Cultural and Gender Biases of Codependence


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.


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) (


~ by splenectomy on May 8, 2013.

One Response to “Cultural and Gender Biases of Codependence”

  1. Selene,
    Great blog, I really love the way you write, good job on the blog.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: