What is Co-Dependency?

Because of all the questions generated by the articles on co-dependency, we would like to answer some of these questions and to explain in further detail what co-dependency actually is and some of the definable symptoms.

Co-dependency is a set of maladaptive, compulsive behaviors learned by family members in order to survive in a family which is experiencing great emotional pain and stress. These behaviors are passed on from generation to generation whether alcoholism is present or not. In other words, the original alcoholic or drug dependent person may have been a great grandfather. No one else for three or four generations may actually become alcoholic but most family members within those three or four generations have learned to use a set of behaviors which help them deal with the emotional pain and stress inherited from the original alcoholic family member and which continues to create emotional pain and stress even to the present time. This set of behaviors eventually becomes co-dependency or dependency disorders.

Some of these dependency disorders are: perfectionism, workaholism, procrastination, compulsive lying, compulsive talking, dependent relationships or over-possessiveness in relationships. Other dependency disorders can be dependency on acquiring status, prestige, material possessions, power or control to the extent that one's behavior causes problems in social interactions with family members, co-workers, friends, authority figures, etc. In addition, persons suffering from alcohol or drug related co-dependency or one of the other dependency disorders often experience themselves being caught up in a kind of treadmill existence so that whether or not goals are achieved, there is still a driven compulsion for more: an anxious feeling of incompleteness or emptiness remains no matter what is accomplished.

Health problems can also exist such as migraine headaches, gastro-intestinal disturbances, colitis, ulcers, high blood pressure and many other high stress related physical illnesses. Emotional problems such as depression anxiety, insomnia and hyperactivity are evident in many co-dependents.

Co-dependency and other dependency disorders result in:

1. Inability to know what is "normal" behavior
2. Difficulty in following a project through
3. Difficulty in knowing how to have fun
4. Judging self without mercy and having low self-esteem
5. Difficulty in developing or sustaining meaningful relationships
6. Over-reacting to change
7. Constantly seeking approval and affirmation, yet having no sense of self-identity
8. Feelings of being different
9. Confusion and sense of inadequacy
10. Being either super-responsible or super-irresponsible
11. Lack of self-confidence in making decisions, no sense of power in making choices.
12. Feeling of fear, insecurity, inadequacy, guilt, hurt and shame which are denied.
13. Inability to see alternatives to situations, thus responding very impulsively.
14. Isolation and fear of people, especially authority figures.
15. Fear of anger and criticism.
16. Being addicted to excitement.
17. Dependency upon others and fear of abandonment.
18. Confusion between love and pity.
19. Tendency to look for "victims" to help.
20. Rigidity and need to control.
21. Lies, when it would be just as easy to tell the truth.

It is very important to say that not everyone who experiences some of these symptoms is suffering from co-dependency or other dependency disorders. However, if you strongly identify with or are actually experiencing several of these symptoms, you may want to seek professional assistance in evaluating the extent of your problem.

Diagnostic Criteria for Co-Dependency

In order to provide a basis for empirical studies of co-dependency, I suggest the following DSM-III style diagnostic criteria:

The essential features of co-dependency include:

1. Continued investment of self-esteem in the ability to influence or control feelings and behavior in oneself and others in the face of obvious adverse consequences.
2. Assumption of responsibility for meeting another's needs to the exclusion of acknowledging one's own needs.
3. Anxiety and boundary distortions in situations of intimacy and separation.
4. Enmeshment in relationships with personality disordered, chemically dependent and impulse disordered individuals.
5. Exhibiting at least three of the following:
   1. Constriction of emotions (with or without dramatic out bursts)
   2. Depression
   3. Hypervigilance
   4. Compulsions
   5. Anxiety
   6. Excessive reliance on denial
   7. Substance abuse
   8. Recurrent victim of physical or sexual abuse
   9. Remaining in a primary relationship with an active substance abuser for at least two years without seeking outside support

Criterion A is a combination of characteristics found in Alcohol Dependence (303.9x) and Dependent Personality Disorder (301.60). Repeated efforts to control both the amount of alcohol ingested and the effects of ingested failure of such efforts, lie at the core of active alcohol dependence. The failures of one's efforts to control the situation are interpreted as signs of an unrealistic sense of what can actually be controlled by force of will. Co-dependents develop a lack of self-confidence and low self-esteem characteristic of Dependent Personality Disorder because they have literally invested their self-esteem in the behavior of others. They suffer from the distorted relationship to will power seen in alcoholics, and therefore invest inordinate amounts of energy in efforts to fix other people in their search for a semblance of self-worth.

Criterion B is borrowed directly from Dependent Personality Disorder

Criterion C is closely related to Borderline Personality Disorder (310.83), in which identity disturbances and problems of toleration being alone are characteristic. It is during moments when the distance from other people is being lengthened or shortened that co-dependents often become acutely anxious. Unlike true borderlines, who are unable to maintain clear ego boundaries at such times, co-dependents voluntarily blur their boundaries in their search for intimacy.

Criterion D combines the pattern of unstable and intense interpersonal relationships seen in Borderline Personality Disorder with the characteristic disturbances in interpersonal relationships seen in Histrionic Personality Disorder (305.50) (e.g., romantic fantasy, emotional excitability and role caricature). The term "enmeshment" implies a quality to such relationships which stems from the voluntary blurring of ego boundaries mentioned under Criterion C.

Criterion E is a list of associated features. It will undoubtedly be improved by empirical studies of co-dependency based on the preceding criteria. Three points are worth making in regard to this list:

1. Many of the symptoms in Criterion E closely parallel Post-Traumatic Stress Disorder (309.81) in which exposure to a stress of such intensity that it would generally be considered to be outside the range of normal human experience produces recognizable stress response syndromes in most individuals. The co-dependents tendency to invest self-esteem in an alcoholic or other drug addict, coupled with denial of how stressful such a relationship is, places him or her in jeopardy of stress related medical illness and stress response syndromes such as Post-Traumatic Stress Disorder.
2. Compulsions are a prominent symptom of co-dependency. Compulsivity in its most general sense implies an abrogation of responsibility for one's actions. One is acting no longer out of choice but rather of being dissociated from one's impulses, and therefore less present in the moment, is the central characteristic of compulsions, and can take many forms: phobias, eating, sex, gambling, shopping, television, exercise, prayer, and the use of drugs. The point of any compulsion is to be less fully present and responsible for one's self. Too often a therapist's attention is given primarily to the object or activity to which the compulsivity is connected, rather than to the function of the compulsion, which is escape from being authentic. Such a mistake is particularly to lead to symptom substitution.
3. When co-dependents drink compulsively, we call them alcoholics. It is a disservice to make large distinctions between alcoholics and co-dependents. Such distinctions lead to confusions among family members regarding what is "alcoholic thinking" versus "co-dependent thinking", when all family members employ precisely the same thought distortions. The implications of seeing all chemical dependents as co-dependents as well will be explored in the next section.

Excerpts Taken From:

Special Article: "Diagnostic Criteria For Co-Dependency", Timmen L. Cermak M.D.

Published concurrently in "Journal of Psychoactive Drugs, January - March 1986

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