Effects of Stereotyping of Women in the Workplace

•December 12, 2013 • Comments Off on Effects of Stereotyping of Women in the Workplace

Women have historically earned less than men in the workforce over the past several decades. This phenomenon persists, with women in the U.S. earning approximately 77 cents on average for every dollar men earn, according to the National Women’s Law Center (2012). Over the past several decades, researchers have offered several theories explaining why women consistently earn less than men, including the idea that stereotyping has made it more difficult for women to move up in the workplace. It is interesting to review various studies that have been conducted over the years from a sociocultural standpoint, the motivation for conducting them, and how social culture with regard to women’s equality has progressed over the years.

In 1973, Linda Ellis and P.M. Bentler investigated the persistence of traditional sex-role standards and stereotypes by studying males and females who were accepting or resistant to traditional sex-role standards, as well as their perceptions of males, females, and themselves. Many women’s social and legal advances were newly established in the United States around the time this study was conducted, so it is not surprising that some researchers focused on stereotyping with regard to women in the workplace. Ellis & Bentler questioned why traditional sex-determined role standards persisted, and suspected that stereotypes were to blame. 25 years later, in 1998, Martell, Parker, Emrich, & Crawford conducted a similar study regarding executive stereotyping on a management level, and how women are perceived as compared with men by male managers using characteristics associated with executives, e.g., courage and leadership skills. Researchers Laurie Rudman and Julie Phelan took a slightly different approach in 2010, nearly four decades after Ellis & Bentler’s study, exploring priming gender roles as an influence over women’s implicit gender stereotypes, and how it affected women’s career choices, presumably to explore whether these stereotypes could be broken by priming.

Ellis & Bentler hypothesized that sex determined roles and stereotypes reinforce each other, and that stereotypes result in perceptions that males and females are better suited for certain roles. They believed that despite the persistence of sex-determined role standard stereotypes, most people are dissatisfied with said standards. Ellis & Bentler’s goal was to study the relationship between perceptions of males and females and the sex role standards as well as the standards and perceptions of the self and “typical” males and females, and to investigate whether it was personality driven. By that time, it had already been established that these sex-determined role standards stifle personality development, marital harmony, originality, achievement, and problem-solving capabilities. Because of these negative effects, it is no wonder researchers have continued to attempt to understand the persistence of stereotyping. In Martell et al.’s project, it was predicted that in the workplace, female managers would be perceived less favorably than male managers with regard to factors that are believed to be necessary for success in management positions. Similarly to the previous studies conducted, Rudman & Phelan believed that priming women with traditional stereotypes would increase their implicit gender stereotypes while decreasing leadership concepts within themselves.

To test their hypotheses, Ellis & Bentler utilized two questionnaires consisting of approximately 255 hundred items, straightforward or controversial, to determine associations between personality types and various sex stereotypes. Likewise, Martell, et al., utilized a rating scale type of questionnaire to perform their study. 297 male managers, aged 25 to 62, participated in Martell, et al.’s study. They derived 76 attributes from various executive development literature, then had 9 male executives choose what they thought were the most important attributes for managers to possess. The chosen attributes were utilized in a 7 point scale to rate successful executives, or managers, by 156 male managers. Finally, the attributes were reduced to four factors which were used for 134 males to rate male and female managers of different levels. Today, the Implicit Association Test (IAT) has become a popular method for researchers to test for implicit associations or stereotypes, and can be more efficient than using a questionnaire method. Rudman & Phelan used the IAT on 175 women to contrast “leader” and “follower” attributes for the self and others, researchers attempted to decipher whether increasing numbers of women in the workforce have impacted gender stereotypes.

Ellis & Bentler found that there was a discrepancy between the self-perception of females with high aspirations of success, as well as their perception of other females, as compared with more traditionally perceived females. I.e., females who disapproved of traditional stereotypes of women had a tendency to be more liberal, intelligent and “masculine” than their counterparts. Martell, et al.’s study resulted in an overwhelming, but not surprising, response showing that women are perceived more negatively than men when depicted as middle managers. Rudman & Phelan discovered that women who were primed by being shown pictures of women associated with nontraditional (masculine oriented) jobs, and men paired with typically feminine jobs, found women in leadership positions to be threatening. It was concluded that upward social comparison actually reduce women’s ability to see themselves with similar characteristics associated with success.

It would appear that females who are liberally minded and success driven face discouragement, not only by stereotyping pressures, but by their own self-doubt. Martell et al. grimly note that there is good reason women should feel threatened—because they are largely viewed as incompetent for management positions. Rudman & Phelan’s study further demonstrated that women face a double threat in that whether women are primed, or exposed to successful women in nontraditional occupations, or exposed to women in traditional occupations, they tend to be discouraged with regard to becoming vanguards in the workplace, themselves, either way. Some researchers are yet hopeful that there may be ways to change this type of influence. With more and more women taking up nontraditional occupations and leadership positions, it may begin to overshadow the stereotypes that persist over time, perhaps in time allowing true equality in pay and promotions in the workplace.

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Systematic Desensitization – A Brief Synopsis

•June 3, 2013 • Leave a Comment

Abstract:  Systematic desensitization is a form of therapy based on classical and operant conditioning used primarily to help individuals cope with phobias, as well as a number of other problematic behaviors that cause distress to the individuals.  Since a phobia is learned, it is believed that “un-learning,” or counterconditioning, the phobia is possible.  Conditioning was first discovered by Ivan Pavlov in his famous dog salivation experiments.  Pavlov’s ideas were expounded upon by psychologists John Watson, Mary Cover Jones, and Joseph Wolpe years later.  This allowed for the development of the counter-conditioning techniques of systematic desensitization and graduated exposure therapy to alleviate anxiety related to phobias in individuals who had learned to fear certain objects or situations.  Today, these techniques are effective and used in a variety of ways to treat phobias and other behavioral problems.  The conditioning techniques are still being explored and developed by researchers, and it will be interesting to see what future directions will be taken in further development of phobia and behavioral treatment.

                                                                                                                                                                                 

Systematic desensitization is a form of therapy used primarily to help individuals cope with phobias, as well as a number of other problematic behaviors that cause distress to individuals.  Graduated exposure therapy, a form of systematic desensitization (at times used synonymously), is the most common type of behavioral treatment used by many therapists to treat anxiety disorders (Kircanski, Mortazavi, Castriotta, Baker, Mystkowski, Yi, & Craske, 2011; Powell, Honey & Symbaluk, 2013, p. 206).  Systematic desensitization is also considered a form of counterconditioning, and has been used to help individuals adjust their thinking about the feared object or situation and learn more acceptable, “rational” responses.  This therapeutic technique is based on principles of classical and operant conditioning, and it works especially well when paired with cognitive behavioral therapy (CBT) (Triscari, Faraci, D’Angelo, Urso, & Catalisano, 2011)).

From a behavioral perspective, a phobia is a maladaptive behavior in which a pattern of avoidance is developed around a perceived threat.  Phobias are learned in that a previously neutral stimulus, e.g., a dog, paired with a negative experience, e.g., being bitten or witnessing someone else being attacked by a dog, transforms the neutral stimulus into a conditioned stimulus wherein any time a person encounters the conditioned stimulus, they will experience fear.  Because the person fears a certain object or situation, they begin to avoid coming into contact with it, which reinforces the phobic behavior.

Since a phobia is learned, it is believed that “un-learning,” or counterconditioning, the phobia is possible.  A person with a phobia will experience extreme anxiety or a panic attack when exposed to the specific object or situation that is feared (Sue, Sue & Sue, p. 126).  Phobias are conditioned responses that reinforced by persistent avoidance of the feared object (p. 130).  An individual suffering from a phobia has paired a stimulus with a negative response, and overgeneralizes a fear response to that stimulus.  The Diagnostic and Statistical Manual of Mental Disorders (DSM) lists three subcategories of phobias, which are agoraphobia, social phobias, and specific phobias.  Though there is debate among mental health professionals regarding the etiology of phobias, most can agree that systematic desensitization is one of the most effective treatments for phobias, regardless of cause (Powell, et al., p. 201; Lang & Lazovik, 1963).  Flooding therapy is considered effective, however, it is more controversial in that if not utilized properly, it could cause medical complications due to stress and exacerbate fears further (Powell, et al., p. 206).  For treatment of phobias, systematic desensitization is preferred by some due to its gentler approach.

Systematic desensitization is, specifically, the pairing of muscle relaxation with the feared stimulus over time in ascending difficulty, until the anxiety towards the feared stimulus is reduced (Sue, et al., p. 132).  It is based on principles of classical conditioning in that it allows an individual to pair a more rewarding feeling, or positive reinforcement, with a stimulus that is regarded as negative, which eventually changes the way the individual views the negative stimulus.  Because it is a gradual progression across a hierarchy, involving many steps, it is seen as a corrective learning experience (Kircanski, et al., 2012).  It was popularized by Joseph Wolpe, a researcher in graduate school, who hypothesized that exposure to phobic stimulus paired with muscle relaxation techniques could help eliminate phobias, as a form of counterconditioning (Powell, et al., p. 202).  Wolpe derived many of his techniques and ideas from the work of Mary Cover Jones, who performed some of the earliest empirical studies on desensitization as a cure for phobias (Jones, 1924).  However, Jones was not the first to study the conditioning and counter-conditioning of phobias.

The first empirical study conducted to test phobia conditioning and extinction was carried out by John Watson in 1920 (Beck, Levinson & Irons, 2009; Watson & Rayner, 1920).  This experiment involved conditioning an 8-month old boy (“Little Albert”) to fear a neutral stimulus, i.e., a laboratory rat, by pairing the unpleasant sound of striking a suspended steel bar whenever the boy touched the rat (1920).  Soon thereafter, the boy began to show signs of fear and distress whenever the rat was present, demonstrating that he had been conditioned to fear the previously neutral stimulus (1920).  The boy’s fear eventually was generalized to the extent he would cry or move away whenever presented with anything resembling the small, white rodent, i.e., fur coats, rabbits, dogs.  Watson believed that “directly conditioned emotional responses as well as those [generalized] persist, although with a certain loss in the intensity of the reaction, for a longer period than one month.”  (Watson & Rayner, 1920)  Before Watson could counter-condition the induced phobia, Little Albert was removed from his immediate access.  He hypothesized that Little Albert’s fears would persist indefinitely, unless he was counter-conditioned (1920).  Two of the methods he had proposed for counter-conditioning included flooding, as in “Constantly confronting the child with those stimuli which called out the responses in the hopes that habituation would come in corresponding to ‘fatigue’ of reflex,” and systematic desensitization, “By trying to ‘recondition’ by feeding the subject candy or other food just as the animal is shown” (1920).

The techniques developed by Watson, Jones and Wolpe were derived from basic classical conditioning techniques that were made famous by physiologist Ivan Pavlov’s conditioning experiments.  Pavlov extensively studied the physiology of digestion and circulation systems of animals, but later noticed that dogs would salivate whenever a bell was rung before food was presented and explored the connection between the psyche and physiology (Samoilov, 2007).  In 1899, he noted that “in the psychology of salivatory glands discovered by us, we see all the elements of what is called the activity of the soul — feelings, desires, the thoughts about the qualities of the oral content” (as cited by Samoilov, 2007).  Pavlov challenged the views of his peers (and his wife) at the time that there was no connection between physiology and psychology, and set up the experiments that became an important step in the advancement of psychology.

At the time, Pavlov did not consider psychology an “exact science” and insisted on using physiological terminology.  Eventually he and his staff integrated psychological terminology into their work, coining new terms such as “conditional” (learned responses) and “unconditional reflexes” (natural responses) (2007).  These came to become principles of classical conditioning.  This contribution to the study of psychology paved the way for scientists and psychologists to expound on Pavlov’s theories, thus developing the conditioning and counterconditioning techniques that are used today, known as variants of systematic desensitization and exposure therapy.

Because of Pavlov’s initiative in connecting physiology and empirical scientific methods with psychology, important discoveries were made.  When further studies were conducted on “conditional reflexes and structural lesions in central nervous system […] it was concluded that under natural conditions, temporal relationships are established between the centers with the highest degree of plasticity” (2007).  The brain’s plasticity in relation to conditioning was evidence of the direct connection between psychology and physiology in that that learning happens physiologically, and can be observed physically in the brain.  If not for Pavlov, this correlation might not have been made at that time, and the field of psychology might not have been taken as seriously by scientists such as Wolpe.

In the decades following Wolpe’s work, some researchers had derived principles from Watson’s, Jones’s, and Wolpe’s experiments, pairing various elements along with systematic desensitization techniques to reduce fear.  In the 1960’s, some researchers used the traditional methods of pairing the feared object with deep muscle relaxation,[i] but additionally applied hypnotism to induce a calmer state (Lang, et al. 1963).  The researchers had 24 participants with a snake phobia create an “anxiety hierarchy” wherein various situations involving snakes were rated from least frightening to most frightening (1963).  The participants were then trained in deep muscle relaxation, which they were to practice at home routinely.  Once the participants were trained, they began 11 sessions of systematic desensitization.  At the beginning of each session, the participants were hypnotized and told to relax, and then imagine the least distressing item on the hierarchy (1963).  After progressing through each item on the hierarchy throughout the 11 sessions, most participants were able to touch and hold a snake with much less anxiety in the end.  It was determined that systematic desensitization was highly effective in “unlearning” phobias, however, hypnosis and psychoanalysis was not necessarily effective (1963).  The researchers noted that “The unlearning of phobic behavior appears to be analogous to the elimination of other responses from a subject’s behavior repertoire” (1963).  Since this time, many empirical studies have been conducted, showing consistent positive results from using the simple, original method of systematic desensitization to correct phobic behavior.

Furthermore, there are uses for systematic desensitization that are not necessarily phobia related.  It has been used to treat autistic children who have strong reactions to certain auditory stimuli (Koegel, Openden & Koegel (2004).   Autistic children are sometimes known to have ultra-sensitive auditory perception, and sounds such as a running vacuum cleaner or blender might cause them adverse reactions (Stiegler & Davis, 2010).  It is still not known whether autistic children who react negatively to certain otherwise innocuous sounds are reacting in pain or discomfort, or are reacting in fear, but there is evidence showing that autistic children are hyper-aware of external stimulus, such as touch and sound (2010).  Regardless of the cause, the reactions of autistic children can be modified to the extent they become comfortable with the noises (Koegel, et al., 2004).  In one study, a hierarchy was created, similar to other systematic desensitization techniques, and the offending noises were moved gradually closer to the children as they engaged in their favorite activities (2004).  This can be considered a form of classical conditioning in that reflexive reactions are eventually controlled by pairing the unfavorable stimulus gradually with the favorable stimulus, thus allowing the subject to learn a positive association between the two.  Elements of operant conditioning seem to be present, as well, in that the lack of reaction to the loud noises is rewarded with treats, reinforcing the calm behavior.  Because the desensitization was largely successful in reducing discomfort around certain sounds in the autistic children, the study gives evidence that the issue of hypersensitive hearing is most likely a phobic reaction rather than one of pain, and could be modified using counter-conditioning techniques.

Other interesting variables of systematic desensitization have been explored, such as pairing humor with a feared object in one study.  The idea is that “experiencing a feared stimulus in a humorous context may enhance feelings of self-efficacy and one’s willingness to encounter or deal with the feared situation” (Ventis, Higbee & Murdock, 2001).  This could be considered a form of classical conditioning in that it sought to modify reflexive behavior by pairing humor with the feared object, thus “rewarding” the participant with feelings of self-efficacy.  It was found in this study that the addition of humor was not significantly more successful than traditional systematic desensitization.  The researchers remarked that it was not surprising because “systematic desensitization has extensive empirical evidence for its effectiveness” (2001).

It will be interesting to see where the principles of classical conditioning may be applied in the treatment of mental disorders in future studies.  For example, in a qualitative review of various treatments for social phobia, it was determined that systematic desensitization was less effective than cognitive behavioral therapy, but more effective than the use of beta-blockers or placebos (Ponniah & Hollon, 2008).  Compared to agoraphobia, social phobia seems to have been neglected with regard to studies involving systematic desensitization.  With further studies, there may a way to customize desensitization treatment that may be more cost effective than cognitive behavioral therapy for those suffering from social phobia.

At present, there are still skeptics with regard to the practice of psychology, but the work of Pavlov, and those inspired by Pavlov, have contributed to giving it a more empirical and scientific basis for confidence.  Individuals who have benefited from systematic desensitization for treatment of phobias are a testament to the research conducted by scientists who believed there was a way to understand what was previously believed to not be understandable.  With regard to the methods derived from classical and operant conditioning, the extensive studies that have been conducted over the decades suggest that there is little need to use superfluous methods.  The basic conditioning methods derived from Pavlov’s initial discoveries have showed consistent effectiveness.  Many individuals continue to benefit from the systematic desensitization techniques that are still used today by therapists, allowing for improvement of their life quality.

References

Beck, H., Levinson, S. & Irons, G. (2009).  Finding little Albert:  A journey to John B. Watson’s infant laboratory.  American Psychologist, Vol 64(7), Oct 2009, 605-614. doi: 10.1037/a0017234

Coldwell, S., Wilhelm, F., Milgrom, P., Pralla, C. Getza, T., Spadaforaa, A. Chiua, I. Lerouxa, B. Ramsaya, D.  (2007).  Combining alprazolam with systematic desensitization therapy for dental injection phobia.  Journal of Anxiety Disorders 21 (2007) 871-887.  Elsevier Ltd.

Jones, M.C. (1924) A laboratory study of fear:  The case of Peter.  Journal of Genetic Psychology.  100th Anniversary Issue.  Reprinted in 1991 from Vol. 31, No. 4, 308-315

Kircanski, K., Mortazavi, A., Castriotta, N., Baker, A., Mystkowski, J., Yi, R., & Craske, M. (2011).  Challenges to the traditional exposure paradigm: Variability in exposure therapy for contamination fears.  Journal of Behavior Therapy & Experimental Psychiatry, 43 (2012) pp. 745-751

Koegel, Openden & Koegel (2004) A systematic desensitization paradigm to treat hypersensitivity to auditory stimuli in children with autism in family contexts.  Research & Practice for Persons with Severe Disabilities, Vol. 29, No. 2, 122-134

Lang, P. & Lazovik, D. (1963) Experimental desensitization of a phobia.  Journal of abnormal and social psychology.  Vol. 66, No. 6, 519-525.

Ponniah, K. & Hollon, S. (2008) Empirically supported psychological interventions for social phobia in adults: a qualitative review of randomized controlled trials.  Psychological Medicine, Vol. 38, Issue 1, January 2008, pp. 3-14

Powell, R., Honey, P.L., & Symbaluk, D. (2013), Introduction to learning and behavior (4th ed.) Wadsworth, Cengage Learning. (citing Spiegler & Guevremont, 2010)

Samoilov, V. (2007) Ivan Petrovich Pavlov (1849-1936).  Journal of the History of Neurosciences, 16:74-89

Stiegler, L., & Davis, R. (2010) Understanding sound sensitivity in individuals with Autism Spectrum Disorder.  Focus on Autism and Other Develomental Disabilities, 25:67, originally published online (taken from http://foa.sagepub.com/content/25/2/67 on 5/23/13)

Sue, D., Sue, D.W. & Sue, S. (2010) Understanding abnormal behavior.  Wadsworth, Cengage Learning, pp. 126, 130

Triscari, M., Faraci, P., D’Angelo, V., Urso, V., & Catalisano, D. (2011) Two treatments for fear of flying compared:  Cognitive behavioral therapy combined with systematic desensitization or eye movement desensitization and reprocessing (EMDR) Aviation Psychology and Applied Human Factors, Vol. 1(1):9–14; DOI: 10.1027/2192-0923/a00003

Watson, J. and Rayner, R. (1920) Conditioned emotional reactions.  Journal of Experimental Psychology, 3(1), 1-14

Ventis, W.L., Higbee, G. & Murdock, S.A. (2001) Using humor in systematic desensitization to reduce fear.  The Journal of General Psychology, 128(2), 241-253.


Footnotes


[i] Deep Muscle Relaxation was a technique developed by Dr. Edmund Jacobson in the 1920’s.  It involves tensing various muscle groups and then releasing the tension, and teaches individuals how to control the tension in their muscles.

Codependence: Future Directions

•May 29, 2013 • Leave a Comment

                                                                                                                                                                                  

The future of codependence as a pathological disorder is contingent upon further systematic studies from which the DSM authors may base its inclusion.  Some mental health professionals and counselors believe that codependence is often comorbid with addiction.  It has also been theorized that codependence is a form of addiction in itself.  Various categorizations for types of codependence have emerged, e.g., love addiction, behavioral addiction, and pathological altruism.  As a result, some addiction researchers have conducted studies indicating similarities between codependence and addiction, and have suggested that future studies be directed toward studying brain activity, genetics and other factors that may make some individuals predisposed to becoming codependent.  The completion of these future studies may greatly assist individuals who suffer from codependence to the same degree individuals may suffer from substance addiction.

                                                                                                                                                                                 

 

 

Over the past several decades, the concept of codependence has evolved, and continues to change with as further research is conducted.  There is still debate as to whether codependence is a form of addiction (Mellody, 1992), is a stand-alone personality disorder (Cermak, 1986), or is a combination of several underlying disorders (Hoeningmann-Lion & Whitehead, 2006).  Many psychology and mental health experts would like to see codependence listed in the DSM in some form (Cermak, 1986), while others are doubtful about its conceptualization as a personality disorder (Troise, 1995).  Since the criteria for codependence is still a very broad and fluid concept, it may be pared down as researchers attempt to pinpoint its causes (McGrath & Oakley, 2011).  It is difficult to foretell whether codependence will eventually end up in the DSM, but movement towards its inclusion, or at least attempts to define and understand it, are likely to continue.

It is alleged at this time that the authors of the DSM-V have created a more streamlined manual, consolidating diagnostic criteria so that there will be fewer disorders (APA, 2013).  The DSM authors have reportedly created a new category of “behavioral addictions” in which the focus is on gambling addiction.  Interestingly, “Internet Use disorder” was also considered for inclusion in the DSM as a form of addiction, but due to lack of sufficient research, it was placed in the DSM’s appendix (2013).  The inclusion of Internet addiction in the appendix, though a relatively new phenomenon, raises a question as to why codependence has been overlooked by the DSM authors, since it is more common and holds a longer standing in psychological history (Young, 1996).  It is clear codependence will not be considered a pathological condition unless a more systematic approach is taken.  Advocates of codependence being listed in the DSM as a personality disorder may wish to implement the suggestion by Harkness, Swenson, Madsen-Hampton & Hale that experts in codependence (namely, substance-abuse counselors) collaborate with clinical researchers to create systematic studies and empirical literature from which the DSM authors may rely upon for evidence (2001).

Harkness, et al., raise an additional question that may be considered in future research:  “Is co-dependency a free-standing disorder that deserves treatment in its own right, or is it an antecedent, a corollary, or a sequel of substance-abuse that corresponds to substance-abuse treatment?”  (2001).  Melody Beattie has commented that “Most recovering addicts and alcoholics have codependency underneath” (2009, p. 72).  Observations like these indicate that oftentimes, addiction may be only part of the problem for an individual, and that codependence may be an underlying factor behind it.  It has been discerned by Elizabeth Gifford & Keith Humphreys that there are usually several contributing factors for causes of addiction, and that psychologists have the ability to analyze individuals in their own unique contexts (2010).  However, the cultural trend in U.S. psychology has been to blame the individual rather than considering other factors, e.g., environment and cultural biases (2010).  Gifford & Humphreys suggest examining the treatment and recovery process directly on multiple levels, especially in the individual’s natural environmental context.

It has been opined that codependent behavior is similar to that of addiction itself, and that it requires similar therapy (Cohen, 1990).  A person suffering from codependence may actually be “addicted to addicts” (1990).  Some addiction researchers have found that “…the more [researchers] have tried to tease apart substance and behavioural addiction, the more similarities they find.  For one thing, the brains of people with addiction look similar whether the addiction is to a substance or to a behaviour” (Murphy, 2012).  It was noted that the same reward centers were activated whether the addiction was to a substance or behavior, when brain scans were conducted using functional magnetic resonance imaging (fMRI) (McGrath & Oakley, 2011).  Heightened levels of empathy and altruism can be explored as it relates to codependence in that neurotransmitter and neural pathway activity in the brain can be studied and pinpointed (2011).  It is suggested that neurobiological correlates may exist, and that it is actually failure of the prefrontal cortex in the brain (which inhibits empathic responses) that causes a higher likelihood of codependence (2011).  Codependence may be a combination of brain chemistry, neural pathways, environmental causes and upbringing, but with lack of empirical evidence to support these theories, the condition will not be taken as seriously as other disorders. Approaching similarly to substance addiction may be a better way to gain support via the DSM.

Codependency’s close resemblance to that of addiction is further compelling reason to continue systematic research to ensure full consideration by the DSM authors in future publications.  There are questions that remain to be answered regarding why some people are susceptible to addiction, and others not.  “Love addiction” and “relationship addiction” are examples of forms of codependence that do not involve substance abuse (Mellody, 1992, Larkin, et al., 2005), but are not recognized by the DSM.  If it is deemed that these types of non-substance addictions are indeed related to substance addiction, then it would make sense to consider it as eligible for insurance coverage and treatment as the latter.  Michael Larkin, Richard Wood and Mark Griffiths state, “There is a belief that some people are destined to become addicted.  Typically this is explained in one (or both) of two ways.  That some people (i.e., ‘addicts’) have an addictive personality, and that there is a genetic basis for addiction” (2005).  Research into genetic predispositions and biology could enlighten the psychology field if correlation is demonstrated between addictive personality and codependence.

At the very least, if the DSM aims to consolidate and streamline its diagnostic criteria, codependence could be acknowledged as a form of addiction, if not its own personality disorder.  As researchers continue to learn about codependence, more insightful approaches can be taken.  There is much room for exploration on the subject.  With further studies and a collective effort by mental health experts, substance-abuse counselors and researchers, there may be enough convincing evidence to include codependence as a disorder in the DSM in the future.

 

 

References

American Psychological Association (www.DSM5.org)

Beattie, M. (2009).  The new codependency:  Help and guidance for today’s generation.  First Simon & Schuster hardcover edition January 2009 (p. 72). New York, NY.

Cermak, T. L. (1986). Diagnosing and treating co-dependence; a guide for professionals who work with chemical dependents, their spouses and children.  Minneapolis, Minnesota:  Johnson Institute Books.  p. 34.  (Retrieved from http://books.google.com/books?id=8IRt8bYu8kgC&pg=PA61&source=gbs_selected_pages&cad=3)

Cohen, L. (1990) Addicted to the addict:  Treating addiction’s other victims.  CMAJ:  Canadian Medical Association Journal; Journal De L’Association Medicale Canadienne, Vol. 142, Issue 4 (1990-Feb-15), pp. 372-376

Gifford, E. & Humphreys, K. (2006).  The psychological science of addiction.  Society for the Study of Addiction (2007).  Addiction. Vol. 102, Issue 3, pp. 352–361, March 2007

Harkness D, Swenson M, Madsen-Hampton K, Hale R.  The Development, Reliability, and Validity of a Clinical Rating Scale for Co-dependency. J Psychoactive Drugs. 2001 Apr-Jun;33(2):159-71. (retrieved from http://web1.boisestate.edu/socwork/HARK/Research.The%20Development,%20Reliability,%20and%20Validity%20of%20a%20Clinical%20Rating%20Scale%20for%20Codependency.htm)

Hoenigmann-Lion, N. & Whitehead, G. (2007): The relationship between codependency and borderline and dependent personality traits.  Alcoholism Treatment Quarterly, 24:4, 55-77

McGrath, M., & Oakley, B.  (2011).  Pathological altruism, B. Oakley, A. Knafo, G. Madhavan & D. S. Wilson, eds., New York: Oxford University Press, p. 50

Mellody, P. (1992). Facing love addiction.  New York: Harper Collins. pp. 113, 119

Murphy, S. (2012) Addictive personality.  New Scientist, 9/8/2012, Vol. 215 Issue 2881, p36-39, 4p

Troise, F.  (1994) An Examination of Cermak’s Conceptualization of Codependency as Personality Disorder.  Alcoholism Treatment Quarterly.  12:1, 1-15

Young, K. 1996.  Internet addiction:  The emergence of a new clinical disorder.  CyberPsychology and Behavior, Vol. 1, No. 3, pp. 237-244. (retrieved from http://www.chabad4israel.org/tznius4israel/newdisorder.pdf )

Cultural and Gender Biases of Codependence

•May 8, 2013 • 1 Comment

                                                                                                                                                                                  

The consideration of codependence as a mental disorder in the DSM involves controversial debate with regard to gender and cultural biases towards what is considered codependent behavior.  Individuals from both individualistic and collectivistic cultures experience negative effects of codependence, indicating it is a universal phenomenon; however, people from collectivistic cultures may not view it as problematic as those from individualistic cultures might.  This blog post explores some of the cultural perspectives of codependence, indicating a need for education and awareness among professionals as well as the general public.  Because cultural contexts vary, mental health practitioners do well to consider the cultural perspectives of codependence in order to effectively understand and treat patients who experience maladaptive symptoms of the same, exercising flexibility in treatment approaches.

                                                                                                                                                                                 

Factors such as cultural and gender bias, societal attitudes and influence (Markus & Kitayama, 1991) should be taken into consideration in any movement to include mental disorders (such as codependence) in the DSM.  Differing cultural perspectives of codependence are highly controversial in the debate over whether it should be considered a formal disorder and listed in the DSM.  The concept of codependence has been criticized by some researchers as a phenomenon viewed from a biased and perhaps individualistic perspective by mental health practitioners and society in the United States, as compared to collectivistic attitudes towards codependence in some other cultures (Chang, 2010; Borovoy, 2001).  Because codependence has been problematic for individuals, regardless of culture, there is a need for further exploration of cultural attitudes towards codependence in order to establish a more universal understanding of it, as well as adapt treatment to suit the needs of each individual.

When deciphering whether a behavioral pattern qualifies as a mental disorder, the behavior must deviate from what is considered normal by the general population (Stein, Phillips, Bolton, Fulford, Sadler, & Kendler, 2010).  This is dependent on the individual’s cultural context, as what may be considered undesirable or threatening for one culture may be considered perfectly normal for another (Nevid, 2009).  In collectivistic cultures, codependent relationships may be considered the norm (Chang, 2010), whereas autonomy and independence are highly valued in the United States (Kwon, 2001).  As a result, codependent behavior, even on innocuous levels, is often frowned upon in American culture.  In popular American media, codependence has frequently been misconstrued in its portrayal of highly attached couples in a negative light (Bays & Thomas, 2005), causing some to conclude that all attached relationship styles are unhealthy (Beattie, 2009, p. 8).  Soo-Young Kwon, a Korean counseling professor, opines, “Theorists of codependence (relationship addiction) show that American awareness of boundaries produces phobic attitudes toward the interwoven interplay of human relationships” (2001).  Because American culture fosters independence, there is concern for a tendency to overgeneralize and/or over-diagnose codependent behavior in the U.S. (Chang, 2010).  American culture and media may also have a role in influencing what its society views as dysfunctional behavior (Gorham, 2006, Thompson & Heinberg, 1999), which may be one explanation for the movement towards categorizing codependence as a mental health disorder.

Some collectivistic cultures tend to discourage setting what Americans might consider “healthy boundaries,” and encouraging more interdependent family and relationship styles (Kwon, 2001).  In Taiwan, it has been noted that “college students are expected to be responsible and care for other people and therefore their concept of self is related to significant others around them, especially parents or family members” (Chang, 2010, citing Lam, 2005).  Kwon acknowledges that in Korea, it is common for college students to live at home, and that boundaries are often minimal or non-existent within the family unit, yet high functioning, non-dysfunctional citizens still emerge from these cultures (2001).  Kwon also expresses concern that, while problems with lack of boundaries may be valid, there is a higher possibility of over-diagnosing individuals who come from collectivistic cultures (2001).

Likewise, Japan boasts a highly efficient, collectivistic society, where the needs of groups as a whole are valued over that of the individual.  Japanese women in particular are encouraged to be sensitive to the needs of others, especially within their families.  However, in recent years, women in Japan have begun recognizing codependence as problematic for them, and have reportedly reached out for help in drawing healthy boundaries between interdependence and codependence (Borovoy, 2001).  Japanese mental health experts tend to agree that codependence is an unhealthy trait, but do not view it as a “pathological” part of the culture.  Rather, Japanese culture has encouraged a society where individuals look after each other, in contrast with American culture that is viewed by some in collectivistic cultures as competitive, inconsiderate and self-indulgent (Borovoy, 2001, citing Doi, 1973).  It could be argued that the concept of codependence is rooted in American individualistic culture, where its citizens are encouraged to care for themselves first (Beattie, 1992, Kwon, 2001), experiencing less hesitation to leave a problematic partner if necessary (Andersen, 1994).  While this may serve a codependent individual’s needs, it has been argued that it discourages the idea that problems can be worked out as a family unit (1994).  Because there are such contrasting perspectives of boundaries and interdependence, therapists should always consider each individual’s cultural context and customize treatment accordingly.

Similarly to cultural biases, the construct of codependence has been criticized as gender biased by some researchers because it tends to blame the same characteristics that women are encouraged to display, such as helpfulness and sensitivity (Anderson, 1994; Dear & Roberts, 2002, Chang, 2011).  Studies have demonstrated that gender bias is a universal phenomenon (Walker, 1999), showing similarities in personalities and families-of-origin between female victims of violence all around the world (1999).  Further research may provide insight as to whether the majority of codependent women (who may also be victims of violence (Frank & Kadison, 1992)) exhibit certain personality traits, allowing for preventive measures (e.g., education) on a more universal level to be taken if these traits are identified earlier.

The cultural and gender biases still at play in the practice of psychology and research indicate there are deeper issues that should also be taken into consideration in future research endeavors.  This may have contributed to the delay in the inclusion of codependence in the DSM, however, there is consistent acknowledgment of maladaptive patterns within both collectivistic and individualistic cultures, which cannot be ignored (Chang, 2010, Borovoy, 2001).  It would be beneficial for further research to be conducted on effective methods of treatment of codependence within collectivistic cultures and individualistic cultures.  Since the DSM does not provide for a formal diagnosis of codependence, it is up to individual therapists to decipher what treatment methods, if any, are appropriate for individuals of different ethnic and cultural backgrounds.  Helping patients find a balance between interdependence and codependence may be one way to approach the issue where differing cultural values are involved.  Awareness and education has repeatedly shown to be a positive remedy where racial and cultural tolerance are concerned (Morris, 1999), and it is no different in the field of mental health where codependence is concerned.

References

Andersen, S. (1994).  A critical analysis of the concept of codependency.  Social Work, Nov. 1994; 39, 6 ProQuest Education Journals (p. 677)

Bays, C. & Thomas, C. (2005)  How i met your mother.  20th Century Fox Television; Bays Thomas Productions. S.2, Ep. 20; 19 September 2005

Beattie, M. (2009).  The new codependency:  Help and guidance for today’s generation.  First Simon & Schuster hardcover edition January 2009 (p. 8). New York, NY.

Beattie, M. (1992).  Codependent no more:  How to stop controlling others and start caring for yourself.  Hazelden Foundation; Hazelden Publishing & Educational Services (pp. 36, 38, 43).  Center City, MN.

Chang, S.H. (2012).  A cultural perspective on codependency and its treatment.  Asia Pacific Journal of Counselling and Psychotherapy. 3:1, 50-60.  Chung Li, Taiwan.

Chang, S.H. (2012).  A cultural perspective on codependency and its treatment.  Asia Pacific Journal of Counselling and Psychotherapy. 3:1, 50-60.  Chung Li, Taiwan., citing Lam, C. (2005) Chinese Construction of Adolescent Development Outcome: Themes Discerned in a Qualitative Study. Child and Adolescent Social Work Journal, Vol. 22, No. 2, April 2005. DOI: 10.1007/s10560-005-3414-y

Dear, G. & Roberts, C. (2002).  The relationships between codependency and femininity and masculinity.             Sex Roles, Vol. 46, Nos. 5/6

Frank, P.B., and Golden, G.K. (1992) Blaming by Naming: Battered Women and the Epidemic of Codependence  Social Work.  37.1 (Jan 1992) (p. 5)

Gorham, B. (2006) News media’s relationship with stereotyping:  The linguistic intergroup bias in response to crime news; Journal of Communication 56, 289-308

Levine, R. (2002) Contexts and culture in psychological research.  New Directions for Child and Adolescent Development, Vol. 2002, Issue 96 (Article first published online: 25 JUN 2002)

Markus, H. & Kitayama, S. ( 1991)  Culture and the self:  Implications for cognition, emotion and motivation.  The American Psychological Association, Inc.  Psychological Review, 1991, Vol. 98, No. 2, 224-253

Mellody, P. (1992). Facing love addiction.  New York: Harper Collins. pp. 113, 119

Morris, Alan (1999).  Race relations and racism in a racially diverse inner city neighborhood:  A case study of Hillbrow, Johannesburg.  Journal of Southern African Studies, Vol. 25, No. 4, pp. 667-694.

Nevid, J. S. (2009). Psychology concepts and applications. (3 ed.). Houghton Mifflin Company.

Kwon, S. (2001).  Codependence and interdependence:  Cross-cultural reappraisals of boundaries and relationality.  Pastoral Psychology, Vol. 50, No. 1.  Human Sciences Press, Inc.

Stein, D., Phillips, K., Bolton, D., Fulford W., Sadler, J. and Kendler, K.  (2010).  Letter to the Editor: Response to the commentaries on ‘What is a mental/psychiatric disorder?’  Psychological Medicine, 40, pp 19311934; doi:10.1017/S0033291710001327

Thompson, J.K. & Heinberg, L.J. (1999) The media’s influence on body image disturbance and eating disorders:  We’ve reviled them, now can we rehabilitate them?  Joumal of Social Issues, Vol. 55, No. 2, 1999, pp. 339-353

U.N. Demographic Yearbook (2008) (http://unstats.un.org/unsd/demographic/products/dyb/dyb2008.htm)

Causes and Treatment of Codependence

•April 9, 2013 • 2 Comments

The theories behind causes and treatment of codependent behavior vary.  Some literature address the causes of codependent behavior, however, relatively few studies have been conducted (N. Hoenigmann-Lion & G. Whitehead, 2007).  Because there is still debate as to whether codependence is a disorder, diagnostic and treatment options are somewhat limited.  Attempts to define codependence and account for causes have resulted in a movement toward more cohesive criteria, but further extensive research has yet to be done.  Explanations offered for the causes of codependent behavior include depression, dysfunctional family-of-origin, and having a combination of personality disorders (Cermak, 1986, p. 57; Hoenigmann, et al., 2007; Prest & Protinsky, 1993).  Experts’ opinions likewise differ in the treatment of codependence.

In 2002, a study (M. Wildmon-White & J. S. Young) compared two groups of women, exploring the differences between their families of origin.  Approximately half of the women in the study were married to sexually addicted men,[1] while the second half were married to non-sexually addicted men.  This study revealed that (codependent) women who were married to sexually addicted men were more likely to have experienced dysfunction, abandonment and/or abuse in their homes growing up, while women who were married to non-sexually addicted men were likely to have had emotionally stable families of origin.  Therefore, it may be logical to conclude that dysfunctional family of origin accounts for the majority of codependent causes.

This is not to say individuals with more stable upbringings are immune to codependence.  A behaviorist approach theorizes that people may inadvertently become codependent based on a ratio of positive reinforcement.  E.g., a dating couple experiences a great deal of positive reinforcement in the beginning of a new relationship, which becomes increasingly intermittent over time.  Lack of reinforcement continues to the extent one partner (the “victimizer”) rarely provides positive reinforcement, which may then cause the other partner (the “victim”) to work much harder to obtain it, thus inadvertently reinforcing the maladaptive behavior of the victimizer (Powell, Honey & Symbaluk, p. 275, 2013).  Regardless of self-esteem or upbringing, many otherwise healthy individuals may find themselves in a similar quandary as individuals with a predisposition towards codependence.

Though treatment for codependence is currently limited, existing methods have been successful.  Treatment programs were established by Al-Anon in the 1950’s as a spinoff from Alcoholics Anonymous.  Family groups had been formed as early as 1939 to support individuals who have experienced problems with someone else’s drinking.  While Al-Anon implements a practical 12-step program for sufferers of codependence, it is limited with specific regard to alcoholism.  However, it has provided a model for modern therapies for various codependent circumstances (Carnes, 1994).

A study conducted at the Department of Behavioral Medicine and Psychiatry at West Virginia University revealed that group therapy was effective in reducing symptoms of codependent behavior, as well as depressive and anxiety-related symptoms, utilizing a 12-session program (as distinguished from a 12-step program) (Byrne, Edmundson & Rankin, 2005).  By the end of the study, most participants had gained a stronger locus of control as well as decreased their instances of codependent behavior.  Because the group process “promotes a sense of universality of these struggles, adding to the experience of not being singularly flawed,” and helps explore current and past relationship issues within the context of the group, it may be the reason some therapists choose to employ this method for treatment of codependence (Byrne, et al., 2005).

Therapists may also choose to treat codependence utilizing client-centered methods, e.g., cognitive behavioral therapy.  Psychotherapy can be effective when therapists assist clients with identifying how their behaviors developed, usually tracing the dysfunction back to the client’s family of origin.  The client’s emotional and behavioral responses are addressed and made conscious, allowing the client to acknowledge their role in codependency, and change their behavior.

A codependency scale was developed to assist therapists in ascertaining relative levels of codependent behavior, which has been helpful in diagnosing and treating codependence (Harkness, Swenson, Madsen-Hampton, & Hale, 2001).  The study in which the scale was developed involved recruiting 274 substance-abuse counselors from rural and urban areas across the U.S., to ensure that diverse perspectives were incorporated.  The researchers reported surprise in their finding that the majority of counselors had a uniform and “statistically-significant degree of order” with regard to their understanding of codependence.  It was acknowledged in this study that, at the time the DSM‑IV was published, codependence was not considered for listing as a disorder.  In part, this is because substance-abuse counselors, rather than clinicians, are generally more adept at working with codependence, however, “…relatively few substance-abuse counselors have acquired the training and resources to mount sophisticated clinical research” (Harkness, et al., 2001).  The authors of the study suggest that research alliances be formed between substance-abuse counselors and clinical researchers to satisfy the empirical requirements of the DSM.  Since the time of this study, little progress has been made, as there is no evidence that it is to be included in the DSM-V, set to be released in May, 2013.

The failure to include co-dependence in the DSM as a psychological disorder is the result of miscategorization and lack of research.  Understandably, as a relatively “new” condition, it will take time and research to empirically categorize and define codependence.  In the interim, many mental health professionals have familiarized themselves with and devised treatment for this condition.  Despite not being included in the DSM, the fact that professionals are taking it upon themselves to treat and counsel those with maladaptive codependent patterns is evidence that further movement toward setting a standard for diagnostic criteria for codependence is imperative.


 

References

Carnes, P. (1994).  Contrary to love:  helping the sexual addict.  Hazelden Foundation.  Center City, Minnesota.  p. 151

Cermak, T. L. (1986). Diagnosing and treating co-dependence; a guide for professionals who work with chemical dependents, their spouses and children.  Minneapolis, Minnesota:  Johnson Institute Books.  p. 34.  (Retrieved from http://books.google.com/books?id=8IRt8bYu8kgC&pg=PA61&source=gbs_selected_pages&cad=3)

Harkness D, Swenson M, Madsen-Hampton K, Hale R.  The development, reliability, and validity of a clinical rating scale for co-dependency. J Psychoactive Drugs. 2001 Apr-Jun;33(2):159-71.

Hoenigmann-Lion, N. M. &. Whitehead, G. (2007):  The relationship between codependency and borderline and dependent personality traits.  Alcoholism Treatment Quarterly, 24:4, 55-77

International Institute for Trauma and Addiction Professionals.  (2001)  FAQs About Sexual Addiction (retrieved from http://www.sexhelp.com/sex-education/what-is-sex-addiction-faqs on 4/6/13)

Byrne, M. , Edmundson, R., & Rankin, E. (2005).  Symptom reduction and enhancement of psychosocial functioning utilizing a relational group treatment program for dependent/codependent population.  Alcoholism Treatment Quarterly, 23:4, 69-84

Powell, R. A., Honey, P. L., & Symbaluk, D. G. (2013).  Introduction to learning and behavior. (4 ed.). Belmont,CA:  Wadsworth Cengage Learning. p. 275

Prest, L. & Protinsky, H. (1993).  Family systems theory:  A unifying framework for codependence.  American Journal of Family Therapy, v21 n4 p352-60 Win 1993

Wildmon-White, L. & Young, J. S. (2002). Family-of-origin characteristics among women married to sexually addicted men.  Sexual Addiction & Compulsivity:  The Journal of Treatment and Prevention (ISSN 1072-0162) 9, 263-273


[1] Sexual addiction is defined as any sexually-related, compulsive behavior that interferes with normal living and causes severe stress on family, friends, loved ones, and one’s work environment.  (IITAP, 2011).

Codependence–An Addiction

•March 27, 2013 • 2 Comments

Is Codependence A Disorder?

Codependence is considered by many mental health experts to be synonymous with “dependence,” “dependent personality disorder,” or “love addiction.”  Despite its distinct, maladaptive traits that are common within many societies, codependence is not formally recognized as a personality disorder, nor is it listed in the current Diagnostic and Statistical Manual of Mental Disorders (DSM).  This phenomenon has been acknowledged as a condition of cyclic behavior at times resulting in abuse and dysfunction within relationships.  It disrupts the daily lives of individuals suffering from codependence, causing themselves as well as their loved ones distress, meeting the primary criteria for mental illness, as defined in the current DSM (Stein, et al., 2010).  However, some experts argue that it is actually a healthy personality trait which fosters trust and intimacy in relationships (Kwon, 2001).  Should there be further movement towards consideration of codependency as a stand-alone personality disorder included in the DSM, or would the inclusion result in over-diagnosis of healthy individuals?

There are varying perspectives on the definition and nature of codependence.  Frequently confused with dependent personality disorder, codependence is different in that dependent individuals have an excessive need to be cared for, while a codependent has an insatiable need to care for someone else (Cermak, 1986; Lion & Whitehead, 2006).  Codependents are caretakers to a fault.  They are known to sacrifice their own happiness and needs in order to ensure another person’s happiness and well-being.  Codependents also tend to be drawn to needy people because of the challenge it presents.  Likewise, needy people are drawn to them.  (Beattie, 1992).  For example, a codependent person may find themselves sticking with and caring for an alcoholic partner, even tolerating abuse, because of their determination to fix the problem.  They unwittingly become part of the problem, suffering repeated letdown and becoming resentful as a result.

Melody Beattie succinctly defines a codependent as:  “…one who has let another person’s behavior affect him or her, and who is obsessed with controlling that person’s behavior” (Beattie, p. 36, 1992).  A person suffering from codependence tends to be extremely sensitive to the moods of their peers and partners because their happiness depends on the happiness of those around them (Beattie, p.43, 1992).  As a coping mechanism, the codependent may attempt to manipulate the behavior of their loved ones using coercion, bribes, threats, and the like, because they perceive they are doing it for the other person’s benefit (Beattie, p. 38, 1992).  However, they frequently end up not only complicating the problem but also feeling used.

Though coherent symptomatic parameters have yet to be established due to lack of systematic research (Morgan, 1991), many psychology professionals can agree that codependence has come to be recognized as pattern of behavior that involves two or more people, most commonly consisting of one substance abuser, e.g., an alcoholic, and at least one enabler.  Lennard Davis, a professor at the University of Chicago, confirms that the “concept of codependence ‘. . . comes directly out of Alcoholics Anonymous, part of a dawning realization that the problem was not solely the addict, but also the family and friends who constitute a network for the alcoholic.’”  (Davis, 2008).  Therefore, codependence could encompass any of the individuals who comprise the support system of the alcoholic or drug abuser.

More recently, variations of codependent relationship styles have come to light.  Pia Mellody, a lecturer and educator specializing in codependence, coined the terms “avoidance addict” and “love addict” to describe the codependent and his or her partner, and has written extensively on the subject of love addiction.  (Mellody, 1992).  According to Mellody, the addict is “dependent on, enmeshed with, and compulsively focused on taking care of another person,” while the avoider “tries to avoid intimate connection within the relationship, usually through some addiction.”  (Ibid).  Most people use work or hobbies as an escape; however, it becomes problematic when a person habitually uses it to create distance.  This, paired with a codependent continually seeking attention from the avoider, results in an unhealthy relationship pattern of hurt feelings, abuse, and nonexistent communication.  Because the avoider has withheld communication, the codependent often becomes obsessed with the avoidant partner and they begin to project and idealize him or her.  On a day to day basis, this certainly causes frustration and distress among codependents.

Addiction has long been established as a disorder.  Whether non-substance addictions such as love, relationship or sex addictions are likewise disorders is controversial.  (Katehakis, 2011).  It is only logical to consider codependence similarly, as it produces the same behaviors as substance addiction in that the codependent craves the feelings of being in love to the extent they engage in self-destructive behavior to get what they want.  Timmen Cermak states in his book, Diagnosing and Treating Co-Dependence, “Although codependency is not as dramatically or directly life threatening as chemical dependence, it is potentially just as fatal.”  (Cermak, 1986).  Compounding the issue, codependents believe their partner is responsible for providing their “drug” of choice.

Cermak, as well as several codependency experts, have for decades supported the idea that codependence should be included as its own standalone disorder in the DSM.  Melody Beattie first introduced the word “codependence” to the public in 1986 in her book, Codependent No More, and continues to spread awareness and self-help techniques.  Beattie’s promotion of codependency as a disorder has been key in its condition being taken more seriously.  Celebrity radio personality and addiction specialist, Dr. Drew Pinsky (“Dr. Drew”), frequently speaks about love addiction publicly, endorsing works by Beattie and Mellody.  Dr. Drew has perhaps been the most instrumental person in recent years to help the mainstream population recognize codependence and to de-stigmatize seeking professional assistance for it.  These experts agree that codependence is a serious and unhealthy addiction, and that therapeutic treatment is recommended for the addict to recover.

Despite the criticism that the current DSM has eroded “the distinction between psychopathology and normal behavior” (Stein, et al., 2010), not having clear criteria for diagnosing those with problematic symptoms relating to codependence could be a hindrance to thousands who might benefit from systematic treatment, specifically, acquiring the skills to maintain healthy relationship boundaries and to care for themselves.  With further research and establishment of clearer diagnostic criteria, society can be further educated about codependence, and individuals may find it easier to seek assistance in breaking their maladaptive cycles.

References

Beattie, M. (1992).  Codependent no more, how to stop controlling others and start caring for yourself.  Minnesota: Hazelden Publishing & Educational Services.  pp. 36, 38, 43

Cermak, T. L. (1986). Diagnosing and treating co-dependence; a guide for professionals who work with chemical dependents, their spouses and children. minneapolis, Minnesota: Johnson Institute Books.  p. 34.  Retrieved from http://books.google.com/books?id=8IRt8bYu8kgC&pg=PA61&source=gbs_selected_pages&cad=3

Davis, Lennard J. (2008). Obsession: A History. London: University of Chicago Press. p. 178. ISBN 0-226-13782-1. (Retrieved March 4, 2013, from Wikipedia http://en.wikipedia.org/wiki/Codependency#cite_note-Davis08-3)

D. J. Stein, K. A. Phillips, D. Bolton, K. W. M. Fulford, J. Z. Sadler and K. S. Kendler (2010).  What is a mental/psychiatric disorder?  From DSM­IV to DSM­V.  Psychological Medicine, 40, pp. 1759­1765 doi:10.1017/S0033291709992261

Katehakis, A.  (2011).  Straight talk about sexual compulsivityThe link between adult attachment styles and sex and love addiction.  Is sex and love addiction really an attachment disorder?  Psychology Today:  Sex, Lies & Trauma.  (Retrieved from http://www.psychologytoday.com/blog/sex-lies-trauma/201109/the-link-between-adult-attachment-styles-and-sex-and-love-addiction)

Kwon, S. (2001).  Codependence and interdependence:  Cross-cultural reappraisals of boundaries and relationality.  Pastoral Psychology, Vol. 50, No. 1.  Human Sciences Press, Inc.

Lion, N. & Whitehead, G.  The relationship between codependency and borderline and dependent personality traits.  Alcoholism Treatment Quarterly, Vol. 24, Number 4 (January 2007), pp. 55-77, http://0-ejournals.ebsco.com.opac.sfsu.edu/direct.asp?ArticleID=44AFA1C1333109856FFD

Mellody, P. (1992). Facing love addiction.  New York: Harper Collins.  p. 7

Morgan, J.P.  (1991).  What is codependency?  Centers for Psychotherapy and NorthShore Psychiatric Hospital, Slidell, Louisiana.  Journal of Clinical Psychology, Vol. 47, No. 5 (September 1991)

Nevid, J. S. (2009). Psychology concepts and applications. (3 ed.). Houghton Mifflin Company.