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The concept of codependency in the family system emerged from the study and treatment of alcoholism (Gorski and Miller 1984). In the alcoholic family system, codependency may be defined as a particular family relationship pattern in which the alcoholic is married to a spouse who, despite being a non-drinker, serves as a helper or facilitator to the alcoholic's problem behavior (Scaturo and McPeak 1998). The spouse, therefore, plays a role in the ongoing chemically dependent behavior of the alcoholic. The spouse's behavior may, unintentionally, foster the maintenance of the drinking problem by enabling the drinking pattern to continue. For example, the codependent spouse may make "sick calls" to the alcoholic's workplace following drinking episodes, thereby delaying the problem from coming to the foreground. Thus, the spouse is said to be a "co-dependent" of the alcoholic's chemically dependent behavior.

Codependency and the Family System: Related Terms and Synonyms

The notion of codependency is predicated upon and encompasses earlier ideas about family functioning. These concepts have included the notions of family homeostasis, interlocking family pathology, the over-adequate/inadequate marital functioning, the one-up/one-down marital relationship, the marital quid pro quo, and marital complementarity. A brief discussion of these concepts will be helpful in clarifying and understanding the nature and scope of codependency.

Family homeostasis ( Jackson 1957) refers to the observation of significant changes in other family members in response to the behavior changes that take place in an identified patient undergoing some form of psychotherapy. For example, the mother of a boy in therapy for low self-esteem may not be entirely pleased by his recent success in winning an achievement award ( Jackson 1957). In such an instance, the mother may rely on her son's low self-image and neediness to enhance her own feelings of usefulness and self-esteem, in which case the mother's subtle discouraging behavior may serve to maintain the boy's problem of poor self-esteem rather than to improve it. Family therapists, who anticipate the family's interdependent needs, are generally prepared for such an upset in the mother in response to such desired gains in treatment by the identified patient (in this instance, her son with low self-esteem). The family, and its interaction patterns, is a homeostatic system that remains in a constant state of balance with respect to one another.

One reason for this homeostatic mechanism in family functioning is that people tend to seek out marital partners whose neurotic needs and emotional issues fit with their own. This observation, which has been termed also the interlocking pathology (Ackerman 1958) in family relationships, is based upon a psychodynamic view of the family. This perspective highlights the interdependence and reciprocal effects of disturbed behavior among the various members of a family, rather than focusing on the emotional distress or internal conflicts of a single family member who is seen exclusively as "the patient." Ackerman (1958) asserted that an individual's personality should be assessed not in isolation, but within the social and emotional context of the entire family group.

A codependent marital relationship has been termed by various family therapists as over-adequate versus inadequate functioning of each of the spouses (Bowen 1960). This configuration has been described similarly as a one-up versus one-down marital relationship (Haley 1963). One-up denotes a dominant position (i.e., the one who is "in charge") in the family hierarchy, while one-down denotes an inferior position (i.e., the one who is being "taken care of") in the power arrangements within the family (Simon, Stierlin, and Wynne 1985). Murray Bowen (1960) points out that these functional positions are, in actuality, only family "facades" rather than representative of the actual abilities of each of the spouses, each one appearing to occupy reciprocal positions in the family relative to the other. Thus, the over-adequate spouse presents a picture of an unrealistic facade of strength in the marriage. Likewise, the inadequate spouse presents a picture of helplessness in relation to the other. In actuality, spouses who have been married for any appreciable length of time usually have comparable emotional strength and maturity (Goldenberg and Goldenberg 1980). The codependent spouse, therefore, occupies the "appearance" of being over-adequate in relation to the inadequate position of the alcoholic spouse.

The above-noted ideas about family systems, upon which the popular concept of codependency is based, are clinical terms that have emerged from the field of family psychotherapy. As a result, code-pendency and its related concepts are a way of describing various kinds of family dysfunction or problem families in which there is some sort of mental health concern. However, degrees of psychopathology, or abnormal behavior, typically exist upon some continuum from the "severely pathological" (e.g., psychotic behavior or suicidality in a given family member) on one end versus relatively "normative social behavior" on the other, with various forms of human behavior falling somewhere in between these two poles. Thus, codependency as a dysfunctional form of family interaction is likely to fall on the pathological end of the continuum. However, this basic pattern of family behavior, in less extreme forms, can be seen in families at the normative end of the continuum, as well.

The concept of marital complementarity (Bateson 1972) has been used to describe dyadic (i.e., two-person) relationship patterns in which an individual's behavior and coping strategies differ from that of their spouse, but the two styles or patterns of behavior fit together in a dynamic equilibrium or active balance with one another (Simon, Stierlin, and Wynne 1985). In addition, the notion of complementary needs among potential spouses has been cited as an important factor in selecting a mate (Winch 1958). Likewise, Don D. Jackson (1965) has applied the legal term, quid pro quo, in the sphere of marriage to describe the type of "bargain," or complementarity, to which couples typically arrive in an agreement to marry. Literally translated from Latin as "something for something," marital quid pro quo implies that arrangements in the marriage generally function best over the long run if a suitable agreement that is genuinely collaborative in nature can be reached by the spouses. For example, to run relatively smoothly, agreements typically need to be made in the "division of family labor," which takes into account the sum total of the labor (both income-producing, as well as maintenance of home life) with sufficient fairness and acknowledgement of the contributions made by both. Only when this division of family functions becomes polarized and taken to the extreme (e.g., breadwinner versus homemaker roles), does such a quid pro quo risk rigidity, misunderstanding, and proneness to family pathology. Codependency is one such form of polarized marital role behavior (e.g., the "helper" versus the "sick" role) that signifies pathological complementarity and family dysfunction.

Codependency: Popular Definition and Usage

Melody Beattie (1987) popularized the concept of codependency in self-help literature (Starker 1990). She defined codependency for the lay reader: "A codependent person is one who has let another person's behavior affect him or her, and who is obsessed with controlling that person's behavior" (Beattie 1987, p. 36). She notes that the expression has been used as "alcohol treatment center jargon" and "professional slang," and acknowledged that the term, as it was used, had a "fuzzy definition."

The popularization of the term codependency has had both positive and negative consequences for the fields of psychotherapy and family therapy. On the positive side of the ledger, the self-help literature in general, and the popular usage of the term codependency in particular, have been helpful in raising public awareness of the complex interrelationships which take place within alcoholic families. They have provided, in relatively simple and understandable terms, an appreciation of the role that everyone assumes in a family where a severe psychological disorder such as alcoholism occurs. For example, wives may "cover" for their alcoholic husbands' inability to keep up with the everyday demands of the home and workplace due to their excessive drinking. Children may take on age-inappropriate tasks, such as making sure that the house is locked at night because the alcoholic parents are too inebriated to do so (this is known as the parentification of children in the family therapy literature [Haley 1976]). In essence, no one in an alcoholic family is immune from the devastating effects which alcohol has upon them, and the contribution to the maintenance of an alcohol problem that others in the family may inadvertently take on. Indeed, enhancing a general understanding of these complex family behaviors is no small contribution to the realm of public education.

However, the widespread usage of the term codependency frequently has resulted in misunderstanding and misuse of the expression by the general public, as well as some imprecision by professional mental health practitioners in clinic settings. With regard to the lay public, Barbara Fiese and Douglas Scaturo (1995) conducted group discussions with adult children of alcoholics (ACOAs) in an effort to understand the difficulties that they confront in parenting their own children, given their own problematic upbringings. In these group discussions, there was a frequent misuse of professional jargon by the ACOAs that often led to misunderstandings of the complex and painful life experiences that the group members were trying to convey to one another. The circuitous use of jargon seemed to prevent group members from communicating with one another in clear, commonly understood language. The use and misuse of such jargon also appeared to short-circuit group discussion by promoting a presumed commonality of family life experience that may or may not have been accurate. Group members responded to the jargon used by others prematurely—without waiting to discover whether actual life experiences were comparable between them. Overall, the use of professional jargon by these lay people appeared to diminish the degree of coherence in their discussions.

Even more problematic is that the widespread generality of the concept's usage has contributed to some degree of imprecision by practicing psychotherapists. The treatment of codependent family dynamics is considerably more complex than the lay concept of codependency might suggest. Scaturo and his colleagues (2000) have discussed several complexities in the family treatment of codependency that require a precise understanding and knowledge of the concept. The first involves the proper therapeutic confrontation of codependent behavior by the psychotherapist in family therapy with this dimension. Briefly, the confrontation of the codependent spouse's contribution to the chemically dependent behavior of the alcoholic involves the complex therapeutic task of "(a) acknowledging and validating the well-intended nature of the codependent's responses, and (b) assisting the codependent spouse in finding new ways of being useful in the family in order not to deprive them of their helping role within the family" (Scaturo et al. 2000, p. 68). A second issue involves making the proper therapeutic distinction between codependency and the "normal" nurturant behavior of a parent or spouse. In short, codependent patients in treatment may engage in inappropriate self-criticism and characterize ordinary and necessary care-taking behaviors in family life as unhealthy "codependency," and it is the therapist's responsibility to assist them in making proper distinctions. Thus, how mental health care professionals understand the concept of codependency has implications for the treatment of these family dynamics as well as how these concepts are understood by codependent patients and their families in treatment.

Codependency in Other Psychological and Family Problems

Codependent family dynamics have been observed in areas of psychological difficulty other than in families with chemical dependency. For example, Scaturo and his colleagues (Scaturo and Hardoby 1988; Scaturo and Hayman 1992) have observed codependent relationships, discussed in terms of "interlocking pathology" (Ackerman 1958), in families of military veterans suffering from Posttraumatic Stress Disorder (PTSD) following traumatic combat experiences in war. PTSD is a psychiatric disorder in which someone who has been exposed to a psychologically traumatic experience, such as combat, experiences an array of disabling symptoms, including intrusive distressing recollections of the experience or recurrent traumatic nightmares, an avoidance of anything that might be associated with the trauma, a numbing of emotional responsiveness to significant others, and a hypervigilance or an exaggerated startle response to the over-anticipation of danger (American Psychiatric Association 1994). In marriages prior to the wartime traumatization, the spouses of combat veterans seem to experience a genuine change in the character of the person that they knew before the war, and returning to an emotionally intimate relationship required a substantial adjustment of mutual expectations. However, in relationships that began after the trauma, something much more like codependency, or interlocking pathology, becomes part of the couple's relationship. The post-traumatic disability is already a known quantity to both parties at the outset of their relationship. The "helper" and "sick" roles are already established as a part of the mutual attraction to one another, and the codependency of the "helper" is an integral part of the relationship's development. The same observation is applicable to forms of traumatic experience other than military trauma, such as the survivors of rape.

Similarly, the psychiatric maladies of panic disorder and agoraphobia are another such example of where the "helper" versus "sick" roles play a part in coping with what ultimately becomes a family problem (Scaturo 1994). Panic attacks are brief periods of intense fear without a clear precipitant (i.e., objective threat) with various psychophysiological symptoms of disabling severity, including heart palpitations, trembling, abdominal distress, and possible fears of dying (American Psychiatric Association 1994). When the fear, or anxiety, is accompanied by fear of being outside one's home, being in a crowd or public place, and such situations are avoided and travel restricted, then agoraphobia may be said to go along with the panic disorder. Again, if the syndrome of panic disorder is a known quantity at the outset of marital relationship, a codependent situation in which clearly defined "helper" and "sick" roles may be easily established. Such a codependent marital dynamic may be one of the reasons that what has been termed "spouse-assisted behavior therapy" (Scaturo 1994)—in which the spouse is included in the anxiety patient's treatment—has been demonstrated to have superior effectiveness over the use of individual behavior therapy with the patient alone (Barlow, O'Brien, and Last 1984; Cerney et al. 1987).


Codependency has been defined as an alcoholic family dynamic in which the alcoholic is married to a spouse who, despite him- or herself not being chemically dependent, serves as a helper in, and inadvertent contributor to, the maintenance of the alcoholic's problem drinking. The notion of codependency was predicated upon related concepts in family systems theory that have included family homeostasis, interlocking family pathology, over-adequate/inadequate marital functioning, the oneup/one-down marital relationship, the marital quid pro quo, and marital complementarity. The popularization of the term codependency among the general public through the self-help literature has had both positive and negative consequences for the practice of psychotherapy. On the one hand, the popular usage of the term has been helpful in raising public awareness regarding the complex interrelationships that transpire within alcoholic families. On the other hand, the widespread usage of the term often has resulted in misunderstanding and misuse of the concept by the general public, as well as some imprecision in its usage by mental health professionals. For example, psychologically healthy and normally nurturing behaviors on the part of a parent or spouse frequently may be misconstrued as pathologically codependent behavior when the complexity, functions, or ramifications of this concept are not fully understood. Finally, although codependent family dynamics were initially observed in chemically dependent families, they have also been observed clinically in families with other kinds of psychological and behavioral difficulties. Examples include families of military veterans suffering from war-related post-traumatic stress disorder and families with a member suffering from panic disorder and agoraphobia. Families in which a member exhibits psychological or behavioral problems are likely to be vulnerable to codependent family dynamics, as well.

See also:Anxiety Disorders; Children of Alcoholics; Family Systems Theory; Marital Quality; Posttraumatic Stress Disorder(PTSD); Substance Abuse; Therapy: Couple Relationships; Therapy: Family Relationships


ackerman, n. w. (1958). "interlocking pathology in family relationships." in changing concepts in psychoanalytic medicine, ed. s. rado and g. daniels. new york: grune and stratton.

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barlow, d. h.; o'brien, g. t.; and last, c. g. (1984)."couples treatment of agoraphobia." behavior therapy 15:41–58.

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beattie, m. (1987). codependent no more. new york: ballantine books.

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scaturo, d. j., and hardoby, w. j. (1988). "psychotherapy with traumatized vietnam combatants: an overview of individual, group, and family treatment modalities." military medicine 153:262–269.

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A term used to describe a person who is intimately involved with a person who is abusing or addicted to alcohol or another substance.

The concept of codependence was first developed in relation to alcohol and other substance abuse addictions. The alcoholic or drug abuser was the dependent, and the person involved with the dependent person in any intimate way (spouse, lover, child, sibling, etc.) was the codependent. The definition of the term has been expanded to include anyone showing an extreme degree of certain personality traits : denial, silent or even cheerful tolerance of unreasonable behavior from others, rigid loyalty to family rules, a need to control others, finding identity through relationships with others, a lack of personal boundaries, and low self-esteem . Some consider it a progressive disease, one which gets worse without treatment until the codependent becomes unable to function successfully in the world. Progressive codependence can lead to depression , isolation, self-destructive behavior (such as bulimia , anorexia , self-mutilation) or even suicide . There is a large self-help movement to help code-pendents take charge of themselves and heal their lives.

There is some criticism of the "codependence movement" by those who feel it is only a fad that encourages labeling and a weak, dependent, victim mentality that obscures more important underlying truths of oppression. Many critics claim the definition of codependence is too vague and the list of symptoms too long and broad to be meaningful. These critics believe that all families fit the "dysfunctional" label; by diagnosing a person as "codependent," all responsibility for the individual's dissatisfaction, shortcomings, and failures comes to rest on the individual and his or her family. Larger issues of cultural, societal, or institutional responsibility are ignored. However, some proponents of the codependence definition are widening their perspective to look at how society as a whole, as well as separate institutions within society, function in an addictive, dysfunctional, or codependent way.

Further Reading

Beattie, Melody. Codependent No More: How to Stop Controlling Others and Start Caring for Yourself. San Francisco: Hazelden/Harper Collins, 1987.

Johnson, Sonia. Wildfire: Igniting the She/Volution. Albuquerque, NM: Wildfire Books, 1989.

Katz, Dr. Stan J., and Eimee E. Liu. The Codependency Conspiracy: How to Break the Recovery Habit and Take Charge of Your Life. New York: Warner Books, 1991.

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The term codependence replaced an earlier term, coalcoholism, in the early 1970s and achieved widespread acceptance among the general public during the 1980s. Both terms point to problematic beliefs and behaviors that family members of chemically dependent people tend to have in common, although the term codependence broadens the concept to cover a wider range of family dysfunctions than chemical dependence alone.

A rather large nonscientific literature has developed on the topic of codependence. Much of it is couched in terms of the need to deal with injuries to emotions sustained during childhoodthat is, to heal the wounds of the "inner child," a term popularized by John Bradshaw.

Despite the current popularity of codependence, awareness that one person's alcoholism affects everyone in the family is not new. The Big Book of Alcoholics Anonymous (1939; 1976) described the experience of family members of alcoholics in the following manner:

We have had a long rendezvous with hurt pride, frustration, misunderstanding and fear. These are not pleasant companions. We have been driven to maudlin sympathy, to bitter resentment. Some of us veered from extreme to extreme, ever hoping that our loved one would be themselves once more.

We have been unselfish and sacrificing. We have told innumerable lies to protect our pride and our husband's reputations. We have prayed, we have begged, we have been patient. We have struck out viciously. We have run away. We have been hysterical. We have been terror stricken. We have sought sympathy. We have had retaliatory love affairs with other men.

Usually we did not leave. We stayed on and on [pp. 104-106].

In his book I'll Quit Tomorrow (1973), Vernon Johnson described the same experiences when he wrote that the ism of alcoholism is shared by other family members. In his words,

While there may be only one alcoholic in a family, the whole family suffers from the alcoholism. For every harmfully dependent person, most often there are two, three, or even more people immediately around him who are just as surely victims of the disease. They too need real help and should be included in any thoroughgoing model of therapy. With every drunk there is a sick dry who is almost a mirror image. [italics added]

The people around the alcoholic person have predictable experiences that are psychologically damaging. As they meet failure after failure, their feelings of fear, frustration, shame, inadequacy, guilt, resentment, self-pity, and anger mount, and so do their defenses. They too use rationalization as a defense against these feelings because they are threatened with a growing sense of self-worthlessness. They too begin to project these masses of free-floating negative feelings about themselves upon the children, back on the spouse, on other family members, on employees, and everybody else at hand. Their defenses have begun to operate in the same way as the alcoholic's, although they are unconscious of this, and they are victimized by their own defenses rather than helped. Out of touch with reality, just like the alcoholic, they say, "I don't need help. It's his problem, not mine!" The chemically dependent and those around him all have impaired judgment; they differ only in the degree of impairment [p. 30].


Although considerable debate still remains among professionals regarding the definition and meaning of codependence, most addiction specialists agree that the concept has successfully ushered huge numbers of people into recovery. Perhaps the best general definition of codependence is called the Scottsdale definition, after the conference location where several lecturers met to achieve consensus:

Co-dependence is a pattern of painful dependence on compulsive behaviors and on approval from others in an attempt to find safety, self-worth and identity.


The following five characteristics form the common thread weaving through the lives of many, if not most, family members of alcoholics and other drug addicts:

  1. Codependents change who they are, and what they are feeling, to please others. Codependents are chameleons who sacrifice their own identity in an effort to get others to love them. They do this for two reasons. First, they fear being abandoned if people know how they really feel or who they really are. Second, they have so little sense of who they are that they need to be in relationships in order to organize their lives and feel complete. Unless they are in a relationship, and can take their cues from another person, they feel desperately lonely and worthless. As a result, codependents are split between two worlds. One world is the facade they show other peoplethe false version of themselves. The other world is how chaotic, fearful, and empty their life feels underneath.
  2. Codependents feel responsible for meeting other peoples' needs, even at the expense of their own needs. Codependents are so afraid of rejection that they will do anything to keep other people happy, including sacrificing their own needs to keep people from leaving them. They actually get more upset if others are disappointed or hurt than if their own problems go unsolved. This habit of focusing more on others often leads to codependents' enabling a family member's drinking. Enabling means that the codependent protects the chemical dependent from the negative consequences of their drinking and other drug usage to keep the other person from having to feel any pain or embarrassment.
  3. Codependents have low self-esteem. Most people who are chemically dependent feel ashamed of themselves and are inwardly very self-critical. So perhaps it is not strange that other family members also begin to feel bad about themselves. For codependents, low self-esteem comes from two main places:
    • It comes from having very little sense of self to esteem. By always pleasing others and taking their whole identity from others, codependents end up not knowing who they are apart from the relationships they are in. It's hard to respect people who are afraid to be themselves, even when it's you!
    • Low self-esteem also comes from believing that they truly are responsible for someone's alcohol/drug use. Once they believe this, they will always feel inadequate when they fail to control the chemical dependent's behavior. This mistaken sense of what should be under their control is at the very core of both codependence and chemical dependence.
  4. Codependents are driven by compulsions. Codependents feel they do not have any real choices about what is happening to them. They typically feel compelled to keep the family together, to stop the drinking or other drug use, to save the family from shame, to work, to eat or diet, to take physical risks, to spend or gamble, to have affairs, to be religious, to keep the house clean, and on and on. The driven quality of compulsions accomplishes two things:
    • Compulsions create excitement and drama. As people battle their compulsions, the adrenaline begins to flow, and simple decisions, such as what to eat or how much to work, are turned into life and death struggles. This drama temporarily gives a feeling of purpose and vitality.
    • Compulsions also occupy a lot of time and block people from their deeper feelings. Codependents often get locked into compulsive behaviors to avoid more painful feelings of fear, sadness, anger, and abandonment caused by a family member's chemical dependence.
  5. Codependents have the same use of denial and distorted relationship to willpower that is typical of active alcoholics and other drug addicts. Denial and an unwillingness to accept human limitations are the two most destructive parts of the ism of alcoholism described by Vernon Johnson. In their own way, codependent family members fall into the same distorted relationship to reality and willpower as the chemical dependent. Both deny reality and think they can control alcoholism (their own or another's) if they just use enough willpower. For example, if chemical dependents deny that they are abusing alcohol or other drugs and remain unaware of its impact on their lives and their relationships with family members, friends, and coworkers, then codependents show exactly the same denial. They often refuse to see that a family member is chemically dependent, or they refuse to acknowledge that their children are being hurt. Shame and the compulsion to keep things under control cause codependents to deny the problem. Denial is a universal human trait, but it is overused by every member of a chemically dependent family.

Codependents are driven by the firm belief that their coping strategies fail because of personal inadequacy. When they cannot control the drinking or other drug use of someone they love, they blame themselves for not trying hard enoughor for not trying the right way. When codependents take too much responsibility for another person's recovery, it keeps the chemical dependent from seeing that only they can be responsible for their own recovery.


In many ways, codependence is the mirror image of a chemical dependent's self-centeredness and grandiosity. Another term for such self-centeredness is narcissism. Codependence is the complement of narcissism, just as a glove complements the hand it is shaped to fit.

In the Greek's myth that gives us the prototype for self-centeredness, Narcissus had relationships only with people who shared his values and interests. He was unable to feel a sense of human connection with people who were separate from him, just as chemical dependents may break off relationships with people who do not support their denial. The myth of Narcissus also gives us the prototype for other-centeredness in Echowho is the perfect reflection of Narcissus. The two fit together and seemed to complete each other. Their relationship had intense chemistry.

In the eternal struggle within each individual between the need to be nurtured and the need to nurture others, Narcissus and Echo (and chemical dependents and codependents) strike a balance between two extreme positions. Rather than balancing the two needs within each of themselves, they allot the need to be validated and appreciated to Narcissus and the need to nurture and be in a relationship to Echo. Neither is capable of a truly mutual relationshipbut, together, they create an intense experience of connectedness.

In healthy families, children remain comfortable with the competing, normal childhood needs to be unconditionally loved and validated as worthwhile (i.e., to be the center) and the opposite need to be completely dependent upon all powerful and good parents (i.e., to have others be the center). When parents are unable to tolerate not being the center of relationships, even with their children (which often happens with a chemically dependent parent), children often renounce their own need to be focused on. They become the opposite of narcissistic; they become codependent.

(See also: Adult Children of Alcoholics (ACOA) ; Al-Anon ; Alateen ; Families and Drug Use )


Alcoholics Anonymous World Services. (1939;1976). The Big Book of Alcoholics Anonymous. New York: Author.

Bradshaw, J. J. (1988). Healing the shame that binds you. Deerfield Beach, Fl: Health Communications.

Cermak, T. L. (1986). Diagnosing and treating co-dependence. Minnesota: Johnson Institute.

Cermak, T. L., (1990-1991). Evaluating and treating adult children of alcoholics. Minnesota: Johnson Institute.

Johnson, V. (1973). I'll quit tomorrow. New York: Harper & Row.

Timmen L. Cermak

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co·de·pend·en·cy / ˌkōdəˈpendənsē/ • n. excessive emotional or psychological reliance on a partner, typically a partner who requires support due to an illness or addiction. DERIVATIVES: co·de·pend·ence / -dəns/ n. co·de·pend·ent / -dənt/ adj. & n.

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