Most of us have heard the term codependency and carry a working definition of what it means in our heads. Most of us also believe it’s an official clinical diagnosis, like those found in the Diagnostic and Statistical Manual of Behavioral Disorders (DSM-5), the go-to reference manual mental health professionals use every day to diagnose mental health disorders. However, although the phenomenon of codependency is real, its symptoms and characteristics overlap with other mental health disorders to the extent that codependency itself – after extensive research and review by the experts who publish the DSM-5 – does not meet the criteria that merit the creation of a standalone diagnosis of codependency.

Codependency: Origins of the Concept

While it is not an official psychiatric condition, we’ll reiterate the fact that the phenomenon of codependency is real. The term first appeared among clinicians involved in the treatment of alcohol and substance use disorder (AUD/SUD) in the early 1980s. It was among a new group of descriptors that “sought to capture the untoward effects of alcoholism on family members of alcoholics.”

The concept of codependency goes back about 80 years. Around 1940, two women who were married to alcoholics – one of whom was the founder of Alcoholics Anonymous, Bill W. – met and decided to support one another as they experienced the effects of their husbands’ disordered use of alcohol. Over the next ten years, the two women – Lois W. and Anne B. – created family groups to support others in their position, and in 1952, coined the name Al-Anon. The goal of Al-Anon is to “…help the families and friends of alcoholics connect and support each other through meetings, information, and shared experiences.”

We know: we have yet to offer a definition of codependency, but we’re almost there, we promise. This historical context is important. It lays the foundation for how we understand codependency today and identifies the roots of the phrase as related to alcohol and substance use disorder. It also teaches us that mental health disorders – including drug and alcohol addiction – affect not only the individuals with the disorder, but also their families, friends, and loved ones.

Codependency Defined

Now we’re ready.

Here’s how the American Psychological Association (APA) defines codependency:

1. The state of being mutually reliant, i.e., a relationship between two individuals who are emotionally dependent on one another.
2. A dysfunctional relationship pattern in which an individual is psychologically dependent on (or controlled by) a person who has a pathological addiction.

We’ll focus on the second half of the definition: codependency as a dysfunctional relationship pattern. In that context, it’s possible to expand what codependency means. It’s also possible to share the signs and characteristics of a codependent relationship. Please keep in mind that codependency is not recognized as a mental illness or a personality disorder but does share things in common with some mental illnesses and personality disorders.

With that said, here’s an expanded concept of codependency, which matches what most people think of when they hear the term:

“Codependency involves sacrificing one’s personal needs to try to meet the needs of others. Someone who is codependent has an extreme focus outside themselves. Their thoughts and actions revolve around other people, such as spouses or relatives. Codependency often appears in relationships which are unbalanced. A person with codependency often tries to save others from themselves. They may get hurt trying to cure a partner’s addictions or dysregulated behaviors.”

This brings us to another term it’s important to understand: enabling or enabler. The APA defines enabling as:

“A process whereby someone (i.e., an enabler) contributes to continued maladaptive or pathological behavior in another person.”

Now we have the full picture. Codependency describes the phenomenon that occurs when an individual enables – often inadvertently – the life-interrupting, maladaptive, or dysfunctional behavior of another individual. The other individual, most often, is a spouse, child, parent, sibling, or loved one.

The Characteristics of Codependency

Individuals who meet the criteria for codependent behavior often enable individuals with a mental health, alcohol, or substance use disorder by engaging in specific behaviors or displaying particular characteristics. These may include:

• Taking responsibility for the actions of the individual or loved one with a mental health or addiction problem
• Attempting to control that individual by making big-picture life decisions for them
• Experiencing low self-esteem
• Avoiding conflict with their loved one, in order to maintain the status quo
• Covering up inappropriate behavior by their loved one
• Excusing inappropriate behavior by their loved one
• Blaming others for their loved one’s behavior

Other characteristics of codependent behavior include:

• The inability to set and keep appropriate boundaries
• An intense fear of being alone
• The chronic tendency to do more for others than is necessary
• An inflated sense of responsibility for the wellbeing of others

When reading through these bullet points, it’s easy to see how a parent, a spouse, a sibling, or a partner can cross the line from helping their loved one manage their problems to contributing to the problems themselves. That’s the conundrum associated with codependency: people who are codependent often begin helping their loved one with the best intentions. But over time, become part of their loved one’s problems, rather than part of the solution to their problems.

Moving Past Codependency

It’s a tricky situation, but there are ways to recognize and move away from a state of codependent enabling toward a state of health support and empowerment – which many people consider to be the opposite of enabling.

If you read the bulleted lists above and recognize yourself or your behavior in any of the items, here are steps you can take to shift the relationship towards stability and balance:

• Learn to say “no”
• Learn to follow through on your “no”
• Create healthy boundaries
• Maintain those boundaries by repeating yourself – in a calm, cool, collected, and dispassionate manner
• Understand that you cannot fix someone: they need to learn to heal themselves
• Teach your loved one skills they can use to manage their own lives and solve their own problems
• Connect your loved one to resources that help them manage their mental health, alcohol, or substance use disorder

Finally, if you think you may be in a codependent relationship, or know someone who may be in a codependent relationship, you may want to consider seeking the support of a mental health professional. This is especially true if you’ve tried unsuccessfully to stop engaging in the behaviors we identify above as characteristic of codependent enabling. If you try to say no but move to yes more often than not – then you may need support. If you try to create healthy boundaries but let them fall more often than – you may need support.

Codependency Awareness Month: Support and Treatment for Codependency

If you need support, the best step – for you and the loved one you may be enabling or codependent upon – is to seek an evaluation from a mental health professional. Once you receive an evaluation, you can collaborate with your provider to create a treatment plan. Treatment for codependency often involves cognitive behavioral therapy (CBT), motivational interviewing (MI), group therapy, and/or family therapy. You can also seek out social support groups such as Al-Anon if you’re reluctant to seek professional help.

Remember: codependency is often directly connected to the mental health, alcohol, or substance use problems of a loved one. Your goal is to help them – and that’s a worthy goal. One way to understand codependency is by seeing it as when helping goes wrong or when helping someone you love ends up hurting you both. You can move past codependency to balance and health: balance and health for you, your loved one, and your family.

It may take time, effort, and professional support – but you can do it.