Causes and Treatment of Codependence

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).

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2 Responses to “Causes and Treatment of Codependence”

  1. […] Causes and Treatment of Codependence (overshadows.wordpress.com) […]

  2. Brilliant summary and insights. Particularly enjoyed the summary:

    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.

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