Codependence and Dependent Personality Disorder

 

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There is great confusion regarding the terms co-dependent, counter-dependent, and dependent. Before we proceed to study the Dependent Personality Disorder in our next article, we would do well to clarify these terms.

Codependents

Like dependents (people with the Dependent Personality Disorder), codependents depend on other people for their emotional gratification and the performance of both inconsequential and crucial daily and psychological functions.

Codependents are needy, demanding, and submissive. They suffer from abandonment anxiety and, to avoid being overwhelmed by it, they cling to others and act immaturely. These behaviours are intended to elicit protective responses and to safeguard the "relationship" with their companion or mate upon whom they depend. Codependents appear to be impervious to abuse. No matter how badly mistreated, they remain committed.

This is where the "co" in "co-dependence" comes into play. By accepting the role of victims, codependents seek to control their abusers and manipulate them. It is a danse macabre in which both members of the dyad collaborate.

The codependent sometimes claims to pity her abuser and cast herself in the grandiose roles of his saviour and redeemer. Her overwhelming empathy imprisons the codependent in these dysfunctional relationships and she feels guilt either because she believes that she had driven the abuser to maltreat her or because she contemplates abandoning him.

Typology of Codependents

Codependence is a complex, multi-faceted, and multi-dimensional defence against the codependent's fears and needs. There are four categories of codependence, stemming from their respective aetiologies:

(i) Codependence that aims to fend of anxieties related to abandonment. These codependents are clingy, smothering, and prone to panic, are plagued with ideas of reference, and display self-negating submissiveness. Their main concern is to prevent their victims (friends, spouses, family members) from deserting them or from attaining true autonomy and independence. These codependents merge with their "loved" ones and experience any sign of abandonment (actual, threatened, or even imagined) as a form of self-annihilation or "amputation".

(ii) Codependence that is geared to cope with the codependent's fear of losing control. By feigning helplessness and neediness such codependents coerce their environment into ceaselessly catering to their needs, wishes, and requirements. These codependents are "drama queens" and their life is a kaleidoscope of instability and chaos. They refuse to grow up and force their nearest and dearest to treat them as emotional and/or physical invalids. They deploy their self-imputed deficiencies and disabilities as weapons.

Both these types of codependents use emotional blackmail and, when necessary, threats to secure the presence and blind compliance of their "suppliers".

(iii) Vicarious codependents live through others. They "sacrifice" themselves in order to glory in the accomplishments of their chosen targets. They subsist on reflected light, on second-hand applause, and on derivative achievements. They have no personal history, having suspended their wishes, preferences, and dreams in favour of another's.

From my book "Malignant Self Love - Narcissism Revisited":

"Inverted Narcissist

Also called "covert narcissist", this is a co-dependent who depends exclusively on narcissists (narcissist-co-dependent). If you are living with a narcissist, have a relationship with one, if you are married to one, if you are working with a narcissist, etc. – it does NOT mean that you are an inverted narcissist.

To "qualify" as an inverted narcissist, you must CRAVE to be in a relationship with a narcissist, regardless of any abuse inflicted on you by him/her. You must ACTIVELY seek relationships with narcissists and ONLY with narcissists, no matter what your (bitter and traumatic) past experience has been. You must feel EMPTY and UNHAPPY in relationships with ANY OTHER kind of person. Only then, and if you satisfy the other diagnostic criteria of a Dependent Personality Disorder, can you be safely labelled an 'inverted narcissist'."

(iv) “Codependent or Borderline narcissists” oscillate between periods of clinging and other codependent behavior patterns (which they interpret as “intimacy”) and eras of aloofness, detachment, and emotional neglect and abandonment (which they regard as legitimate and the only possible manifestations of their personal autonomy and space.) They also tend to form with their intimate partner a shared psychosis. These are all the outcomes of their overwhelming and all-pervasive abandonment anxiety: they either smother their partner in an attempt to forestall desertion – or they pre-emptively abandon ship, thus avoiding hurt and maintaining an illusion of control over the situation ("I walked out on her and dumped her, not the other way around.")

The codependent deploys strategies such as merger (becoming one with her intimate partner while renouncing all personal autonomy and independence of both of them, up to a point of shared psychosis); coextensivity (the “ventriloquist defense”: insisting that the partner mind-reads her and acts in ways that reflect her inner psychological states and moods); and shifting boundaries (using behavioural unpredictability and ambient uncertainty to induce paralysing dependence in the partner.)

(v) Finally, there is another form of dependence that is so subtle that it eluded detection until very recently.

Counterdependents

Counterdependents reject and despise authority and often clash with authority figures (parents, boss, the Law). Their sense of self-worth and their very self-identity are premised on and derived from (in other words, are dependent on) these acts of bravura and defiance. They are “personal autonomy militants”. Counterdependents are fiercely, militantly independent; controlling; self-centered; and aggressive. Many of them are antisocial and use Projective Identification (i.e. force people to behave in ways that buttresses and affirm the counterdependent's view of the world and his expectations).

These behavior patterns are often the result of a deep-seated fear of intimacy. In an intimate relationship, the counterdependent feels enslaved, ensnared, and captive. Counterdependents are locked into "approach-avoidance repetition complex" cycles. Hesitant approach is followed by avoidance of commitment. They are "lone wolves" and bad team players.

From my book "Malignant Self Love - Narcissism Revisited":

"Counterdependence is a reaction formation. The counterdependent dreads his own weaknesses. He seeks to overcome them by projecting an image of omnipotence, omniscience, success, self-sufficiency, and superiority.

Most "classical" (overt) narcissists are counterdependent. Their emotions and needs are buried under "scar tissue" which had formed, coalesced, and hardened during years of one form of abuse or another. Grandiosity, a sense of entitlement, a lack of empathy, and overweening haughtiness usually hide gnawing insecurity and a fluctuating sense of self-worth."

(continued below)


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The Dependent Personality Disorder is a much disputed mental health diagnosis.

We are all dependent to some degree. We all like to be taken care of. When is this need judged to be pathological, compulsive, pervasive, and excessive? Clinicians who contributed to the study of this disorder use words such as "craving", "clinging", "stifling" (both the dependent and her partner), and "humiliating", or "submissive". But these are all subjective terms, open to disagreement and differences of opinion.

Moreover, virtually all cultures encourage dependency to varying degrees. Even in developed countries, many women, the very old, the very young, the sick, the criminal, and the mentally-handicapped are denied personal autonomy and are legally and economically dependent on others (or on the authorities). Thus, the Dependent Personality Disorder is diagnosed only when such behavior does not conform to social or cultural norms.

Codependents, as they are sometimes known, are possessed with fantastic worries and concerns and are paralyzed by their abandonment anxiety and fear of separation. This inner turmoil renders them indecisive. Even the simplest everyday decision becomes an excruciating ordeal. This is why codependents rarely initiate projects or do things on their own.

Dependents typically go around eliciting constant and repeated reassurances and advice from myriad sources. This recurrent solicitation of succour is proof that the codependent seeks to transfer responsibility for his or her life to others, whether they have agreed to assume it or not.

This recoil and studious avoidance of challenges may give the wrong impression that the Dependent is indolent or insipid. Yet, most Dependents are neither. They are often fired by repressed ambition, energy, and imagination. It is their lack self-confidence that holds them back. They don't trust their own abilities and judgment.

Absent an inner compass and a realistic assessment of their positive qualities on the one hand and limitations on the other hand, Dependents are forced to rely on crucial input from the outside. Realizing this, their behavior becomes self-negating: they never disagree with meaningful others or criticizes them. They are afraid to lose their support and emotional nurturance.

Consequently, as I have written in the Open Site Encyclopedia entry on this disorder:

"The codependent moulds himself/herself and bends over backward to cater to the needs of his nearest and dearest and satisfy their every whim, wish, expectation, and demand. Nothing is too unpleasant or unacceptable if it serves to secure the uninterrupted presence of the codependent's family and friends and the emotional sustenance s/he can extract (or extort) from them.

The codependent does not feel fully alive when alone. S/he feels helpless, threatened, ill-at-ease, and child-like. This acute discomfort drives the codependent to hop from one relationship to another. The sources of nurturance are interchangeable. To the codependent, being with someone, with anyone, no matter who, is always preferable to solitude."

Read Notes from the therapy of a Dependent (Codependent) Patient

The Codependent’s Inner Mother and Child

Parents of codependents teach their offspring to expect only conditional, transactional love: the child is supposed to render a service or fulfil the parent's wishes in return for affection and compassion, attention and emotion. Ineluctably, the hurt child reacts with rage to this unjust mistreatment.

With no recourse to the offending parent, this fury is either directed outwardly, at others (who stand in for the bad parent) - or inwardly. The former solution yields a psychopath, or a passive-aggressive (negativistic) - the latter solution, a masochist. Similarly, with an unavailable parent, the child's reserve of love can be directed inward, at himself (to yield a narcissist), or outward, towards others (and, thus, form a codependent.)

 

All these choices retard personal growth and are self-annihilating. In all four paths the adult plays the dual roles of a punitive parent and an eternal child, who is unable and unwilling to grow up for fear of incurring the wrath of the parent with whom he had merged so thoroughly early on.

 

When the codependent merges with a love object, she interprets her newfound attachment and bond as a betrayal of the punitive parent. She fully anticipates the internalized parent’s disapproval and dreads its (self-)destructive disciplinarian measures. In an attempt to placate this implacable divinity she turns on her partner and lashes out at him, thus establishing where her true loyalties and affiliation lie (i.e., with the parent.) Concurrently, she punishes herself as she tries to pre-empt the merciless onslaught of her sadistic parental introjects and superego: she engages in a panoply of self-destructive and self-defeating behaviours.

 

Acutely aware of the risk of losing her partner owing to her abusive misconduct, the codependent experiences extreme abandonment anxiety. She swings wildly between self-effacing and clinging (“doormat”) behaviours on the one hand and explosive, vituperative invective on the other hand: the former being the manifestations of her “eternal child” and the latter expressions of her “punitive parent”.

 

Such abrupt shifts in affect and conduct are often misdiagnosed as the hallmarks of a mood disorder, especially Bipolar Disorder. But where Dependent Personality Disorder is diagnosed, these pendular tectonic upheavals are indicative of an underlying personality structure rather than of any biochemically-induced perturbations.

"I Can't Live Without Him/Her"

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Akin to addiction, dependence on other people fulfils important mental health functions. First, it is an organizing principle: it serves to explain behaviours and events within a coherent "narrative" (fictional story) or frame of reference ("I acted this way because ..."). Second, it gives meaning to life. Third: the constant ups and downs satisfy your need for excitement and thrills. Fourth, and most crucially, your addiction and emotional lability place you at the center of attention and allow you to manipulate people around you to do your bidding.

Indeed, you are convinced that you cannot live without your dependence.

This is a subtle and important distinction: you can survive without him or her, but you believe profoundly (erroneously as it happens) that you cannot go on living without your addiction to your partner. You experience your dependence as your best friend, your comfort zone, as familiar and warm and fitting as an old pair of slippers. You are addicted to and dependent on your dependence, but you attribute its source to boyfriends, mates, spouses, children, parents - anyone who happens to fit the bill and the plot of your narrative. They come and go - your addiction remains intact; they are interchangeable - your dependence is immutable.

So, what can you do about it?

Extreme cases of codependence (such as Dependent or Borderline Personality Disorders) require professional help. Luckily, dependence is a spectrum and most people with dependent traits and behaviours are clustered somewhere in the middle. Help yourself by realizing that the world never comes to end when relationships do: it is your dependence which reacts with desperation, not you. Next, analyze your addiction: what are the stories and narratives that underlie it? Do you tend to idealize your intimate partner? If so, can you see him or her in a more realistic light? Are you anxious about being abandoned? Why? Have you been traumatically abandoned in the past, as a child, perhaps? Write down the worst possible scenario: the relationship is over and s/he leaves you. Is your physical survival at stake? Of course not. Make a list of the consequences of the breakup and write, next to each one what you can and intend to do about it. Armed with this plan of action, you are bound to feel safer and more confident.

Finally, make sure to share your thoughts, fears, and emotions with friends and family. Social support is indispensable. One good friend is worth a hundred therapy sessions.

Countering Abandonment and Separation Anxiety

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Clinging and smothering behaviours are the unsavoury consequences of a deep-set existential, almost mortal fear of abandonment and separation. For the codependent to maintain a long-term, healthy relationship, she must first confront her anxieties head on. This can be done via psychotherapy: the therapeutic alliance is a contract between patient and therapist which provides for a safe environment, where abandonment is not an option and, thus, where the client can resume personal growth and form a modicum of self-autonomy. In extremis, a psychiatrist may wish to prescribe anti-anxiety medication.

Self-help is also an option, though; meditation, yoga, and the elimination of any and all addictions, such as workaholism, or binge eating. Feelings of emptiness and loneliness – at the core of abandonment anxiety and other dysfunctional attachment styles – can be countered with meaningful activities (mainly altruistic and charitable) and true, stable friends, who provide a safe haven and are unlikely to abandon her and, therefore, constitute a holding, supportive, and nourishing environment.

The codependent’s reflexive responses to her inner turmoil are self-defeating and counterproductive. They often bring about the very outcomes she fears most. But these outcomes also tend to buttress her worldview (“the world is hostile, I am bound to get hurt”) and sustain her comfort zone (“abuse and abandonment are familiar to me; at least I know the ropes and how to cope with them.”)

This is why she needs to exit this realm of mirrored fears and fearsome mental tumult. She should adopt new avocations and hobbies, meet new people, engage is non-committal, dispensable relationships, and, in general, take life more lightly.

Some codependents develop a type of “militant independence” as a defense against their own sorely felt vulnerability (their dependence.) But even these daring “rebels” tend to view their relationships in terms of “black and white” (an infantile psychological defense mechanism known as “splitting”.) They tend to regard their relationships as either doomed to failure or everlasting and their mates as both unique and indispensable (“soulmate”, “twin”) or completely interchangeable (objectified.)

These, of course, are misperceptions; cognitive deficits grounded in emotional immaturity and thwarted personal development. All relationships have a life expectancy, a “sell by”, “good before”, or expiry date. No one is irreplaceable or completely interchangeable. The codependent’s problems are rooted in a profound lack of self-love and an absence of object constancy (she regards herself as unloved and unlovable when she is all by herself.)

Yet, clinging, codependent, and counterdependent (fiercely independent, defiant, and intimacy-retarding) behaviours can be modified. If you fear abandonment to the point of a phobia, here’s my advice:

Compile a written, very detailed “mission statement” regarding all the aspects of your romantic relationships: how would you like them to look like and how would you go about securing the best outcomes. Revisit and revise this “charter” regularly.

List your 3 most important mate choice criteria: what would you be looking for in a first date and without which there will be no second date. This list is your filter, your proverbial selective membrane. Revisit and revise it regularly as your taste and preferences change.

Conduct a thorough background check on your prospective intimate partner. Go online and Google his name; visit his social networking accounts; ask friends and family for information and an appraisal of his character, temperament, and personality. This preparatory research will put you in control and empower you. It will serve as an antidote to uncertainty and the anxiety attendant upon it.

Next use the “Volatility Threshold” and the “Threat Monitoring” tools.

The “Volatility Threshold” instrument is a compilation of 1-3 types of behaviours that you consider critically desirable (“deal-makers”) in your partner. Observe him and add up the number of times he had acted inconsistently and, thus, reversed these crucial aspects of his behavior substantially and essentially. Decide in advance how many “strikes” would constitute a “deal-breaker” and when he reaches this number – simply leave. Do not share with him either the existence or the content of this “test” lest it might affect his performance and cause him to playact and prevaricate.

As a codependent, you tend to jump to conclusions and then “jump the gun”: you greatly exaggerate the significance of even minor infractions and disagreements and you are always unduly fatalistic and pessimistic about the survival chances of your relationships. The “Threat Monitoring” tool is comprised of an inventory of warning signs and red flags that, in your view and from your experience, herald and portend abandonment. The aim is to falsify this list: to prove to you that, more often than not, you are wrong in predicting a breakup.

In general, try to act as though you were a scientist: construct alternative hypotheses (interpretations of behaviours and events) to account for what you regard as transgressions and bad omens. Test these hypotheses before you decide to end it all with a grand gesture, a dramatic exit, or a decisive finale. Preemptive abandonment is based more on your insecurities than on facts, so make sure to test your hypotheses – and your partner - in a variety of settings before you call it a day and before you prophesy doom and gloom.

 

This “scientific” approach to your intimate relationship has the added benefit of delaying the instant alleviation of your anxiety which consists of impulsive, ill-thought actions. It takes time to form hypotheses and test them. This lapse between trigger and reaction is all you need. By the time you have formed your informed opinion, your anxiety will have abated and you will no longer feel the urge to “do something now, whatever it may be!”

 

Armed with these “weapons” you should feel a lot more confident as you enter a new romantic liaison. But, the secret of the longevity of long-term relationships lies in being who you are, in acting transparently, in externalizing your internal dialog and inner voices. In short: if you want your relationships to last, you should express your emotions and concerns on a regular basis. You should knowingly and willingly assume all the risks associated with doing so: of exposing the chinks in your armour; of your vulnerabilities and blind spots being abused, exploited, and leveraged; of being misunderstood, even mocked. But the rewards of being open with your partner (without being naive or gullible) are enormous and multifarious: stronger bonding often results in long-lasting relationships.

 

Early on you should confer with your intimate partner and inform him of what, to you, constitutes a threat: what types of conduct he should avoid and what modes of communication he should eschew. You should both agree on protocols of communication: fears, needs, triggers, wishes, boundaries, requests, priorities, and preferences should all be shared on a regular basis and in a structured and predictable manner. Remember: structure, predictability, even formality are great antidotes to anxiety.

 

But there is only that much that your partner can do to ameliorate your mental anguish. You can and should help him in this oft-Herculean task. You can start by using drama to desensitize yourself to your phobia. In your mind imagine and rehearse, in excruciating detail, both the worst-case and best-case scenarios (abandonment in the wake of adultery versus blissful marriage, for instance.)

 

In these reveries, do not act as an observer: place yourself firmly at the scene of the action and prepare detailed responses within these impromptu plays. At first, this pseudo-theatre may prove agonizing, but the more you exercise your capacity for daydreaming the more you will find yourself immune to abandonment. You may even end up laughing out loud during the more egregious scenes!

 

Similarly, prepare highly-detailed contingency plans of action for every eventuality, including the various ways in which your relationship can disintegrate. Be prepared for anything and everything, thoroughly and well in advance. Planning equals control and control means lessened dread.

 

Issues and Goals in the Treatment of Dependent Personality Disorder (Codependence, or Codependency)

 

ISSUE 1

 

The patient has alloplastic defenses and an external locus of control. Though she believes that she is in full control of her life, her behavior is mostly reactive and she is buffeted by circumstances and decisions made by other people - hence her tendency to blame the outside world for every misfortune, mishap, and defeat she endures. She rarely takes responsibility for her choices and actions and is frequently surprised and resentful when faced with the consequences of her misconduct.

 

The patient is convinced that she is worthless and bad, a loser and no-good. She is masochistically self-destructive and self-defeating in her romantic relationships. These propensities are compounded by a predilection to decompensate and act out, sometimes violently, when her defences fail her.

 

GOAL 1

 

To develop autoplastic defences and an internal locus of control: to learn to assume responsibility for her actions and refrain from self-destructive and self-defeating behaviors.

 

ISSUE 2

 

Having been deprived of it in her childhood, the patient is on a perpetual quest for ideal love: motherly, protective, engulfing, omnipresent, and responsive. Her mate should be handsome, sexy, and should draw attention from and elicit envy. He should be fun to be with and intelligent, although passive, malleable, compliant, and subservient.

 

Yet, the typical codependent has been exposed only to transactional and conditional love from her parents: love was granted in return for meeting their unrealistic and, therefore, inevitably frustrating expectations.

 

Such patients resort to fantasy and develop a deficient reality test when it comes to their romantic liaisons. The patient lacks self-awareness and sets conflicting goals for her intimate partners: they are supposed to provide sex, intimacy, companionship and friendship - but also agree to be objectified and to self-deny in order to fulfil their roles in the codependent's "film".

 

GOAL 2

 

To develop realistic expectations regarding love, romance, and relationships as well as relationship skills.

ISSUE 3

 

The narcissistic codependent idealizes her intimate romantic partners and then devalues them. She seeks to "mold" and "sculpt" them to conform to her vision of the relationship. She deprives them of their self-autonomy and makes all decisions for them. In other words: she treats them as objects, she objectifies them. Such a patient is also a verbal and, at times, physical abuser. This impoverishes her relationships and hinders the development of real intimacy and love: there is no real sharing, no discourse, common interests, or joint personal growth.

 

Owing to the patient's insecure attachment style and abandonment/separation anxiety, she tends to cling to her partner, monopolize his time, smother him, and secure his presence and affection with material gifts (she is a compulsive giver.) As she holds himself worthless and a loser, she finds it hard to believe that any man would attach to her voluntarily, without being bribed or coerced to do so. She tends to suspect her partner's motives and is somewhat paranoid. She is possessive and romantically jealous, though not exceedingly so. This environment tends to foster aversions in her romantic partners.

 

GOAL 3

 

To develop a productive and healthy attachment style and learn relationship skills.

 

ISSUE 4

 

The codependent's proclaimed desire for stability, safety, predictability, and reliability conflicts with her lifestyle which is itinerant, labile, chaotic, and involves addictive and reckless behaviors. Her need for drama, excitement, and thrill (adrenaline junkie) extends to her romantic relationships. Owing to her low threshold for boredom and multiple depressive, dysphoric, anhedonic, and anergic episodes, she seeks distractions and the partner to provide them. She, therefore, shows a marked preference for men with mental health issues who are likely to lead disorganized lives and to react to her abuse dramatically and theatrically.

 

GOAL 4

 

Learn how to choose partners who would bring stability and safety into the relationship and how to interact with them constructively. Learn anger management skills.

 

ISSUE 5

 

The narcissistic codependent has strong narcissistic defences, especially when it comes to maintaining her grandiosity with the aid of narcissistic supply. She needs to feel chosen and desired (a flip coin of and antidote to her fear of rejection); be the centre of attention (vicariously, via her intimate partner); and to conform to expectations, values, of judgments or her peer group, relatives, and other role models and reference figures. See: Inverted Narcissist.

 

GOAL 5

 

To develop a more realistic assessment of herself and her romantic partners and, thus, reduce her dependence on narcissistic defences and narcissistic supply.

 


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