What is codependency?

Causes

Common causes of codependency include being a child of a drug or alcohol abuser or coming from a home that is dysfunctional in other ways.

Risk Factors

Persons who were exposed to a dysfunctional family situation as a child are at risk for developing codependency. This risk is attributed to the difficult realities and premature responsibilities that made it challenging for the child to cope. This risk also is attributed to the lack of role models to demonstrate the appropriate management of emotions and behavior.

Symptoms

There is no universally accepted list of symptoms of codependency; symptoms can vary from person to person and are described differently by different sources. A key characteristic of many codependent persons is caretaking, or feeling responsible for other people and feeling excessively compelled to help other people solve their problems. This can result in overcommitment and a feeling of being constantly under pressure.

Even though codependent persons will take on excessive responsibilities, they also often blame others for their own negative feelings and for their situation. Conversely, some participants in codependent relationships may become extremely irresponsible.

Codependent persons often have feelings of low self-worth, will generally blame themselves for many situations, and will have trouble receiving compliments or praise. Low self-worth is often associated with feelings of guilt as well.

Codependent persons can engage in denial, or “pretending” that uncomfortable situations or feelings are not happening. They also can seem to be rigid and controlled; this can be a result of not wanting to deal with uncomfortable emotions, such as fear and guilt.

It is not uncommon for codependent persons to obsess about specific people or problems and to perceive themselves as unable to get things done or have a “normal” life because of these people or problems. They also tend to feel unable to be comfortable or happy with themselves and, as a result, seek happiness from external sources. They often worry that they will be left alone or abandoned and may tolerate abuse in relationships because of this fear. A term often used in association with codependence is poor boundaries, meaning that people who are codependent may allow others to treat them inappropriately or to hurt them.

Codependent persons often feel unable to trust themselves or others. They have not learned effective ways to communicate and may use such manipulative strategies as blaming and begging to get what they want from others. They often are uncomfortable with angry emotions.

Codependent persons often are described as engaging in “enabling” behavior, meaning that they enable the person with whom they are in an unhealthy relationship to continue behaviors that are harmful for both of them. For example, an enabler might continue to “cover” for an alcoholic who frequently engages in binge drinking. In such as case, the codependent person might contact the person’s place of employment to call in sick for that person or to otherwise lie to help him or her avoid the consequences of the behavior.

People who struggle with codependency for a long period of time may feel withdrawn and depressed and may even consider suicide. They also may become addicted to alcohol, drugs, or other harmful behaviors, such as compulsive or binge eating.

Authors on codependency have identified several ways to broadly categorize patterns that are typical of the condition. For example, the three dimensions of the personality of an addict, as identified by C. Robert Cloniger, are described as novelty seeking, harm-avoidance, and reward-dependence. Codependent persons may gravitate toward either extreme of these dimensions.

In the case of novelty seeking, codependent persons can be high novelty-seeking, exhibiting impulsive behaviors, or low novelty-seeking, with a rigid style of coping. In the reward-dependence dimension, codependent persons can be either eager to help others or appear socially detached and self-willed. In the harm-avoidance dimension, codependent persons can be either excessively pessimistic or anxious, or they can be overconfident and eager to take risks.

Codependent behaviors also have been explained, originally by Sharon Wegscheider-Cruse, in terms of “survival roles” in the family or relationship that arise from a dysfunctional environment. Survival roles include the “family hero,” who takes on tremendous responsibilities; the “family scapegoat,” who accepts blame; the “lost child,” who remains removed from most people; and the “mascot,” who attracts attention by acting inappropriately.

Screening and Diagnosis

The diagnosis of codependency is not listed in the Diagnostic and Statistical Manual of Mental Disorders, which is used by psychiatrists and other mental health professionals as a diagnostic guide.. However, several personality disorders in the manual contain elements recognized by authors on codependency as being part of the condition.

Many who write about codependency encourage the codependent person to examine his or her own behaviors to determine if he or she is codependent. Self-help groups, including Co-Dependents Anonymous (CoDA) and Nar-Anon, provide checklist-style guidelines for identifying patterns of thought and behavior that indicate codependency. For example, the CoDA patterns of codependency list includes thoughts and behaviors indicative of patterns of denial, low self-esteem, compliance, and control. Nar-Anon lists twelve common characteristics of codependency. Many mental health care professionals, particularly those who work in the area of substance abuse and addiction, are familiar with the characteristics of codependency and can help persons identify dysfunctional patterns and behaviors.

Treatment and Therapy

Mental health professionals can work with codependent persons in individual or group therapy sessions with the goal of modifying dysfunctional patterns and adopting healthy coping skills. Although much of the focus of treatment for codependency tends to be on the caretaker, it is important to note that the addict or substance abuser in the relationship is also considered to be codependent.

Experts thus suggest that the problems of abuse and addiction cannot be fully resolved if the codependency is ignored. Programs designed to address addiction often involve education for the patient and family on codependency.

Self-help programs including CoDA and Nar Anon provide support and instruction to aid the person in monitoring and modifying his or her own behaviors based on the same twelve-step model that is often employed by substance abusers and addicts in programs such as Alcoholics Anonymous and Narcotic Anonymous.

The twelve steps identified by CoDA begin with “We admitted that we are powerless over others—that our lives had become unmanageable” and progress to a final step of carrying the messages learned through the twelve steps to other codependent persons. CoDA also provides examples of patterns of recovery that can, over time, replace patterns of codependency that most likely developed over many years.

Prevention

Literature regarding the prevention of codependency is limited. However, it has been suggested that codependency might be prevented or mitigated by the early employment of healthy coping strategies to deal with dysfunctional behaviors such as drug or alcohol abuse.

Bibliography

Beattie, Melody. Codependent No More. San Francisco: HarperCollins, 1987. This internationally best-selling book describes codependency in easy-to-understand language with the aid of many examples from real life.

Co-Dependents Anonymous. “Patterns and Characteristics of Codependence.” 2010. Web. 16 Apr. 2012. http://www.coda.org/tools4recovery/patterns-new.htm. Lists common characteristics of codependency in a checklist-style format.

---. “The Twelve Steps of Co-Dependents Anonymous.” 2010. Web. 16 Apr. 2012. http://www.coda.org/tools4recovery/twelve-steps.htm. Lists the twelve steps subscribed to by CoDA members.

Cruse, Joseph R. Painful Affairs: Looking for Love through Addiction and Co-dependency. Deerfield Beach, FL: Health Communications, 1989. A physician describes the similarities between chemical dependency and codependency and provides insights into dysfunctional patterns of behavior.

Websites of Interest

Co-Dependents Anonymous

http://www.coda.org

Mental Health America

http://www.mentalhealthamerica.net/go/codependency