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Paper Abstract:
Co-dependency. Description of co-dependency and surrounding issues. Patterns of traits and behaviors of co-dependent people. Discussion of co-dependency within a family systems perspective. Criteria for co-dependency diagnosis. The disease model concept; personality disorder concept.

Paper Introduction:
CODEPENDENCY The following presents the topic of codependency Part I includes adescription of codependency and surrounding issues diagnosingcodependency etiology and prevention and treatment of codependency PartII presents a discussion of codependency within a family systemsperspective which is followed by a summary and conclusions Part I Codependency DescribedDefinition and Characteristics of Codependency Springer Britt and Schlenker defined codependency as anunhealthy devotion to a relationship at the cost of one\'s personal andpsychological needs p This definition has been used to describe apattern of compulsive

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To change thefunctioning of one is to change the functioning of another (Bowen Center,2 4; Worden, 1999). The codependent person caters to the needs ofanother in the hope that this other will be obligated to return the lovewanted and needed. Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV). Sex Roles, 43(11-12), 787-82 .Loring, S., & Cowan, G. Journal of Mental Health, 2 (4), 344-359.Huycke, J. Externalfocus or approval seeking was associated with negative aspects offemininity. According to Minuchin the family's ability to adapt is based onfactors such as structural components. The child thus sacrifices the true selffor the codependent self that cares for the parent or other. A., Britt, T. Failure to adapt to lifestress results in dysfunction (Huycke, 2 ; Worden, 1999).Studies of Family Structure and Codependency Burris (1999) studied 73 women and determined that codependency wasassociated with high maternal control and low maternal care. However it has alsobeen stated that this disease model is inappropriate since it fails todistinguish between severity of symptoms and related treatment needs. Pacific Grove, CA. L., Barrett, K., & McKinnon, T. Reconceptualizing codependency in women: A sense of connectedness, not pathology. Diagnosing Codependency Wells, Glickauf-Hughes, and Jones (1999) reported that codependencyhas become a construct that is popular but over generalized to the point ofbeing unable to permit a differential diagnosis or be used adequately fortreatment planning. C. Whilecodependency has become a popular term with self-help treatments available,Cermak (1999) suggests that this is inadequate and in depth codependencytreatment is required. Cermak (1999) reported that treatment has been limited by tendenciesto treat symptoms only or to treat the disorder as if it is an adjunct totreating the chemically dependent individual. The codependentstrives to care for another to the point of crossing boundaries and in turndemands that they receive similar treatment. Thus family problemsresult with boundaries are too porous or enmeshed or boundaries which aretoo rigid or disengaged. Wells, Glickauf-Hughes, and Jones (1999) investigated therelationship of codependency to low self-esteem and shame-proneness, andchildhood parents. Preliminary screening of the women showedsignificantly elevated levels of psychopathology with over 5 % havingclinically meaningful elevations on five or more scales of the MMPI. They exhibit a failure to set andmaintain boundaries as they attempt to control and deal with feelings oflow self-worth and needs for approval and care from others. Twelve-step programs such asAl-Anon and Alateen are designed to help the codependent but these may failto make in depth changes. MMPI profiles of women in codependency treatment. The codependent person invests their self-esteem to influence another. This is supported by Wells et al.(1999) who further pointed out that the child in this family develops afalse self to deal with the family system. Treatment of the codependent includes treatment for the familyof the codependent with obsessive-compulsive tendencies. Women scored higher than men on external focus. (1996). By these newdefinitions it is estimated that 96% of the female population suffer fromcodependency. (2 ). Bowen Theory. Critical analysis of the concept of codependency. Gender role, achievement and affiliation,locus of control, and empathy were assessed as were symptoms of depression,antisocial behaviors, and substance abuse. The emotional system in this family is heightened and overtime this tension results in symptoms. As pointed out byBowen, when a family is unable to allow for the differentiation of theself, this tendency is often multigenerational. Springer et al. Codependency is viewed as having origins in childhood, a definablecourse, and a predictable outcome. Some functions may demand that an individual align with aparticular subsystem at the expense of another. Individuals with thisdisorder are often pessimistic and have self-doubt, belittling theirabilities and assets. PartII presents a discussion of codependency within a family systemsperspective, which is followed by a summary and conclusions. Since study findingsconflict and there is no clear definition of codependency, a lack ofdiagnostic criteria, and no set guidelines for treatment, it is importantto consider all possibilities. These behaviors are an effort to find feelings of self-worth, identity, and safety. (1997). Part I Codependency DescribedDefinition and Characteristics of Codependency Springer, Britt, and Schlenker (1998) defined codependency as "anunhealthy devotion to a relationship at the cost of one's personal andpsychological needs" (p. Journal of Personality Assessment, 58, 211-214.Wells, M., Glickauf-Hughes, C., & Jones, R. Beattie, a popular author from the 198 s, specified241 dependency characteristics organized by 14 categories, which broadeneddefinitions to include many behaviors. (1998) studied codependency as aconstruct in a sample of college students to determine personalitycharacteristics and relationship quality. According to this type ofdefinition, anyone who is involved in an addictive process is codependent.Advocates of codependency as a disease fail to distinguish between severeor minor problems. Metis, 1(1), 95.Granello, D. Codependent labels maypunish women who are feminine and take on the care-taking role as they havebeen socialized to accept. According to Bowen's theory individuation of the self develops withinthe family process when there is a balance in functioning. The child sacrifices theindividuation of the self and becomes codependent with a pattern of takingcare of the parent and later others, in an attempt to receive love.However this false self is based on shame and fails to bring the loveintended. (1998) found that codependency functions were related tolower self-esteem, lower feelings of interpersonal control, self-consciousness, social anxiety, and dysfunctional relationships. These investigators used the Minnesota Multi-PhasicPersonality Inventory (MMPI) to examine the profiles of 73 women involvedin a 1 -day residential program specifically for treatment of codependency. Gender roles and their perceptions may also be related tocodependency (Dear & Roberts, 2 2). These behaviors are associatedwith pathological consequences such as depression, anxiety, low self-esteem, and a lack of assertion. (2 1). Minuchin's structural family therapy includes thenotion that families have the function of socializing children andproviding mutual support. The familyfails to allow for autonomy to develop when disruptive family emotionalsystems due to alcoholism are found. Bowen's theory of family therapy relies on eightconcepts: triangles (three-person relationship system), differentiation ofself (ability to think and be, separately from the other), nuclear familyemotional system (patterns include marital conflict, dysfunction in aspouse, impairment of a child, and emotional distance), family projectionprocess (parents transmit problems to a child), multigenerationaltransmission process (patterns of differentiation are passed to generationsthrough relationships), emotional cutoff (reduced or total emotional cutoff from a family member and/or physical cutoff), sibling position(positions have characteristics), and societal emotional process (culturalforces result in societal and family functioning). Cermak (1999) reported that there is no accepted definition ofcodependence and this is a problem leading to difficulty in understanding,diagnosing, and treating codependence. The relationships between codependency and femininity and masculinity. 141). (2 2). This is an issue forprofessionals treating the codependent; professional care must adhere tostrict boundary setting and limitations.Family Systems for Understanding Codependency Minuchin's theory points out that when boundaries in a familysubsystem are enmeshed, independence is prohibited. Cermak (1991) agrees with this position and suggeststhe criteria for diagnosis of codependency as a personality disorder.These criteria include: a continued investment of self-esteem in theability to control oneself and others in the face of serious adverseconsequences; assumption of responsibility for meeting others' needs to theexclusion of acknowledging one's owns; anxiety and boundary distortionsregarding intimacy and separation; and enmeshment in relationships withpersonality disordered, chemically dependent, other co-dependent, and/orimpulse disordered individuals. Parents learned to bedependent on others and transfer this dependency to their addictions andtheir children. The codependentaccording to a disease model would be suffering to the point of beingunable to function and treatment would assist in helping the patient regainfunctioning ability. Theresearchers noted that there is no formal diagnostic category forcodependency and all the women in the treatment program were therefore self-identified as codependent. Roots forlove addiction can also include biological tendencies for increasedendorphins when love produces a high arousal state, and cultural influenceswhich define roles and expectations. E. M. Martsolf (2 2) reported that the codependent suffers from problemswith interpersonal relationships that stem from their family of origin.The author noted that the literature remains unclear regarding the conceptof codependency with criticisms that it is ill defined, tends to overpathologize traditional female roles, and is globally used to describe anyproblematic interpersonal relationship. Self-sacrificing was associated with positive aspects offemininity. L. Thuscodependency was associated with inadequate parental bonding and childrensubject to this lack develop behaviors such as being attentive andresponsive toward exploitive parents. (1996). The dependent personality disorder describesseveral codependency features and many therefore state that codependencyshould be classified in the DSM. A healthy boundary allowsthe individual to function within the subsystem in an appropriate manner.For example the parenting subsystem needs to have healthy boundaries to beeffective. Causes of codependency are not clear however this problem is viewedas contextual and related to early parenting (Burris, 1999; Loring & Cowan,1997). Treatment mustmodel and teach appropriate boundaries. Codependency: Clarifying the construct. (1998). Diagnosing and treating co-dependence. Children develop defenses such as denial, rationalization, andprojection and symptoms of depression, anxiety, low self-esteem, andphysical problems. Gender, gender roles and personality: Gender differences in the prediction of coping and psychological symptoms. The treatment program model was based on the twelve-step philosophy. Issues in Mental Health Nursing, 22(3), 273-286.Walfish, S., Stendmark, D. Health & Social Work, 2 (4), 272-278.Dear, G. Structural dysfunctions lead to family dysfunction andinclude triangulation, power disorders, and coalitions within the family.Failure to transition from one life cycle stage to another results indevelopmental failures and family dysfunction. ReferencesAmerican Psychiatric Association (APA). Favorini (1995) pointed out that treatment of codependency requires aposition that inspires empowerment in the client. Springer, et al. (1994). A. Thetreatment group did suffer from common problems however profiles wereheterogeneous suggesting that there is no "typical" codependent individual. The codependent person is unable to carefor their own needs. S. Love addiction is thought to be a result of unmet needs,developing in proportion to this lack. Glenday (1996) stated that as a feminists, she rejects the notion ofcodependency since it is a term that labels women for the behavior thatthey have been socialized to accept. Obsessive-compulsive disorder results in burdens for thefamily members who must comply with bizarre behaviors to pacify theirrelative. However, it is also noted thatthere is a set of behaviors associated with the term codependent.Codependent behaviors and symptoms include a focus on others with self-neglect, low self-worth, and hiding the self. Most behaviors exist within a socialcontext and family provides the biggest source of this social interaction.Therefore the family system is considered. Thustreatment would need to include a focus on the parent and other subsystems. Codependency Etiology Codependency is viewed as an interpersonal phenomenon (Loring &Cowan, 1997). L. The essential feature of this disorder is apervasive and excessive need to be taken care of that, results insubmissive and clinging behavior. (1999). (1999). Increased recognition of personalneeds and wants is also important. In reality these behaviors are not rewarded by love andin fact the codependent person is frequently neglected and resented whichleads to increased feelings of inadequacy and needing more. Inaddition it is argued that this disorder tends to be associated with womenand this is resulting in women questioning their care-taking qualities;femininity is becoming viewed as pathological (Anderson, 1994). Do thispopularity the definition of codependency has expanded and all familymembers and the chemical dependent's close social network are now included. At present workingdefinitions of codependency which include patterns of dependence oncompulsive behaviors and approval from others to find self-worth, identity,and safety, have no discriminate validity. Journal of Social & Clinical Psychology, 18(3), 277-298.Cermak, T. The characteristics of thisdisease are consistent across individuals and create significantdysfunction. Causes of codependency are not clear. Thus it wasconcluded that the relationship between codependency and gender-role iscomplex and further complicates the description of codependency. (1999). Data showed a moderateassociation between codependency and gender-role identification. Codependency: A grass roots construct's relationship to shame-proness, low self-esteem, and childhood parentification. Found online at:, L. It is argued that codependency should be considered adisease, which demands appropriate in-depth treatment. As pointed out byMartsolf (2 2) the codependent person adapts to their family of originwith specific boundary behaviors. (1995). (1998). Anderson (1994) argues against the disease model of codependency.This author stated that the disease model defines codependency as presentin every member of an addictive family and often worse than alcoholismitself. Orthopedic Nursing, 21(6), 61-68.Messner, B. Family therapists are in the unique position ofcoming into contact with couples and children who are suffering from theeffects of family dysfunction or alcoholism. Inaddition, the disease model would allow for treatment despite the cause.In fact there can be many causes; causes of codependency may include genderrole identification, family dysfunction, or more. Structural family therapy. Dear and Roberts (2 2) further studied the codependency model withinthe roles of femininity and masculinity. While there is no category for codependence as a disorder in the DMS-IV, symptoms and characteristics are similar to the diagnosis of DependentPersonality Disorder. This shame is distinguished from guilt andis related to feeling bad, inadequate, and hopeless. Life stress such as parent dysfunction due to alcoholism can disrupthomeostasis of a family and result in failure to adapt. The family systems approach can be used tounderstand and treat the codependent. The disease model would eliminate labeling since itwould provide a clear definition of a disorder that was separate from mildsymptoms such as tendencies to seek approval from others. Burris (1999) pointed out thatfeminist critics of codependency argue that this concept is sexist andtherefore not worthy of measurement or study. Is codependency a meaningful concept? These behaviors aredependent on the gender of the codependent person and they reflectinequality within a relationship. Boundaries are created by certain rules thatdefine participants and behaviors. Most agree that goals ofrecovery for the codependent include increased self-respect and self-awareness, increased ability to care of the self, and increasedidentification and expression of feelings. Journal of Mental Health Counseling, 2 (2), 141-158.Stafford, L. In fact anyone who grew up in an emotionally repressive family can now belabeled a codependent. Minuchin's Theory. (1995). Diffused boundaries in enmeshed subsystems prohibitindependence and rigid boundaries require high levels of stress to overcomesubsystem barriers. The definition of codependency includes obsessive-compulsivetendencies. A. M. Found online at: www.thebowencenter.orgBurris, C. Family therapy basics, second edition. Prevention and Treatment of Codependency Messner (1996) reported that by the late 197 s chemical dependencytreatment professionals had identified spouses of alcoholics as codependentsince they exhibited symptoms similar to alcoholism. Dueto the current confusion surrounding the topic of codependency, it isconcluded that the disease model offers the solution to all concerns. Sex Roles, 46(5/6), 159- 166.Favorini, A. This definition has been used to describe apattern of compulsive behaviors that are motivated by the need for approvalfrom another. Criteria have not been agreed on for the assessment ofcodependency. Codependent behaviormay depend on the context of a relationship and judgments of the behaviorand the people involved are contextual in nature. (1997). This application trivializes the addictivebehaviors associated with chemical dependency. A feminist critique of the concept of codependency. Findings showed thatmasculinity was related to lower depression and higher antisocial andsubstance abuse factors; femininity was related to lower antisocial andsubstance abuse factors. Cermak (1999) stated that current treatment of codependency tends tobe simplistic but in reality more than self-help is needed. It was found that codependencywas related to a greater ability to share emotions, but this did not leadto increased feelings of being connected, cared for, or supported.Springer, et al. C. Prevention of codependency can beginwith health professional's early identification of the problem. The disease concept would ultimately provide exact criteria fordiagnosis and, as is stipulated by the DSM, symptoms would need to besevere enough that they interfered with functioning. Stand by your (exploitive) man: Codependency and responses to performance feedback. Cooper (995) presented codependency treatment models, which can beused to treat families with members suffering from obsessive-compulsivedisorder. W., & Schlenker, B. Applying the codependency model to a group for families of obsessive-compulsive people. R. The higher the tension, the morepeople in the family will develop these symptoms. (2 ). Part II Codependency Within the Family SystemFamily System Approaches Bowen Theory. Concept of codependency: Blaming the victim or pathway to recovery. They seek others to dominate and protect them. E., Suzanne E., & Krone, A. (1994). American Journal of Family Therapy, 27(1), 63-71.Worden, M. H., Marr, J. Summary and Conclusions In summary, the literature findings show that codependency isdifficult to define but overall impressions include a pattern of compulsivebehaviors motivated by a need for approval from another. Center City, MN: Hazelden.Cooper, M. H., & Beamish, P. Burris (1999) reportedsupport for the notion that codependency is caused by an extreme relianceon relationships that are designed for personal fulfillment. Munichin and Bowen point out thatthe family system creates and supports codependency and resulting symptoms. Washington, DC: APA.Anderson, S. In conclusion, the literature pointed out the inconclusivenessregarding codependent definition, diagnosis criteria, and treatmentconsiderations. The family process is influenced bythe individual differentiation of the self, which includes a balancebetween intellectual and emotional functioning, and autonomy andtogetherness in social situations. A self-help book might be appropriate for those suffering fromsymptoms but inappropriate for those suffering from the disease. Cooper statedthat typically treatment of the codependent involves a 12-step model aswith Alcoholics Anonymous and self-help groups that use behavioral andcognitive treatments combined with spirituality. Stages of recovery include: thesurvival stage, with treatment that dismantles denial systems, focusesattention back on the client, and helps clients recognize how theyperpetuate their problems; the re-identification stage, with treatment thatidentifies the client as a codependent, works through grieving processeswhen power illusions are lost, brings awareness of compulsivity, andinvestigates realistic limits; the core issues stage, with treatment thatfocuses on helping the client understand how their codependence ispervasive, and helps them generalize findings; and the re-integration stagewith a focus on termination (Cermak, 1999). (1992). Extraordinary self-sacrifices are madeto maintain important bonds. (2 4). This clinical definition ofcodependency views the disorder as a disease. Inaddition codependency is associated with boundary issues. Thus for this system's approach, thefamily and its members are connected emotionally, so much so that eachaffects the other's thoughts, feelings, and actions. There may be several subsystems in onefamily. Also included in theirbehaviors is a tendency to fail to set and adhere to appropriaterelationship boundaries.Codependency and Gender Gender role may be a cause of codependency. It is hypothesized that these labels mayactually be the cause of negative symptoms and behaviors associated withcodependency. Psychology of Addictive Behaviors, 13(1), 39-48.Glenday, M. Codependency, boundaries, and professional nurse caring: Understanding similarities and differences in nursing practice. (1998) reported that behaviors andsymptoms develop due to malfunctions in the addictive and codependentfamily. Global criteria and vague boundaries make thecodependency concept meaningless with regard to diagnostic criteria. While men can be codependent the literature usually refers towomen. Also included are three or more of thefollowing: Excessive reliance on denial; constriction of emotions;depression; hyper vigilance; compulsions; anxiety; substance abuse; victimor recurrent physical or sexual abuse; stress-related medical illnesses; orin a primary relationship with an active substance abuser for two yearswithout seeking help. As noted earlier, Martsoff (2 2) pointed out that, problems in thefamily of origin lead to the development of codependency with symptoms ofself-neglect, low self-worth, hiding the self, and medical problems. Problemsassociated with codependency include depression, anxiety, low self-esteem,and health concerns (Springer et al., 1998). CODEPENDENCY The following presents the topic of codependency. Codependency: An interpersonal phenomenon. A failure to meet needs inchildhood leads to low self-esteem and an attempt to gain control of theself, which results in giving outside forces ultimate control. Arguments against the use of personalitydisorder for a diagnosis of codependency include that personality disordersare recognizable by age 16 years and are highly resistant to treatment andchange. These individuals fear separation and engagein dependent behavior to elicit care-giving. Social Work, 39(6), 677-685.Bowen Center. Thus the diseasemodel would specify severity and this would imply the need for in depthtreatment. In these families, children areenlisted to care for the parents. Findings of their study showed thatthose who labeled themselves as codependent were associated with morepathological symptoms than those who did not self-label themselves ascodependent, regardless of the psychological state of their parents. Personality factors did not account for gendereffects but gender roles affected personality factors and symptoms. Contrary to this, research studies have shown that adult childrenof alcoholics or codependents improve rapidly with treatment (Anderson,1994). People with this disease tend to enterinto addictive relationships. Anyone experiencing anxiety orunhappiness can easily label themselves as codependent. In addition, physicians andother health professionals can intervene when patients are not respondingappropriately to therapy do to their emotional life (Cermak, 1999). Sizing up codependency recovery. Failure to distinguish codependency therapy fromfamily therapy is also a problem. Successful treatment must determine ifthe client is using drugs or alcohol, if their home environment issupportive to recovery, if the client is suffering from posttraumaticstress disorder, whether individual or group therapy is preferable, andwhat state of recovery the client is in. In-depththerapy is required to make characterological changes. Center City, MN: Hazelden.Springer, C. (1999). In a study of 3 2 college students,these factors were investigated. This disease model is argued against since personality disordersare found at a young age and tend to resist treatment, while thecodependent has been found to respond to treatment. Milwaukee: University of Wisconsin. Lengua and Stormshak(2 ) studied the differences in genders with regard to codependencyissues such as coping and psychological symptoms. This recovery also includedhelping the codependent to let go of what cannot be controlled and avoidingtendencies to be overly responsible. Alternatively, George, Marr,Barrett, and McKinnon (1999) reported different results regardingcodependency and alcoholic parentage. Rather, there are many types of codependents and treatment must considerthese differences. Subjects were 25 undergraduates (17 to 25 years). Findings showed that codependent femaleswere judged less healthy than codependent males and females were consideredbetter partners. A sample of 2 college students was used and subjectscompleted questionnaires to include the Beattie Co-Dependency Checklist,the Test of Self Conscious Affect, the Rosenberg Self-Esteem Questionnaire,and the Parentification Questionnaire. Families operate through subsystems that requireboundary clarity and permeability that is adequate. & Roberts, C. Wells, Glickauf-Hughes, and Jones (1999) stated that codependency isrelated to the development of a false self that is shame-based, other-oriented, and over-conforming. Is it love or is it addiction, second addiction. Findings demonstrated that self-esteem, shame levels, and parenting were related to codependency. Social Work, 4 (6), 827-83 .George, W. These patterns are found in shame-based familieswhere needs for dependency are not met. This theory links theindividual and family differentiation. Theyfear being alone and will agree with things they believe are wrong or willvolunteer for unpleasant tasks to ensure them the care and support theyneed (APA, 1994). Families function and differentiate as individuals through thesubsystems. D. In addition it isstated that this model leads to labeling of feminine qualities aspathological (Anderson, 1994). Since that time theterm has developed a life of its own and now includes a broad list ofcharacteristics that make it a popular diagnosis. Sex Roles, 36(1/2), 115-124.Martsolf, D. Western Journal of Communication, 6 (2), 1 1-1 8.Schaeffer, B. Granello and Beamish (1998) noted that codependency has become apopular movement complete with self-diagnosis and self-help books andworkshops. This author proposed thatcodependence has a recognizable pattern of traits and behaviors and thispattern creates enough dysfunction to warrant a diagnosis of MixedPersonality Disorder, as found in DSM III. Codependency is described asa pattern of care-taking or parenting as a style of relating to others,learned in childhood. Schaeffer (1997)pointed out that addiction has three elements: continued behavior despiteadverse consequences; obsession or preoccupation; and feelings of being outof control. Cermak (1999) pointed outthat symptoms are severe enough to warrant a diagnosis of personalitydisorder. When the family is too enmeshed ordisengaged or when there are coalitions, triangulation, and problems withpower, the children are unable to develop autonomy. J., & Stormshak, E. The shame isinternalized and related to low self-esteem. Part I includes adescription of codependency and surrounding issues, diagnosingcodependency, etiology, and prevention and treatment of codependency. Alcoholic parentage, self-labeling, and endorsement of ACOA-Codependent traits. Codependency has been equated with love addiction. Walfish, Stendmark, Suzanne, and Krone (1992) reported on treatment ofcodependency in women. In a studyof 73 females, findings showed that codependents demonstrated a differencein mood as a function of receiving positive or negative feedback fromeither an exploitive or nurturant source. (1998). Individuals label themselves as codependent and have numerousbest-selling books on the topic to assist them with self-treatment.Workbooks provide a 12-week, step-by-step treatment plan. Denial,rationalization, and projection are frequently used to defend againstpainful feelings and situations. These judgments of codependent behavior were contextual.Parenting and Codependency Burris (1999) supported the notion that codependency is caused by andcharacterized by an extreme reliance on relationships with exploitiveindividuals for personal fulfillment, beginning with parents. These positions aresupported by studies. Early interventionin the treatment of codependency includes the recognition of this problemby family therapists. Critics of the disease model state that it labels behaviors and leadsto interpersonal problems. M., (2 2). T.

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