Treating Codependency the Current Diagnostic and Statistical

¶ … Treating Codependency

Codependency

The current Diagnostic and Statistical Manual of Mental Disorders (2000) does not contain a section describing the symptoms of codependency. The closest in terms of symptoms is dependent personality disorder (301.6); however, a diagnosis with this disorder implies the symptoms are interfering with the person's ability to function in a way that would be consistent with cultural norms and realistic expectations. Despite this caveat, the symptoms associated with dependent personality disorder can be instructive.

A person with dependent personality disorder may (1) need the assistance of others to help them make decisions, (2) will prefer to let other take responsibility for their own lives, (3) tend to go along with what others decide to avoid loss of support, (4) lack sufficient self-confidence to initiate their own activities, (5) are capable of engaging in demeaning tasks in order to gain or retain the support and nurturance of others, (6) find being alone difficult, (7) will quickly find another support person to fill a recent void, and (8) be preoccupied with fears about being left to fend for themselves (American Psychiatric Association, 2000). If five of the above symptoms are met, then the patient would be diagnosed as having this disorder.

Despite its lack of support from the American Psychiatric Association, finding a therapist to treat the condition is not difficult in urban America and other developed countries. This lack of recognition is probably the reason there are as many definitions of codependency as there are therapists treating this condition. One definition defines codependency as a personality style with passivity, low self-esteem, and the need to help others (GoodTherapy.org, 2013), which is significantly different from the symptoms of dependent personality disorder. Another defines this condition as delayed identity development that culminates in adult behaviors characterized by addiction to an out-of-control significant other (Ballis, n.d.). This latter definition implies that a childhood populated by an out-of-control adult, such as an alcoholic parent, fosters the need to mate with and control an alcoholic spouse in adulthood. A common thread that runs through the informal definitions of codependency is the association with addicts in childhood and adulthood, although some have expanded the definition to include any spouse with behavioral problems, including domestic violence, gambling, workaholics, and the mentally ill (Dear, 1996).

An important trait associated with codependency is an inability to be intimate with another person (Ballis, n.d.; GoodTherapy.org, 2013). Intimacy requires an ability to identify and express felt emotions, along with maintaining healthy boundaries. Only then can a person care about others or commit to a relationship based on love. An example of this would be parents disagreeing about what religion their children should be brought up in and spending the time and energy to fully express their feelings before deciding what to do. In contrast, codependents have a difficult time accessing their emotions, let alone expressing them in a health way. The result is an avoidance of expressing their own needs and conflict, out of fear that the relationship they depend on might disintegrate.

An Imperfect Model

Despite the widespread popular acceptance of codependency as a behavioral disorder, it remains controversial among academics. As Dear (1996) points out, this disease or disorder has been defined and treated in the absence of any empirical evidence supporting its existence as a distinct mental illness. In essence, codependency is nothing new and as a model it may be doing more harm than good. For example, the coping patterns of codependents are not unique or necessarily pathological and the term codependent is demeaning to women given its original definition as the female spouse of an alcoholic or drug addict.

In particular, Dear (1996) criticizes the use of a codependency model in the area of domestic violence interventions. The term implies that the victimized spouse is at fault for not ending the relationship. Since this is frequently a woman, outdated gender stereotypes tend to be reinforced. The use of a codependency model also reinforces the victim's low self-esteem, distorts what is really occurring, shifts responsibility for the violence to the victim, and makes it harder to seek the help of others. What domestic abuse victims need instead, argues Dear, is a clear message that they are not responsible for the violent acts perpetrated against them and that their fears and concerns about escaping the situation are valid. The codependency model is also problematic because is excludes gender and socialization factors that contribute to a domestic violence situation. In other words, the codependency model is not only inadequate, unscientific, and outdated, but also causes harm when it blames the victims for remaining in the abusive relationship.