Personality disorders are specific diagnoses that typically indicate severe disturbances across several areas of functioning. These disorders involve disturbances in behavior, personal and social functioning and perception of self, others and the world. Additionally, personality disorders are considered to be chronic and pervasive patterns of coping that, by adulthood, have become inflexible. There is a great deal of literature and research that traces these diagnoses back to early developmental years. Because personality disorders reveal themselves in their most pronounced forms within relationships, they are generally thought to be consequences of early attachment and bonding experiences that were interrupted or dysfunctional. For example, many individuals with personality disorders have experienced erratic parenting and childhood abuse and/or neglect. Further, such individuals typically have a series of relationship problems in adulthood that are characterized the same behaviors, feelings, thoughts and beliefs that are disruptive and distressful in relationships.
While the diagnosis of a personality disorder is usually reserved for individuals in late adolescence and adulthood, early family experiences are often addressed in treatment in order to correct current dysfunctional behavior, distorted thinking and perception and distressful emotion caused by these disorders. Treatment is considered to be a long-term endeavor.
To illustrate the nature of personality disorders, their characteristics and their pervasive dysfunction in relationships, the Antisocial Personality Disorder is used here as an example. This disorder is one in which there is a pattern of disregard for and violation of the rights of others. Some of the diagnostic criteria for Antisocial Personality Disorder are:
• failure to conform to social norms
• unlawful behavior
• deceitfulness, lying, use of aliases or conning others
• impulsivity– acting without consideration of consequences
• disregard for safety of self and others
• failure to honor one’s responsibilities and obligations
• lack of remorse
These criteria clearly describe dysfunctional ways of behaving in relationship to others. To further illustrate how relationship issues are related to personality disorders, there is strong evidence that individuals who have had erratic, abusive or neglectful parents are vulnerable to developing this disorder. Also, the treatment for individuals with this disorder (and other personality disorders) attempts to correct one’s relationship to others. For example, treatment of Antisocial Personality Disorder often seeks to repair some of the missing moral development of early life such as the experience of having empathy for others.
Antisocial Personality Disorder is just one example of personality diagnoses that address the dysfunctional styles of behaving and coping within relationship to others. Other personality disorders are listed here along with a brief description of relationship problems found in each:
• Borderline Personality Disorder– relationships are governed by fear of abandonment by others
• Histrionic Personality Disorder– there is an intense need for the attention of others and relationships are thought to be more intimate than they really are
• Narcissistic Personality Disorder– there is a belief that one is more special and more entitled than others
• Avoidant Personality Disorder—there is avoidance of interpersonal contact and fear of being disliked
• Dependent Personality Disorder– there is an excessive reliance upon others
• Obsessive-Compulsive Personality Disorder– there is rigidity that interferes with relationships
• Paranoid Personality Disorder—there is a belief that others cannot be trusted
• Schizoid Personality Disorder– there is no enjoyment or desire for close relationships
• Schizotypal Personality Disorder– there is acute discomfort in relationships and an inability to maintain them
All of these personality disorders describe distorted interpersonal boundaries and a distortion in the ability to be appropriately intimate with others. Relationships in families of substance use and addiction can display many of the characteristics of all of these personality disorders and are traditionally thought of as causing intimacy problems for individuals who grow up in these sorts of families. In particular, codependent traits and behaviors have become identified as especially prominent in such families and while codependency is not identified as a formal diagnosis of personality, it does speak of specific dysfunctional personality characteristics, behavior and coping that are enduring and patterned as are those in personality disorders.
Codependency became an issue of concern in substance treatment long before the term was coined. An earlier concept, co-alcoholism, embodied the many traits, characteristics, behaviors and dynamics of codependency, but was used specifically to describe relationships involving alcohol. Co-alcoholics were considered to be family members of alcoholics — primarily spouses — who were impacted by the alcoholism of their loved one in dysfunctional ways. Co-alcoholic and enabler were used interchangeably to describe a person who took on the responsibilities of the alcoholic and made amends and/or accommodations for the alcoholic’s behavior. Denial of the alcoholism was seen as a core characteristic of co-alcoholics and enablers. The behavior of co-alcoholics was also seen as contributing to the progression of the disease of alcoholism.
Treatment of alcoholism grew to include family members in hopes of intervening in co-alcoholic behavior and thus improving the chances of alcoholics maintaining recovery. Addressing family system dynamics was considered to be essential in the recovery efforts of substance dependent individuals and continue to be today. In the 1980s, the adult child and codependency self-help movements– particularly among 12 Step groups– further defined and popularized these concepts.
There is a significant body of literature about relationships and family dynamics that involve substance use. Some early authors who have addressed these issues are:
• Melody Beattie, Codependent No More and Beyond Codependency
• Claudia Black, It Will Never Happen to Me and It’s Never Too Late to Have a Happy Childhood
• John Bradshaw, Healing the Shame That Binds You; Homecoming: Reclaiming and Championing Your Inner Child; Family Secrets: the Path to Self-Acceptance and Reunion
• Pia Melody, Facing Codependence; Breaking Free and Facing Love Addiction
Such literature has helped define in depth the difficulties and dynamics of codependency as well as the process of recovering from such relationship dysfunction. Further, such works have identified codependency as usually beginning in childhood in one’s family of origin and to be characterized by behavior in relationships as well as by certain types of thoughts, feelings and perceptions of one’s self in relationship to others. Some of the hallmarks of codependency are:
• Behavior of codependency
o attempts to control others
o attempts to please others
o assuming responsibility for others
Such behaviors are common in relationships of addiction and are classic examples of the behavior seen in the family members of addicts and alcoholics. These behaviors are typically used to lessen the impact of the loved one’s addiction.
• Emotions of codependency
The emotions of codependence are direct results of living with another’s addiction and attempting to solve the problems surrounding the addiction as well attempting to solve the problems of the addict.
• Beliefs of codependency
o self-worth depends upon a relationship
o good feelings depend upon others’ approval
o self-esteem depends upon solving others’ problems
o well-being depends upon the status of the relationship
Such beliefs underlie the behaviors and feelings of codependency. Another person is the focus and good feelings about the self are derived solely from the relationship. Co-dependency is based upon an inherent “no-win” situation because codependents involve themselves with dysfunctional people who “need” “to be fixed”.
There are several ways that codependency can be manifested within relationships. Some of these are:
• becoming submissive
These characteristics are typically caused by anxiety and fear of loss and abandonment. These are individuals that we typically call “people pleasers” who seek approval and act from a motivation to be liked. The threat of losing their relationship causes these types of codependents to lose themselves as they seek to understand and demonstrate what the other person wants. Their chief motivation is to avoid abandonment.
Other codependents are more concerned with a fear of losing control. This is manifested in relationships by:
• being demanding
• being manipulative
• using emotional blackmail
• creating turmoil, chaos and drama
Still other codependents live their lives through others by:
• making personal sacrifices
• being focused on the well-being of another while disregarding one’s own well-being
• being focused on the goals of another while dismissing one’s own
• being focused on the thoughts and feelings of another while dismissing one’s
Codependents display a variety of behaviors that can, at various times, include a unique mix of the many types listed here. The common theme is, however, a focus upon accommodating and maintaining a relationship with someone who is impaired. Traditionally, codependency has been in relationship to an individual with a substance disorder, however, these characteristics can be found in relationship to people with other dysfunction such as mental illness and criminal behavior. Typically, codependents have learned these behaviors as children and continue them throughout adulthood to some degree in all their relationships. For this reason, codependents, like individuals who have personality disorders, display fixed patterns of coping and interaction within relationships. Along with their behaviors there are also fixed beliefs about self, others and the world that create poor coping and distress in daily life.
Self-help groups such as Codependents Anonymous use the 12 Steps of Alcoholics Anonymous to address codependency and recovery. The first step of Codependents Anonymous is the only step of the 12 which differs from the original 12 Steps used in Alcoholics Anonymous. The first step of Alcoholics Anonymous says:
We admitted we were powerless over alcohol and that our lives had become unmanageable.
In contrast, the first step of Codependence Anonymous states:
We admitted we were powerless over others and that our lives had become unmanageable.
Codependents Anonymous suggests several points to consider when determining if one has codependency. Among these are:
• patterns of denial that cause difficulty in identifying feelings
• patterns of low self-esteem that cause difficulty in making decisions, getting one’s needs met and perceiving oneself as lovable or worthwhile
• patterns of compliance that honor others’ opinions, feelings, desires and wishes, while dismissing one’s own
• patterns of control in which one behaves to be needed, approved of, care for others and control others
As in the diagnoses of personality disorders, these patterns of codependency are considered to be chronic and fixed patterns of behavior and coping. Recovery implies the need to change behavior and coping strategies in relationships. Codependents Anonymous offers a definition of codependency recovery in its preamble stating:
Co-Dependents Anonymous is a fellowship of men and women whose common purpose is to develop healthy relationships…share with each other in a journey of self-discovery — learning to love the self.
Recovery pursuits for the codependent involve becoming aware of one’s own feelings, values and beliefs; improving interpersonal boundaries in which one’s own needs and wishes are honored; tolerating true intimacy; developing assertiveness and improving self-care. Self-help groups are valuable recovery resources for codependency and many find that psychotherapy and counseling are as well. Often therapy will address current issues, along with problems from earlier stages of life such as those in one’s family of origin where codependent beliefs and behaviors were learned. In many ways, treatment for codependency is similar to treatment for formal personality disorders in which dysfunctional beliefs and perceptions must be replaced with more appropriate ones.