codependency and therapy Codependency is a concept that refers to a specific type of dysfunctional relationship, often occurring among people who care for or support those with an addiction. While codependency is not a disease appearing in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it was previously considered for admission as a personality disorder. According to an article appearing in Alcoholism Treatment Quarterly, codependency was rejected as a distinct and separate diagnosis. Despite this, the concept of codependency has been used by many mental health professionals, organizations, and individuals to describe an unhealthy relationship pattern, and codependency continues to be a commonly used term, particularly among Alcoholics Anonymous and other related organizations.

Codependency is generally described as a tendency to be overly concerned with the wellbeing of others to the detriment of oneself. According to the National Library of Medicine, people who follow this relationship pattern tend to be controlling, have low self-esteem, are overly compliant, seem overly sensitive, and remain loyal to people who haven’t earned their loyalty. Since the term’s rise in popularity, it has been criticized for pathologizing normal emotional responses among people in helping roles.

The concept of codependency was first developed by mental health professionals to describe a pattern seen among the families of those suffering from alcoholism, in which an individual indirectly supports or encourages another’s addiction by enabling that person’s poor choices or irresponsibility. This term was eventually expanded to describe this same type of relationship seen among not only the families of alcoholics, but also people with other addictions, mental health disorders, or other serious problems.

Symptoms of Codependency

 

Because codependence is not a formal diagnosis, the definition of the term grew organically out of a combination of informal observations and formal research. Co-Dependents Anonymous, a support group founded on the principals of Alcoholics Anonymous, lists several clusters of common characteristics of people in codependent relationships, including denial, low self-esteem, compliance, control, and avoidance. Characteristics within each of these groupings include:

  • Denial

    • Low awareness of one’s own emotions, or denial of how one is feeling
    • Thinks of oneself as unselfish and completely dedicated to others
    • Lack of empathy and awareness for others’ feelings
    • Sees others as having the same negative traits as oneself
    • Believes one can take care of oneself without help
    • Uses defenses, such as humor or anger, to hide one’s feelings
    • Avoids direct confrontation
    • Refuses to acknowledge the unavailable nature of the people one is attracted to

  • Low self-esteem

    • Struggles to make decisions
    • Judges one’s own thoughts, feelings, and actions harshly
    • Feels embarrassed when given positive attention
    • Sees the opinions of others as being more valuable than one’s own opinions
    • Feels unlovable or not worthwhile
    • Seeks out the praise and recognition of others as a way of relieving feelings of inadequacy
    • Struggles to acknowledge mistakes
    • Cannot identify or express personal wants and needs
    • Depends on others to provide a sense of safety
    • Struggles to complete projects or meet deadlines
    • Has difficulty prioritizing and setting boundaries

  • Compliance

    • Remains in harmful relationships and situations too long
    • Betrays one’s own morals or values to avoid angering others
    • Ignores one’s interests to do what others want
    • Takes on the feelings of others
    • Fears expressing feelings or beliefs that differ from others
    • Replaces emotional intimacy with sexual intimacy
    • Ignores the consequences of one’s actions

  • Control

    • Doesn’t believe others can take care of themselves
    • Tries to control the thoughts, feelings, or actions of others
    • Gives advice without being asked
    • Is resentful of those who reject advice
    • Gives excessive gifts to others as a way of gaining affection
    • Uses sexuality to gain attention and approval
    • Must feel needed by others
    • Expects others to meet personal needs
    • Attempts to convince others of one’s capacity to be caring and compassionate
    • Blames or shames other people to exploit personal emotions
    • Will not cooperate or negotiate
    • Manipulates outcomes through indifference, helplessness, authority, or rage
    • Pretends to agree with others to get what is desired

  • Avoidance

    • Acts in ways that cause rejection from others
    • Judges others harshly
    • Avoids intimacy
    • Allows the addictions of others to dominate
    • Avoids conflict through indirect or evasive communication
    • Refuses to participate in recovery that would allow health relationships
    • Ignores personal needs or feelings in order to avoid vulnerability
    • Pushes others away despite desiring relationships
    • Sees emotions as weakness

Causes of Codependency

 
According to an article published by American Family Physician, codependency develops as a way to cope with a stressful family situation involving a secret that is seen as shameful, such as addiction or mental illness. This situation causes family members to adopt unhealthy helping roles as a way to compensate for the illness.

Another recent article reports that when the concept of codependency was first developed, the term was applied exclusively to women. It has since, of course, been demonstrated that men can also be codependent. Children are at an increased risk for developing codependent relationships, especially if a parent is in a codependent relationship or suffers from addiction or mental illness. Codependency can develop as a pattern within families, continuing from one generation to the next as children learn codependency from their parents.

Codependency and Addiction

 
Codependent relationships can be detrimental to everyone involved. A codependent individual enables someone suffering from addiction to continue abusing substances by consistently compensating for the addicted individual’s poor choices. The codependent person’s support allows the addicted person to avoid dealing with the full consequences of substance use. Subsequently, the codependent person gains a sense of identity and security from the addicted person’s reliance.

This cycle of codependence and addiction creates a relationship in which neither individual is encouraged to recover from their respective issues. Addiction is maintained, and the unhealthy thoughts and beliefs of the codependent person are not addressed. Because this relationship pattern is common among the families and loved ones of people suffering from addiction, treatment for substance use disorders sometimes includes the support system of the addicted individual. Providing mental health treatment to everyone caught in this cycle of codependence can encourage recovery from addiction, as the enabling behaviors of the codependent person are stopped.

Treating Codependency

 
Psychological and interpersonal struggles such as codependence are generally treated through psychotherapy, also called talk therapy. One of the most commonly employed models of therapy that is consistently supported by research is Cognitive Behavioral Therapy. According to the National Institute of Mental Health, Cognitive Behavioral Therapy attempts to alter a person’s feelings and beliefs by analyzing unhelpful patterns of thought and behavior, and establishing new, healthier patterns.

Family-focused therapy is also commonly employed and can be very helpful for people in codependent relationships, as the entire family unit is typically affected by unhealthy relationship patterns. Family-focused therapy treats mental health disorders by repairing and strengthening relationships between family members, and teaching healthy ways to communicate wants and needs so loved ones can support an individual who is suffering without falling into unhealthy patterns, such as codependency.

While the concept of codependency was first formed by individuals involved with Alcoholics Anonymous, Co-Dependents Anonymous, or CoDA, is a branch of AA dedicated to those dealing with codependency issues. Many people find self-help methods and support networks like CoDA to be very helpful in dealing with codependency.