Codependency

In psychology, codependency is a theory that attempts to explain imbalanced relationships where one person enables another person's self-destructive behavior,<ref>Template:Cite book</ref> such as addiction, poor mental health, immaturity, irresponsibility, or under-achievement.<ref name="BPDFamily">Template:Cite news</ref>

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.<ref>Template:Cite journal</ref>

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.<ref>Template:Cite journal</ref>

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".<ref name="cermak-1986b">Template:Cite journal</ref><ref>Template:Cite book</ref> 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.<ref name="Davis08">Template:Cite book</ref> 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.<ref>Template:Cite book</ref>

In 1986, psychiatrist Timmen L. Cermak published Diagnosing and Treating Co-Dependence, from which he developed the unsuccessful argument that codependency should be diagnosable as a personality disorder in people who maintained relationships with "personality disordered, chemically dependent, other co-dependent, and/or impulse disordered individuals."<ref name=":1">Template:Cite book</ref><ref name="cermak-1986b" /><ref>Template:Cite journal</ref><ref name="jmorgan">Template:Cite journal</ref>

Melody Beattie popularized the concept of codependency in 1986 with the bestselling book Codependent No More,<ref>Template:Cite web</ref> which drew on her personal experience in recovery and as a caregiver for somebody with a substance use disorder and interviews with members of Al-Anon, a support group for family members of alcoholics. Beattie's work formed the basis for the development of a twelve-step organisation called Co-Dependents Anonymous, founded in 1986.<ref name="Irving 1999 30">Template:Cite book</ref>

Definition

Codependency has no established definition or diagnostic criteria within the mental health community.<ref name="advpsych">Template:Cite book</ref><ref name="sanderson">Template:Cite journal</ref> It has not been included as a condition in any edition of the DSM or ICD.

A 1994 review of the literature on codependency found that there was no consensus on a clear definition of the term, that the concept lacked empirical validation across the surveyed articles, and that most authors who attempted to define codependency instead conflate that task with developing theories about its nature and origins.<ref name="Hands-101994">Template:Cite journal</ref><ref name="Dear-2004">Template:Cite journal</ref> A 2004 survey that sought to clarify the definition of codependency, as a prelude to evaluating it as a possible psychological diagnosis, found that definitions within surveyed papers varied significantly, but tended to identify as core elements high self-sacrifice, a focus on others' needs, suppression of one's own emotions, and attempts to control or fix other people's problems.<ref name="Dear-2004" />

According to psychiatrist Timmen Cermak, the concept of codependency carries three different levels of meaning:Template:Sfn

• 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.<ref>Template:Cite book</ref>
• A psychological concept, a shorthand means for health professionals to describe and explain certain behavior with each other.<ref name="Klostermann-052013">Template:Cite journal</ref>
• A psychological disorder, implying that there is a consistent pattern of traits or behaviors across individuals that can create significant dysfunction.<ref name="Klostermann-052013" /><ref>Template:Cite book</ref>

Writer 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."<ref>Template:Cite book</ref>

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.<ref name="dummies">Template:Cite book</ref>

In the Medical Subject Heading (MeSH) vocabulary maintained by the U.S. National Library of Medicine, 'Codependency' is described for indexing purposes as "a relational pattern in which a person attempts to derive a sense of purpose through relationships with others."<ref>Template:Cite web</ref> This reflects usage in the literature rather than an official definition.

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,"<ref name=":0">Template:Cite web</ref> but provides a list of "patterns and characteristics of codependence" that can be used by laypeople for self-evaluation.<ref>Template:Cite web</ref><ref name="patterns">Template:Cite web</ref> The community health organization, Mental Health America, characterizes codependency as "relationship addiction" based upon its association with low self-esteem, and with patterns of unhealthy and abusive relationships.<ref>Template:Cite web</ref>

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.<ref>Template:Cite journal</ref>

Romantic 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.<ref name="lancer">Template:Cite book</ref>

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.<ref name="webmd">Template:Cite web</ref>Template:Better source needed

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.<ref name="lancer"/> 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.<ref>Template:Cite journal</ref> Generally, a parent who takes care of their own needs (emotional and physical) in a healthy way will be a better caregiver, 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.<ref>Template:Cite journal</ref>

Relationship with other disorders

Codependency may occur within the context of relationships with people with DSM and ICD 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."<ref name="Danielle">Template:Cite web</ref><ref>Template:Cite book</ref> A 2017 study found that 45% of assessed codependent people were also borderline.<ref name=":2">Template:Cite journal</ref>
• 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.<ref>Simon Crompton, All About Me: Loving a Narcissist (London 2007) pp. 157, 235</ref> A codependent person can provide the narcissist with an obedient and attentive audience.<ref>Crompton, p. 31</ref> 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.<ref>Template:Cite journal</ref>

Of the commonly recognised personality disorders, codependency is most similar to dependent personality disorder."<ref name=":1" /><ref name=":3">Template:Cite journal</ref> A 2017 study found that only 14.5% of codependent people assessed were also dependent.<ref name=":2" /> The two conditions differ in important ways.<ref name=":1" /><ref name=":3" /> A dependent person seeks satisfaction from someone else running their life, while a codependent person seeks satisfaction from running someone else's life to that person's satisfaction. Both have a weak ego and prioritise the stronger ego of another person, but one wishes to be passive and the other active.

Psychiatrist Karen Horney defined the concept of morbid dependency in her 1942 book Self-Analysis, later expanding on it in her 1950 book Neurosis and Human Growth. Others later associated this condition with codepedency.<ref>Template:Cite book</ref><ref>Template:Cite book</ref>Template:Better source needed

Codependency can be seen as a form of learned helplessness<ref>Template:Cite journal</ref> and pathological altruism.<ref>Template:Cite book</ref>

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.<ref>Template:Cite journal</ref> 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.<ref>Template:Cite journal</ref>

Individuals who identify with codependency may benefit from psychotherapy, including cognitive behavioral therapy and mindfulness practices.<ref>Template:Cite journal</ref>Template:Better source needed

Many self-help guides have been written on the subject of codependency.<ref>Template:Cite journal</ref> 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.<ref name="COLLET1990">Template:Cite journal</ref>

Controversy

As codependency is not clinically diagnosable as a mental health condition, there is no medical consensus as to its definition,<ref name="advpsych" /> and no evidence that codependency is caused by a disease process,<ref>Template:Cite journal</ref> the term becomes easily applicable to many behaviors and has been overused by some self-help authors and support communities.<ref name= kaminer>Template:Cite web</ref> 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.<ref>Template:Cite web</ref>

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<ref>Template:Cite journal</ref> diseases, as well as the pathologizing of personality characteristics associated with women.<ref name=Anderson>Template:Cite journal</ref> 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.<ref>Template:Cite journal</ref>

References

Cited works

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Further reading

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