Codependence: Future Directions

                                                                                                                                                                                  

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 )

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~ by splenectomy on May 29, 2013.

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