions is that healthy empathy and caregiving is motivated by conscious choice; whereas for codependents, their actions are compulsive, and they usually aren't able to weigh in the consequences of them or their own needs that they're sacrificing. Some scholars and treatment providers feel that codependency is an overresponsibility and that overresponsibility needs to be understood as a positive impulse gone awry. Responsibility for relationships with others needs to coexist with responsibility to self.^[17]

Codependency has been referred to as the disease of a lost self.^[2][18] Codependent relationships are marked by intimacy problems, dependency, control (including caretaking) denial, dysfunctional communication and boundaries, and high reactivity. Often, there is imbalance, so one person is abusive or in control or supports or enables another person's addiction, poor mental health, immaturity, irresponsibility, or under-achievement.^[19] Some codependents often find themselves in relationships where their primary role is that of rescuer, supporter, and confidante. These helper types are often dependent on the other person's poor functioning to satisfy their own emotional needs.^[1] Many codependents place a lower priority on their own needs, while being excessively preoccupied with the needs of others. Codependency can occur in any type of relationship, including family, work, friendship, and also romantic, peer or community relationships.^[20]

Commonly cited symptoms of codependency are:^[1][21]

• intense and unstable interpersonal relationships
• inability to tolerate being alone, accompanied by frantic efforts to avoid being alone
• chronic feelings of boredom and emptiness
• subordinating one's own needs to those of the person with whom one is involved
• overwhelming desire for acceptance and affection
• perfectionism
• over-controlling
• external referencing
• dishonesty and denial
• manipulation
• lack of trust
• low self-worth.

Patterns and characteristics

Codependency can occur in any type of relationship, including family, work, friendship, and also romantic, peer or community relationships.^[20]

Enmeshed romantic relationship

In a codependent relationship, the codependent's sense of purpose is based on making extreme sacrifices to satisfy their partner's needs. Codependent relationships signify a degree of unhealthy "clinginess", where one person does not have self-sufficiency or autonomy. One or both parties depend on their loved one for fulfillment.^[22] There is almost always a subconscious reason for continuing to put another person's life ahead of your own, and often it is because of the mistaken notion that self-worth comes from other people.

Particularly problematic pairings include:

Personality disorder and codependent pairing

• 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. Too often in these kinds of relationships, the codependent will gain a sense of worth by being "the sane one" or "the responsible one".^[23]

• Narcissistic personality disorder. Codependents of narcissists are sometimes called co-narcissists.^[24] 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.^[25] Codependents can provide the narcissist with an obedient and attentive audience — the perfect backdrop for a self-absorbed narcissist.^[26] Among the reciprocally interlocking interactions of the pair are the narcissist's overpowering need to feel important and special and the co-dependent person's strong need to help others feel that way.

Codependent and/or impulse-disordered individuals and codependent pairing^[27]

• Attention-deficit hyperactivity disorder (ADHD).
• Obsessive-compulsive disorder (OCD)
• Manic state of bipolar disorder

Dysfunctional family

In the dysfunctional family the child learns to become attuned to the parent's needs and feelings instead of the other way around.^[19] Parenting is a role that requires a certain amount of self-sacrifice and giving a child's needs a high priority. A parent can, nevertheless, be codependent towards their own children if the caretaking or parental sacrifice reaches unhealthy or destructive levels.^[20] 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.^[20] 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.

Recovery and Prognosis

Not all mental health professionals agree about standard methods of treatment.^[28] Caring for an individual with a physical addiction is not necessarily treating a pathology. The caregiver may only require assertiveness skills and the ability to place responsibility for the addiction on the other.^[16][29] 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 and Celebrate Recovery a Christian, Bible-based group.^[30] Many self-help guides have been written on the subject of codependency.

Sometimes an individual can, in attempts to recover from codependency, go from being overly passive or overly giving to being overly aggressive or excessively selfish.^[16] Many therapists maintain that finding a balance through healthy assertiveness (which leaves room for being a caring person and also engaging in healthy caring behavior) is true recovery from codependency and that becoming extremely selfish, a bully, or an otherwise conflict-addicted person is not.^[16][29] Developing a permanent stance of being a victim (having a victim mentality) would also not constitute true recovery from codependency and could be another example of going from one extreme to another.^[16] 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).^[16] 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.^[16] A victim mentality may also occur in combination with passive–aggressive control issues.^[16] 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.^[16]

Unresolved patterns of codependency can lead to more serious problems like alcoholism, drug addiction, eating disorders, sex addiction, psychosomatic illnesses, and other self-destructive or self-defeating behaviors.^[31] People with codependency are also more likely to attract further abuse from aggressive individuals, 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.^[31] For some people, the social insecurity caused by codependency can progress into full-blown social anxiety disorders like social phobia, avoidant personality disorder or painful shyness.^[31] Other stress-related disorders like panic disorder, depression or PTSD may also be present.^[31]

Failed proposal for inclusion in DSM

Timmen Cermak, M.D., proposed that co‐dependency be listed as a personality disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987). Cermak reasoned that when specific personality traits become excessive and maladaptive and caused significant impairment in functioning or caused significant distress, it warrants a personality disorder diagnosis.^[27]

Cermak proposed the following criteria for this disorder:^[27]

1. Continued investment of self-esteem in the ability to control both oneself and others in the face of serious adverse consequences.
2. Assumption of responsibility for meeting others' needs to the exclusion of acknowledging one's own.
3. Anxiety and boundary distortions around intimacy and separation.
4. Enmeshment in relationships with personality disordered, chemically dependent, other co ‐ dependent, and/or impulse ‐ disordered individuals.
5. Three or more of the following:
   1. Excessive reliance on denial
   2. Constriction of emotions (with or without dramatic outbursts)
   3. Depression
   4. Hypervigilance
   5. Compulsions
   6. Anxiety
   7. Substance abuse
   8. Has been (or is) the victim of recurrent physical or sexual abuse
   9. Stress ‐ related medical illnesses
   10. Has remained in a primary relationship with an active substance abuser for at least two years without seeking outside help.

Controversies

Some scholars believe that codependency is not a negative trait, and does not need to be treated, as it is more likely a healthy personality trait taken to excess. Codependency in nonclinical populations has some links with favourable characteristics of family functioning.^[32] Stan Katz states that codependence is over-diagnosed, and that many people who could be helped with shorter-term treatments instead become dependent on long-term self-help programs.^[33] The language of, symptoms of, and treatment for codependence derive from the medical model suggesting a disease process underlies the behavior. However, there is no evidence that codependence is caused by a disease process.

In their book, “Attached.”, Dr. Amir Levine and Rachel S. F. Heller, address what they call the “codependency myth” by asserting that attachment theory is a more scientific and helpful model for understanding and dealing with attachment in adults.^[34]

See also

References

Further reading

• Cermak M.D, Timmen L., Diagnosing and Treating Co-Dependence: A Guide for Professionals Who Work with Chemical Dependents, Their Spouses, and Children (Professional Series), 1998, Hazelden Publishing, Minnesota, ISBN 978-0935908329
• CoDA, Co-Dependents Anonymous, 1997, CoDA Resource Publishing, Phoenix, ISBN 978-0964710504
• Beattie, Melody Codependent No More: How to Stop Controlling Others and Start Caring for Yourself, 1986, Hazelden, Minnesota, ISBN 978-0894864025
• Whitfield M.D., Charles L.,Healing The Child Within: Discovery and Recovery for Adult Children of Dysfunctional Families, 1987, Health Communications, Inc., Florida, ISBN 978-0932194404
• Lancer, Darlene, Conquering Shame and Codependency: 8 Steps to Freeing the True You, 2014, Hazelden, Minnesota, ISBN 1616495332

External links

• Codependency support: general at DMOZ
• Codependency support: co-alcoholic at DMOZ
• Codependency support: borderline personality disorder at DMOZ