Understanding Codependency, Codependent Behavior, And Mental Health

A healthy relationship usually involves the provision of care and support between partners. However, when two people depend on one another to meet all their emotional or psychological needs, they may have a codependent dynamic. Codependency or interdependency can occur in friendships, romantic relationships, work relationships, or relationships with family members. 

When codependency takes root, both individuals may lose sight of who they are outside of their connection to each other. Addressing codependency in relationships often involves working with a therapist to identify unhealthy patterns and develop healthier coping mechanisms. Learning more about these patterns may help those facing codependency open themselves up to a healthier dynamic in the future. 

What is codependency?

The APA Dictionary of Psychology lists two definitions of codependency. The first definition describes a state of mutual reliance, such as a relationship where two individuals believe they are dependent on one another for their well-being. The second definition involves a dysfunctional relationship pattern in which an individual is psychologically dependent on or controlled by someone with a substance use disorder (previously called substance abuse disorder).

While substance use can be a part of codependency, it may not be in every case. Psychiatrist Timmen Cermak explored the relationship between alcoholism and codependency in his 1986 work, “Diagnostic Criteria for Codependency,” but codependency is not a clinical diagnosis. Rather, it is an emotional and behavioral condition in clinical psychology characterized by the provision of continuing support to an individual, often at the exclusion of meeting one’s own needs. Typically, the individual who receives this attention is a family member who has a concurrent, ongoing need or desire for such support. 

Why codependency develops

The concept of codependency used to be primarily applied to those who maintain relationships with partners with substance use disorders. In the way that "substance abuse" has been changed to the more acceptable term, "substance use," the way researchers understand codependency has also changed. No longer only used to describe partners of people living with a chemical dependency, the term codependency now encompasses many types of relationships or situations where this dynamic is present. 

Family and generational factors 

According to Mental Health America, a dysfunctional family dynamic is the primary source of codependency. Dysfunctional families often develop patterns of unhealthy behavior because of a specific challenge, such as a history of emotional, physical, or sexual abuse, or one person’s addiction or mental illness. These patterns can be passed down from one generation to the next.

Common signs and behaviors of codependency

Codependent patterns can be recognizable across various types of relationships. Knowing what to look for can help you identify unhealthy behaviors early on and respond accordingly.

Behavioral and emotional signs

Some people who have problems with codependency can also be susceptible to learned behavioral or thought patterns, which can create a tendency toward this type of dynamic. These common signs and other emotional responses might include:

• A perception that one is responsible for the actions of others
• A tendency to make excuses for others
• Low self-worth
• Confusing love with pity
• A desire to control others
• Difficulty recognizing and expressing feelings
• Difficulty adjusting to change
• An unhealthy dependence on relationships
• Offering more than their part
• Desiring the approval of others
• Desiring recognition 
• Difficulty with assertiveness 
• Intimacy challenges 
• Difficulty setting healthy boundaries
• Poor communication skills
• Difficulty making decisions
• A fear of abandonment
• Frequent anger or irritability 

Codependency may be present when the above symptoms are frequent or negatively impact an individual's mental health or the security of the relationship. In these cases, a counselor may help you examine your patterns to identify whether codependency might be a challenge for you and how to move forward. 

Patterns in different relationships 

Codependent relationship dynamics can appear in many types of relationships, including romantic, familial, and even professional relationships. In romantic relationships, codependence may manifest as prioritizing the relationship over the individual’s needs. In family relationships, one family member may feel obligated to manage the well-being of a sibling, parent, or child. A codependent relationship with a coworker may look like taking on extra tasks or being unable to say no to extra hours in an effort to avoid tension.

When codependency becomes harmful

Codependency can be misinterpreted as loyalty or devotion to a relationship, but when it consistently overrides self-respect, autonomy, boundaries, and safety, it can become harmful.

Possible mental health consequences

Codependency can lead to the reinforcement of unhealthy relationship dynamics and things that make relationships worse, rather than mutual respect and support. When one partner continually manages another person’s emotions by over-accommodating and making excuses, it can eventually lead to resentment or emotional burnout. In time, this can cause increased anxiety, lower self-esteem, and an eroded sense of self. 

Codependency as a red flag

In some cases, codependency can be a sign of deeper, larger problems. When one person is over-giving, and the other is benefitting, it can lead to manipulation, exploitation, or other forms of control within the relationship. Recognizing this pattern can be crucial to knowing when to seek help.

How clinicians assess codependency

Clinicians may use screening tools, such as self-report questionnaires and in-depth interviews, to determine whether a person or couple can benefit from codependency treatment. While there is no official diagnosis of codependency in clinical psychology, understanding whether codependent behaviors are present in a relationship can help ensure people get support and treatment that is tailored to their needs.

Evidence-based treatment approaches

Learning to break the patterns of codependency may not happen overnight. However, with applicable resources, tools, and practice, you may feel better equipped to address potentially unhealthy behaviors, set boundaries, and develop a strong sense of self. Below are a few support options you may have when facing codependent relationships. 

Individual therapy

Individual therapy can be one way to identify and manage patterns of codependency. This approach to codependency treatment can include cognitive behavioral therapy to help identify unhealthy patterns behind people-pleasing behaviors and the fear of conflict. Trauma-informed work can also support those who developed codependent behavior or have difficulty adjusting as a result of trauma.

Group therapy and 12-step style programs

Support groups are another way that some people choose to work through challenges in their lives. It often helps to spend time with people who are experiencing similar concerns to give and receive mutual support. One of the most widely known codependency support groups is Al-Anon. It's a 12-step program for people in a codependent relationship with someone who has alcohol use challenges. Codependents Anonymous is another 12-step program with a broader focus intended to include anyone in any type of codependent relationship.

Practical steps to begin changing patterns

Here are some actionable things you can do to take steps toward changing patterns and healthy dependence:

• Before you react or make excuses for someone, ask, “Is this my responsibility?”
• Start to set boundaries for how you spend your time
• Say no to things without overexplaining your reasons
• Pay attention to when you make excuses for others
• Focus more on communicating truthfully and respectfully rather than keeping the peace

How to build healthier, interdependent relationships

Interdependent relationships can balance support, connection, and respect with individuality and autonomy. These relationship skills can be learned, even for people who have had codependent relationships in the past.

Boundary-setting scripts and daily practices

Setting boundaries can be key to any healthy relationship. Here are some simple scripts that can help you notice your emotional responses and communicate your own boundaries to take steps toward healthy dependence: 

• I am here to listen and offer you support, but I cannot fix this for you.
• If you need to talk about this more, let me know, and we can find a time that works well for both of us to revisit this conversation. 
• I need to think about this for a while before I give you an answer.
• I’m sorry, I’m not available, but I hope that you find the support that you need. 

Relearning self-worth

Codependency can come at the expense of one’s own self-worth. Relearning that you are valuable and worthy of love and respect can improve self-esteem and may lead to relationship dynamics that reflect mutual support and healthy dependence.

Therapy and treatment options for codependency