Commonly known as “relationship addiction,” co-dependency involves emotional, spiritual, physical, or mental enmeshment with a loved one.
Co-Dependent Personality: The Dis-Ease of Authenticity
The term “co-dependency” was initially coined by Alcoholics Anonymous in 1950 to describe individuals whose unhealthy choices enable and encourage their partner with addiction. Although this is still true, co-dependency has since come to encompass a much broader definition.
Although it is not recognized as a clinical diagnosis or a personality disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), co-dependency is an unhealthy and potentially toxic relational dynamic. Commonly known as “relationship addiction,” co-dependency involves emotional, spiritual, physical, or mental enmeshment with a loved one. Enmeshment simply means growing up in a family system that lacks boundaries (e.g., how you feel about me is how I feel about myself; what is yours is mine and what is mine is yours; and if one family member is in trouble, the whole family is).
Clinical psychologist Renee Exelbert, PhD, CFT, classifies an adult relationship as co-dependent when one partner (known as “the taker”) needs the other partner (“the giver”), who in turn needs to be needed. Co-dependent relationships are thus constructed around an inequity of power that promotes the needs of the “taker” while leaving the “giver” to sacrifice themselves, walk on eggshells to avoid conflict, and feel the need to constantly apologize, even when they have not done anything wrong.
Individuals who are co-dependent are usually well-intentioned without realizing they are sabotaging the relationship by caring excessively for the person who is struggling. By constantly rescuing, saving, and providing financial support, the “giver” is enabling the “taker” to become more dependent on them. The “giver” who likes to be needed often gets satisfaction by being recognized for their service; however, this can only go on for so long before the choices the “giver” makes backfires.
For some “givers,” co-dependent relationships become commonplace, and they subconsciously gravitate to these relationships because their brain likes what is familiar to them. Over time, they end up seeking romantic relationships and friendships where they are encouraged to behave as martyrs—devoting all their time and energy to care for others who are often emotionally unavailable, and thus completely losing sight of what is important to them.
Why Does Co-Dependency Happen?
Co-dependency is often learned in a dysfunctional family dynamic by watching other family members display co-dependency and can be passed down from one generation to the next. In a functional family dynamic, a child is nurtured while their dependency and developmental needs are properly met, allowing them to grow up to be healthy adults with a sense of autonomy. In a dysfunctional family, when a child’s dependency and developmental needs are not met, they become an adult with a child’s needs.
Co-dependency is a trauma response to the stress a child is exposed to growing up in a dysfunctional family. According to Gabor Maté, MD, excess stress occurs when the demands made on a child exceed his developmental capacity to fulfill. The most common drivers of stress on children are a lack of control, a lack of information, and a lack of certainty. Frequent stressors to children growing up in dysfunctional families include abandonment, parental rage, addiction, and physical abuse—all of which are out of the child’s control and capacity to comprehend.
When there is so much tension and stress in a family, no family member can attend to their own needs. Each member ends up “de-selfing” to try and exert some control over the family situation. Due to their chronic attention to keeping the family system intact, members of a dysfunctional family system learn to disconnect from their authentic self to survive. When the dysfunctionality and trauma they are exposed to is too intense or frequent, the body’s stress responses that was once adaptive turns maladaptive. Thus, these children grow up feeling that something is off, but they are not able to put a finger on what is causing them to disconnect from their authentic self. Instead, they assume that they are the problem. To these children, it is the lack of stress in their adult lives that evokes boredom and a sense of uneasiness. In other words, these same children become addicted to the cortisol released from chronic exposure to stress. And as adults with the needs of children, they unconsciously desire stress, whereby it is the absence of stress that makes them feel as though things are not normal.
Just like a war veteran who develops post-traumatic stress disorder, the child learns to adapt, and their autonomic nervous system prepares them for flight, flight, or flee response. They become hypervigilant to the threat, their heart rate goes up, muscles become tenser, and blood vessels constrict to shift the blood to the body parts that oversee the fight, flight, or freeze reaction. These physiological changes in their bodies are intended as a “survival state” until the situation is normalized in their mind. To survive the harsh conditions of growing up in a dysfunctional family system, a child learns to deny abuse by idealizing their parents and shifting the blame onto themselves, believing that they must have done something bad to receive this harsh treatment from their parents. Due to their vulnerability, children will also “freeze” or tune out from their body to tolerate the abuse. They learn how to repress, identify, or re-enact the pain. As a child growing up with these survival strategies, it becomes part of who they are as adults, and they enter their adult relationships with this unfinished business from their childhood. Thus, co-dependency is a survival behavior a child learns to master in order to overcome toxic dysfunctional family dynamics.
Perhaps the best way to explain the concept of growing up in a dysfunctional family is through Maslow’s hierarchy of needs, a psychological theory of motivation proposed by Abraham Maslow in 1943.1 His theory states that humans have basic, psychological, and self-fulfillment needs, which he divides into 5 categories that determine individual behavior: (1) physiological, (2) safety, (3) belongingness & love, (4) esteem, and (5) self-actualization.1 As a humanist, Maslow believed that individuals are born with a desire to become self-actualized or to be all they can be in life. But for that to happen, humans need their basic needs met first. If we look at these hierarchal needs in the context of growing up in a dysfunctional family system, we realize that these “adult children” carry a wounded inner child who was deprived of their fundamental developmental needs as children and perhaps can only go so far in achieving their potential in life.
As “adult children,” co-dependent adults end up with a fragile self-image and learn to guard against the outside perceptions of that self-image. Because of their dysfunctional upbringing, they believe they are responsible for what others think about them (e.g., how you feel about me is how I feel about myself). They deceive themselves by detaching from their authentic being to be what others want and expect of them.
In the words of Maté, through his latest book, The Myth of Normal: Trauma, Illness, & Healing in a Toxic Culture, “...often people’s behavior is not a matter of conscious decision to follow the social norm, but of ‘wanting to act as they have to act.’”2 In other words, culture creates members who will serve its purpose. What is considered normal and natural by the culture are established not by what is good for people, but by what is expected of them. These traits are then enshrined as “human nature,” and any deviation from them is perceived as abnormal. It is also worth noting that social character, which is dictated by what considered to be the “norm,” is different from the individual character we each possess and display to the outside word. The social culture defines and governs us, giving us the assurance that we will fit in. And for the most part, people will develop and behave in ways that seems to be normal, which conforms to the dominant ideas.
The social culture exploits codependency in all of us through the following 3 habits:
1. Separation from Oneself. We live in an image-mad culture that sustains itself in large part by making people feel inadequate about themselves. There are far too many examples, but one that is worth sharing is how the media holds out ideals of physical perfection against which young and old measure themselves, and which lead people to be ashamed of their very own bodies. When it comes to social media, we too often present an artificial version of ourselves: a fake persona not of who we are but of how we would like to be perceived to the outside world. How many of us are caught up with our online personas? How far are we digitally going with these filters that present an idealized image designed to get us the greatest number of “likes”? And how many times do we incessantly check the number of “likes” we receive? The more “likes” we get, the better we feel about the filtered persona we package and post online. This is rooted in our need for validation from growing up in a dysfunctional system that deprived us of our basic developmental needs. To fill the void, we rush to social media, texts, and email in the hope of getting a quick surge of dopamine through the buzz, flash, or beeps we get. Each positive notification is a digitized hug for the child we once were, recreating the support we were deprived of when we needed it most.
In addition, the very same culture we live in exploits inauthenticity in all of us, a culture where we feel we are never enough. Thus, we find ourselves constantly running after the next gig, accolade, promotion, and speaking engagement. We are seldom acknowledged for who we are and often find ourselves living in an autopilot caught up with unrealistic societal expectations of us. Instead of living in a culture that promotes belonging where we can show up at our natural best, we live in a transactional culture that limits our value to metrics so we can fit in.
2. Consumer Hunger. Among the great accomplishment of mass consumption culture has been to convince us that what we want is equivalent to what we need. When we are not able to achieve the desires dumped on us by the mass consumption culture, we feel we have personally failed ourselves as well as those in our charge.
In the words of Maté, “commercials full of happy looking people tell nothing about the products being sold. But they tell everything about the fears, fancies, and dreams of those who might buy them. What the advertiser needs to know is not what is right about the product but what is wrong about the buyer.”2 And driven by a culture that instills lack of enoughness in all of us, we become hooked to consumption.
3. Hypnotic Passivity. The educational system is no help when it comes to co-dependency. As academics and health care professionals, pharmacists are wired to value hard skills, clearly identifiable capabilities that are black and white, easily gradable, and quantifiable; skills that give us instant gratification and a quick surge of dopamine. If you believe in one thing, you are seen as that singular thing only, with no gray area allowed. This problem originates in how children are taught in public schools. When you go to schools, you are regimented. You are taught that this is the way you’re supposed to behave. Additionally, our school system puts enormous emphasis on cognitive skills but very little emphasis on human skills such as how to best cope with challenges in life.
In my case, hardly any emphasis was put on the work and the skills that came out of the right hemisphere of my brain, which is responsible for all the feelings we have and is the source of art, music, and poetry. It is the very same hemisphere that is responsible for core creativity and imagination. I was often penalized not only by my family but equally by my teachers for showing an affinity to skills that engaged the right side of my brain. When I was interning straight out of classes in pharmacy school, I was often penalized for not proposing treatment strategies that reflected the clinical guideline. My initial attempt as a creative learner was to propose treatment strategies that were patient centric and I believed the clinical guidelines were there to guide my decisions. My strategies were often marked wrong and at times, I was not given an opportunity to defend the case I was trying to make.In another words, I was seldom rewarded for attempting to solve a problem but merely graded on what was right or wrong.
Breaking Away from Co-Dependency
As I started writing this article, I found it useful to familiarize myself with the 12 steps of Alcoholics Anonymous, a topic I was first exposed to when I attended the American Pharmacists Association’s Institute on Substance Use Disorder. During the institute, I learned that when a patient with alcohol addiction seeks recovery, the first thing they need to do is have the courage to admit they have a problem. This opens a door that allows them to shed their armor of shame.
The codependency recovery strategies I propose are closely aligned with the 12 steps of Alcoholics Anonymous. The road to recovery always starts with admitting you have a problem and to do so, you must shed the shame-based armor that you have worn over the years. The road of recovery from codependency is contingent on the willingness to go through the pain and face the wounds of your inner child. This is only possible if we allow ourselves to grieve the loss of our unmet developmental needs. We must come to terms with the fact that our childhood has passed and will never return, as much as we sometimes want it to.
Below are some approaches I recommend to break away from the habit of codependency.
Know Yourself Through Mindfulness. One of the best ways to connect to your true authentic self is through mindfulness. Mindfulness can be finding joy in the small things such as drinking an excellent cup of tea or coffee, listening to soft music, taking a hot bath, listening to an interesting podcast in our commute to work, observing nature, watering our plants, or spending quality time with family. To be mindful, we must learn to temper the hyperactive amygdala (body’s alarm system) and prevent it from controlling our mental state. This can be achieved through emotional resilience. Emotional resilience is about adopting healthy approaches coping with stress without becoming emotionally overwhelmed.
Through mindfulness, you learn to use your brain to guide your body towards healing through the “top-down” vagal tone pathway. You learn to notice and tolerate the physical sensations when remembering the past. With trauma being a visceral disease, we need to open ourselves to our inner experiences and focus our bodies on sensations through mindfulness. Mindfulness calms the sympathetic nervous system, and we are less likely to be thrown in a fight or flight response. The goal through mindfulness is to identify some consistent activities that train your mind to stay present in the moment.
Through yoga, you learn to empower your body and send the signals to your brain using the “bottom-up” vagal tone pathway. Regardless of what type of yoga you practice, all include asanas (stretching and posture work) and pranayama (breath work techniques). Just like mindfulness, yoga improves arousal problems and relationships with the body. Yoga is about looking inward and listening to the things our body has to say to us and focuses attention on breathing and sensations with every movement. As you continue to practice, you start noticing a connection between your emotions and your body.
Learning to slowly breathe in, hold, and slowly release your breath when accessing painful memories is helpful in recovery. As you continue taking deep breathes, you are slowing the activation of the PNS system, allowing you to relax and rest.
Learn to Develop Boundaries. Setting boundaries is about shedding the false toxic personas that we’ve worn our entire life. It is about saying no to all the roles that have been imposed on us to fit in. Boundaries are about saying “no,” plain and simple. “No” is not merely about changing others, but about admitting the need to change ourselves. It means we no longer need validation from others to measure our self-worth.
The first step in establishing boundaries is to identify an area where boundaries are missing.Boundaries come in various forms: physical, emotional, mental, and resource boundaries. It is critical to conduct an inventory of the people in our life and honestly evaluate our interactions with them. For example, if a friend only calls you when they need help with something you’re good at, s girlfriend frequently calls you to emotionally dump her ex-boyfriend drama, or a family member makes jokes about your style or appearance.
How do these scenarios make you feel? Do you become resentful? Are you willing to directly address the potentially toxic dynamics of these relationships? Do you need to completely distance yourself from these relationships, or can you create healthier interactions by establishing specific boundaries? Codependency is a trauma response; we do not know how to attune to what our instincts are telling us about the encounter, nor are we able to separate ourselves from toxic relationship dynamics. One way to determine where boundaries are missing is to pay close attention to the sensations your body experiences when you interact with others.
Once you’ve determined the type of boundary you need to set, address it with the other party in a non-confrontational manner. It is best to have this conversation only when the relationship is free of any volatility. State why you are implementing the boundary and once you have established your boundary, embrace accountability. Perhaps the hardest thing to do when establishing boundaries is adhering to them ourselves. Just like how individuals with alcohol addiction take their sobriety seriously, so do we with boundaries.It’s very easy to fall for the emotional patterns of codependency from childhood trauma. When we are triggered and fall prey to codependency, it’s critical to observe and immediately identify triggers prevent a codependency relapse.
Know Your "Why." We can be successful, look great on paper and do the most amazing things in the world, but if we are not doing it from the heart, our accomplishments slowly become meaningless to us. Knowing our “why” is about our purpose, cause, and belief. It is the reason why we exist. All my life I have been a human going through life on autopilot, which involved achievements, success, and wealth with little purpose in life. Achievements, success, and wealth are merely results. And when we fail to achieve those results, we label ourselves a failure. To transcend from a human “doing” to a human being, I had to slowly detach from those things that falsely defined who I was supposed to be.I stopped viewing things through a cultural lens in favor of a lens that determined my why. My purpose. My meaning. Our “why” is something we all possess, and discovering it paves the way to living an authentic, purposeful life.
About the Author
Helen Sairany earned her PharmD degree from Northeastern University and her MBA from the University of Maryland. She has extensive experience in executive leadership, administrative management, regulatory practice, and accreditation systems thanks to her work as a trauma-informed pharmacist; state executive and CEO for the South Carolina Pharmacy Association; director of content development and partnership at the American Pharmacists Association; director of quality assirance at the University of Duhok College of Pharmacy; and field provider for Doctors Without Borders in Iraq and Western Syria.
1. McLeod S. Maslow’s Hierarchy of Needs. Simply Psychology. Published 2007. Updated April 4, 2022. Accessed December 1, 2022. https://www.simplypsychology.org/maslow.html#:~:text=There%20are%20five%20levels%20in,esteem%2C%20and%20self%2Dactualization.
2. Maté G. The Myth of Normal: Trauma, Illness, & Healing in a Toxic Culture. 2022; Avery. Accessed December 1, 2022.