Codependency

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]

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] 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]

Lack of formal 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.

The concept of codependency carries three different levels of meaning:^[16]

• 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.^[17]
• A psychological concept, a shorthand means of describing and explaining human behavior.^[18]
• A psychological disorder, implying that there is a consistent pattern of traits or behaviors across individuals that can create significant dysfunction.^[18][19]

Discussion of codependency tends to approach the subject as a 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 Due to the lack of such agreement, there is no established definition or diagnostic criteria of "codependency" 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]

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."^[21] Therapist and self-help author Darlene Lancer expresses 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.^[22]

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,"^[23] but provides a list of "patterns and characteristics of codependence" that can be used by laypeople for self-evaluation.^[24][25] The community health organization, Mental Health America characterizes it as a form of "relationship addiction" in the sense that affected people have low-self esteem and high neediness, seeking fulfillment from external factors such as being needed by someone else, a situation that turns codependent when that someone is a dysfunctional family member.^[26]

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.^[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]

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.^[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]

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."^[35]
• 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.^[36] A codependent person can provide the narcissist with an obedient and attentive audience.^[37] 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.^[38]

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.^[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]

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.^[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]

Controversy

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]

See also

• Alcoholism in family systems
• Adult Children of Alcoholics
• Attachment theory
• Anxious-preoccupied attachment style
• Codependents Anonymous
• Dependent personality disorder