Codependency

Codependency is a behavioral condition in a relationship where one person enables another person's addiction, poor mental health, immaturity, irresponsibility, or under-achievement.[1] Among the core characteristics of codependency is an excessive reliance on other people for approval and a sense of identity.[1] Definitions of codependency vary, but it is generally defined as a subclinical, situational, and/or episodic behavioral condition similar to that of dependent personality disorder. The term is less individually diagnostic and more descriptive of a relationship dynamic.[1]

History

The idea of codependency 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.[2]

The term codependency 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."[3] The term “codependent” is used to describe how family members and friends might actually interfere with recovery by overhelping."[4]

The application of this term was very much driven by the self-help community.[5] 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 48 weeks.[5] 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.[5] Melody Beattie popularized the concept of codependency in 1986 with the book Codependent No More which sold eight million copies.[6] 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).[7] Cermak's book paved the way for a Twelve-step take-off program, called Co-Dependents Anonymous.[8] The first Co-Dependents Anonymous meeting was held October 22, 1986.[8]

Definition

"Dependency" is well-established in psychological literature. Early psychoanalytic theory emphasized the oral character and structural basis of dependency, social learning theory considers a tendency to be acquired by learning and experience, and ethological attachment theory posits that attachment or affectional bonding is the basis for dependency.

Codependency

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 cause significant impairment in functioning or cause significant distress, it warrants a personality disorder diagnosis. Cermak's definition was published in the Journal of Psychoactive Drugs in 1986[9] and is the most detailed definition in peer reviewed literature.

Cermak proposed the following criteria for this disorder:[9]

  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, 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.

Codependency has not been included in the Diagnostic and Statistical Manual of Mental Disorders; DSM-III-R or later versions.

Dependent personality disorder

Dependent personality disorder is included in 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 the 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.[10]

Behaviors and characteristics

Individual dynamics

A codependent is someone who cannot function on their own and whose thinking and behavior is instead organized around another person, process, or substance.[11] 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.[12]

Romantic relationship dynamics

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]

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.[13]

Commonly observable characteristics of codependency are:[1][14]

In a codependent relationship, the codependent person's sense of purpose 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.[15] 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.[16] 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. Further, the codependent may gain a sense of worth by being "the sane one" or "the responsible one".[17]
  • Narcissistic personality disorder – codependents of narcissists are sometimes called co-narcissists.[18] 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.[19] Codependents can provide the narcissist with an obedient and attentive audience.[20] 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.
Codependent or impulse-disordered individuals and codependent pairing[9]

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.[13] 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.[12] 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.[12] Codependent relationships often manifest through enabling behaviors, especially between parents and their children.[21] 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.[22] 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.[23][24] 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.[25] 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.[23] 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.[23][24] 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.[23] 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).[23] 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.[23] A victim mentality may also occur in combination with passive–aggressive control issues.[23] 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.[23]

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.[26] People with codependency are also 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.[26] 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.[26] Other stress-related disorders like panic disorder, depression or PTSD may also be present.[26]

Controversy

While 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), it was not accepted by the committee and, as such, no medical consensus exists on the definition of codependency.[1]

With no definition, the term is easily applicable to many behaviors and has been overused by some self-help authors and support communities.[27]

Some clinicians think that the term codependency has been overused by the general populace and labeling a patient as codependent can be confusing and may even shame them rather than help them focus on how their traumas shape their current relationships.[28]

Codependency is a theory. There is no evidence that codependence is caused by a disease process.[29] Attachment theory may be a more helpful model for understanding and dealing with attachment in adults.[30]

Codependency does not refer to all caring behavior or feelings, but only those that are excessive to an unhealthy degree.[23] Some scholars and treatment providers think 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.[31]

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See also

References
  1. Johnson, R. Skip (13 July 2014). "Codependency and Codependent Relationships". BPDFamily.com. Retrieved 9 September 2014.
  2. Rotunda, Ph.D, Robert J. "Codependency". University of West Florida.
  3. Davis, Lennard J. (2008). Obsession: A History. London: University of Chicago Press. p. 178. ISBN 978-0-226-13782-7.
  4. Hendriksen, Ellen. "Is Your Relationship Codependent? And What Exactly Does That Mean?". Scientific American. Scientific American. Retrieved 12 January 2017.
  5. Travis, Trish (2009). The Language of the Heart, A Cultural History of the Recovery Movement from Alcoholics Anonymous to Oprah Winfrey. Chapel Hill, N.C.: University of North Carolina Press. p. 168. ISBN 978-0-8078-3319-3.
  6. J. S. Rice, A Disease of One's Own (1998) p. 2
  7. Morgan Jr., JP (1991). "What is codependency?". J Clin Psychol. 47 (5): 720–9. doi:10.1002/1097-4679(199109)47:5<720::aid-jclp2270470515>3.0.co;2-5. PMID 1939721.
  8. Irving, Leslie (1999). Codependent Forevermore, The Invention of Self in a Twelve Step Group. Chicago: University of Chicago Press. p. 30. ISBN 978-0-226-38471-9.
  9. Cermak M.D., Timmen L. (1986). "Diagnostic Criteria for Codependency". Journal of Psychoactive Drugs. 18 (1): 15–20. doi:10.1080/02791072.1986.10524475. PMID 3701499.
  10. Sperry, M.D., Ph.D, Len (13 May 2013). Handbook of Diagnosis and Treatment of DSM-IV Personality Disorders. Kentucky: Routledge. p. 108. ISBN 9780415935692.CS1 maint: multiple names: authors list (link)
  11. Lancer, Darlene (2012). Codependency for Dummies (1st ed.). New Jersey: John Wiley & Sons, Inc. p. 30. ISBN 978-1118095225.
  12. Codependents Anonymous: Patterns and Characteristics Archived 2013-08-24 at the Wayback Machine
  13. Lancer, Darlene (2014). Conquering Shame and Codependency: 8 Steps to Freeing the True You. Minnesota: Hazelden. pp. 63–65. ISBN 978-1-61649-533-6.
  14. Winning Teams: Definitions in Psychology, Dr. David Thomas PhD
  15. Wetzler, PhD, Scott. "Psychology division chief at Albert Einstein College of Medicine". WebMD. Retrieved 5 December 2014.
  16. Reynolds, Rick (2014-08-19). "Why Is Codependency A Serious Problem For Relationships?".
  17. Danielle, Alicia. "Codependency and Borderline Personality Disorder: How to Spot It". Clearview Women's Center. Archived from the original on 7 December 2014. Retrieved 5 December 2014.
  18. Rappoport, Alan, PhD. Co-Narcissism: How We Adapt to Narcissistic Parents. The Therapist, 2005.
  19. Simon Crompton, All About Me: Loving a Narcissist (London 2007) p. 157 and p. 235
  20. Crompton, p. 31
  21. "Are You Enabling?". Ambrosia Treatment Center. 2016-02-11. Retrieved 14 August 2017.
  22. Gomberg, Edith S Lisansky (1989). Gomberg, Edith S (ed.). On Terms Used and Abused: The Concept of 'Codependency'. Drugs & Society. 3. pp. 113–32. doi:10.1300/J023v03n03_05. ISBN 978-0-86656-965-1.
  23. Moos, R.H.; Finney, J.W.; Cronkite, R.C. (1990). Alcoholism Treatment: Context, Process and Outcome. New York: Oxford University Press. ISBN 978-0-19-504362-4.
  24. Affleck, Glenn; Tennen, Howard; Croog, Sydney; Levine, Sol (1987). "Causal attribution, perceived benefits, and morbidity after a heart attack: An 8-year study". Journal of Consulting and Clinical Psychology. 55 (1): 29–35. doi:10.1037/0022-006X.55.1.29. PMID 3571655.
  25. Collet, L (1990). "After the anger, what then? ACOA: Self-help or self-pity?". Family Therapy Networker. 14 (1): 22–31.
  26. "Codependence", in: Benjamin J. Sadock & Virginia A. Sadock (eds), Kaplan & Sadock's Comprehensive Textbook of Psychiatry on CD, Philadelphia: Lippincott Williams & Wilkins, 7th ed. 2000, ISBN 0-7817-2141-5, ISBN 2-07-032070-7.
  27. Kaminer, Wendy (1990). "Chances Are You're Codependent Too".
  28. Pikiewicz, Kristi. ""Codependent" No More?".
  29. Chiauzzi; Liljegren (1993). "Taboo topics in addiction treatment. An empirical review of clinical folklore". Journal of Substance Abuse Treatment. 10 (3): 303–16. doi:10.1016/0740-5472(93)90079-H. PMID 8315704.
  30. Levine, Amir; Heller, Rachael S. F. (2010). Attached. New York, New York: Tarcher/Penguin. pp. 56–61. ISBN 9781101475164.
  31. Anderson, S.C. (1994). "A critical analysis of the concept of codependency". Social Work. 39 (6): 677–685. PMID 7992137.

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
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