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

Uploaded 10/14/2018, approx. 23 minute read

Esteemed colleagues, good morning or good afternoon.

My name is Sam Vaknin, and I'm a visiting professor of psychology in Southern Federal University in Rostov-on-Don in the Russian Federation, as well as a professor of finance and a professor of psychology in CIAPS, the Centre for International Advanced and Professional Studies.

Today I would like to discuss the issue of codependency.

As we all know, codependency is not an official mental health diagnosis, at least not within the Diagnostic and Statistical Manual in its latest iteration, which is the fifth edition of 2013.

Instead, there is something called dependent personality disorder, and there has been in the Diagnostic and Statistical Manual for almost for well over 20 years.

So this creates a great confusion regarding the terms codependent, counterdependent, dependent, etc, etc.

So perhaps before we proceed to study dependent personality disorder, we would do well to try to clarify these terms.

As Lidia Radielewska observes, we all need to be needed. We all want to feel useful and able to give.

People resent the narcissist partly because his false self, the facade he puts out to the world, is so self-sufficient.

But codependents take this to a whole different level, to a new extreme.

Like dependents, people with dependent personality disorder, codependents depend on other people for their emotional gratification, the regulation of their motions and moods, reducing lability, and the performance of both inconsequential and crucial daily psychological or in Freudian balance ego functions.

Codependents seek to fuse or to merge with their significant others. By becoming one with their intimate partners, codependents are able to actually love themselves by loving others.

It is like loving yourself by proxy, vicariously.

Codependents are needy, demanding, clinging, and submissive. They suffer from abandonment anxiety, and to avoid being overwhelmed by it, they cling to others and act immaturity.

And in this sense, they're very reminiscent of some aspects of borderline personality disorder and some aspects of the complex post-traumatic stress disorder syndrome.

These behaviors are intended to elicit protective responses and to safeguard the relationship with a companion or mate upon whom they depend.

Codependents appear to be impervious to abuse. No matter how badly they are mistreated, they usually remain committed to the relationship.

In extreme codependents, this fusion, this merger with a significant other, lead to in-house stalking as the codependents strive to preserve the integrity and the cohesion of her personality and the representations of her loved ones within her mind.

So what I call in-house stalking is actually stalking perpetrated by the codependent on her intimate partner.

This is where the call in codependents comes into play.

By accepting the role of victims, codependents seek to control their abuses and to manipulate them. It is a dance macabre in which both members of the dyad collaborate. It's a kind of traumatic bonding or trauma bonding.

In codependency, the codependents sometimes claim to pity her abuse. She casts herself in the grandiose roles of his savior or his redeemer or his mother.

Her overwhelming empathy imprisons the codependents in these dysfunctional relationships and she feels guilt either because she believes that she had driven the abuser to mistreat her or because she contemplates more and more seriously to abandon her.

There are various types of codependents.

Codependency is a complex, multifaceted, multidimensional defense against the codependents' fears and needs.

So I distinguish between four categories of codependency stemming from their respective etiologies, so psychodynamic processes and psychological etiology.

So the first category is codependency that aims to fend off anxieties related to abandonment.

These codependents are clingy, smoldering, and prone to panic. They are plagued with ideas of reference, differential ideation, and they display self-negating submissiveness. Their main concern is to prevent their victims, friends, spouses, family members from abandoning and deserting them or from attaining true autonomy and independence.

These codependents merge with their loved ones and experience any sign of abandonment or autonomy, personal autonomy, whether real, actual, friend, imagine. They experience these as form a form of self-annihilation or even amputation.

They do not allow the apartments to kind of separate an individual.

The second category of codependency is codependency that is geared to cope with the codependents' fear of losing control.

By feigning helplessness and neediness, such codependents coerce their environment into ceaselessly and seamlessly, catering to their needs, wishes, and requirements.

These codependents are drama queens. Their life is a kaleidoscope of instability, chaos, and lability. They refuse to grow up. They force their nearest and nearest to treat them as emotional or physical invalids. They deploy their self-infuded efficiencies and disabilities. They yield them and will them as well as.

Both types of, both these types of codependents, type one and type two, use emotional blackmailing when necessary, guilt-free, and when necessary, threats to secure the presence of blind compliance, blind compliance, alter suppliers, anything less, triggers anxiety.

The third category are vicarious codependents. These are codependents who live through others, more or less like the moon's reflected sunlight. They sacrifice themselves in order to glory the accomplishments of their chosen targets. They subsist on reflected light, as I said, on second-hand applause, and on derivative achievements and accomplishments. They have no personal mystery, having suspended their lives, their wishes, preferences, and dreams in favor of another. They live by proxy. They live vicariously. They live through another, a parasitic existence.

One subtype of such codependents is what I call inverted narcissist. The inverted narcissist is a form of covert narcissist. It is a codependent who depends exclusively on narcissists. A narcissist codependent.

If you're living with a narcissist, if you have a relationship with a narcissist, if you're married to one, if you're working with a narcissist, etc., this does not mean that you're an inverted narcissist, to qualify, so to speak.

As an inverted narcissist, you must crave to be in a relationship with a narcissist, regardless of any abuse inflicted on you by him. You must actively seek relationships with narcissists and audience narcissists, no matter what your bitter and traumatic past experience has been. You must feel empty and unhappy in relationships with any other type of person.

Only then, and if you satisfy the other diagnostic criteria of dependent personality disorder, only then can you be safely labeled an inverted narcissist.

So this is an example of a vicarious codependent, the category three. And category four is codependent or borderline narcissist.

These are narcissists who 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 only possible manifestations of their personal autonomy and need for space.

They also tend to form with their intimate partner a shared psychosis or a shared psychotic disorder. These are all outcomes of their overwhelming and outpervasive abandonment anxiety.

They either smother their partner in an attempt to forestall desertion, or they preemptively abandon sheep, thus avoiding her and maintaining an illusion of control over the situation.

They say, I walked out on her, I dumped her, not the other way around. The codependent deploy strategies such as merger becoming one with her intimate partner, while renouncing all personal autonomy and all independence of both of them, up to a point of shared psychosis.

Another strategy is co-extensivity, the ventriloquist defense, insisting the department mind reads her and acts in ways that reflect her inner psychological states and moods.

And then there's the classic strategy of shifting, ever shifting, or shape shifting boundaries, using behavioral unpredictability and ambient uncertainty to induce paralysis and a paralyzing dependence in the partner.

There's another form of co-dependence that is so subtle that it eluded detection until very recently, and that's counter dependence.

Counter dependence reject and despise authority and often clash with authority figures, such as parents, bosses, the law, their contumaciousness, the sense of self worth and their very self identity are premised on and derived from, in other words, dependent on.

These acts of bravura and defiance, they are personal autonomy, militants.

Counter dependence are fiercely militantly independent, controlling, self- centered and aggressive. Many of them are antisocial, and they use projective identification. They force people to behave in ways that buttress and affirm their view of the world and its expectations.

These behavior patterns are often the result of a deep seated fear of intimacy.

In an intimate relationship, the counter dependent feels enslaved and snared, captive. Counter dependence are locked into an approach avoidance repulsion, repetition compulsion.

The hesitant approach is followed by avoidance of commitment and then another stifled approach and so on.

These people alone were the very bad team players.

Counter dependence is a reaction formation. The counter dependent dreads his own weakness. He seeks to overcome these weaknesses by projecting an image of omnipotence, omniscience, success, sub sufficiency, and superiority.

Most classical overt losses are in effect counter dependence, and of course all psychopaths. Their emotions and needs are buried under scar tissue, which had formed and coalesced and hardened during the years of one form of abuse or another.

Grandiosity, a sense of entitlement, lack of empathy, over-winning hotiness, over-winning hotiness usually hide knowing insecurity and fluctuating sense of self-worth.

And then there's situational co-dependence.

Some patients develop co-dependent behaviors and traits in the wake of a life crisis, especially if this crisis involves an abandonment and resulting solitude.

So in the wake of a divorce or an empty nest, one must once children embark on their own countless lives or live home or together.

Such late onset co-dependence fosters a complex emotional and behavioral chain reaction, whose role is to resolve the inner conflict by reading oneself of the emergent undesirable co-dependent conduct.

Consciously, such a patient may at first feel liberated, but unconsciously, being abruptly dumped and lonesome has a disorienting and disconcerting effect akin to intoxication.

Many patients rush headlong and indiscriminately into new relationships.

Deep inside, this kind of patient has always dreaded being lonely.

Lonely, not alone.

Following the divorce, the death of a significant other, or an intimate partner, passing away of parents or other loved ones, children relocating to college, following similar episodes of dislocation, the patient suppresses this dread because she possesses no real effective solutions and antidotes to her sudden solitude.

And she has developed long meaningful ways to cope with it.

We are taught that denied and repressed emotions often re-emerge in camouflage, as it were.

The dread of ending up all alone is such that the patient becomes co-dependent in order to make sure that she never finds herself in a situation like this, never finds herself alone.

Her co-dependency is a series of dysfunctional behaviors that are intended to fend off abandonment and loneliness.

And still, patients who develop situational co-dependents, unlike classic lifelong co-dependents, are fundamentally balanced and strong personalities who cherish their self-control.

So they always keep all their options open, including the vital option of going alone yet again. They make sure to choose the wrong partner and that they spectacularly expose his egregious misconduct so that they can get rid of them and of the newly acquired co-dependency in good conscience and at the same time.


So to reiterate, the situational co-dependent is characterized by a deep-set fear of being lonely, an abandonment anxiety, a form of attachment disorder, as an underlying dormant inner landscape.

This lurking abandonment anxiety is awakened by life's tribulations, divorce and emptiness, death of one's nearest and dearest.

At first, the newly found freedom is exhilarating and intoxicating, but this feel-good factor actually serves to enhance the anxiety.

The inner dialogue goes something like this.

What if it feels so good that I will opt to remain by myself for the rest of my days? This prospect is terrifying.

So a conflict erupts, inner internal conflict between conscious emotions and behaviors, liberation, joy, pleasure signal, and a nagging unconscious anxiety. I'm not getting any younger. This can go on forever. I've got to settle down, find appropriate mate, not to be left alone. I shouldn't get addicted to being alone.

To allay this internal tension, the patient comes up with situational co-dependency as a coping strategy to attract and bond with a mate so as to forego abandon.

Yet the situation co-dependent is equally stunning. She's very unhappy with her newfound co-dependency, though at this stage she's utterly unaware of all these dynamics. It runs contrary, her co-dependency runs contrary to her primary nature as accomplished certain self-confident person with a well-regulated sense of self-worth.

She feels the need to frustrate this new set of compulsive addictions, her co-dependency, and to get rid of it because it threatens who she is and who she thinks she is, her identity and self-perception.

Surely she is not the clingy, maudlin, weak, out-of-control type. All her life she has known herself to be strong, a good judge of character, intelligent and in control. Co-dependency does not become her.

But how could she get rid of this new co-dependency?

Well, in three easy steps.

She chooses the wrong partner unconsciously and obviously it leads again to being alone. She proves to the satisfaction that he is the wrong partner for her. She gets rid of him, thus re-establishing her autonomy, her resilience, her self-control and demonstrating credibly that she is co-dependent no more.

To make matters clear, co-dependency is a much disputed mental health pseudo-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? And who decides?

Clinicians who contributed to the study of this disorder use words such as craving, clinging, stifling, both the dependent and her partner. They use words such as humiliating or submissive.

But these are all subjective terms, either culture-bound or represent value judgments. They are open to disagreement. They are open to differences of opinion.

Moreover, virtually in all cultures and societies, dependency is encouraged to varying degrees, especially in women. Even in developed countries, many women, very old, very young, deceived, the criminal and the mentally handicapped, are denied personal autonomy. They are legally and economically dependent on others and of the authorities.

Thus, dependent personality disorder is diagnosed only when such behavior does not conform to social or cultural or worries.

Co-dependences, they are sometimes known, are possessed with fantastic worries and concerns. They are paralyzed by their abandonment, anxiety and fear of separation. And this inner turmoil renders them indecisive. Even the simplest everyday decision, simplest everyday decision becomes an excruciating ordeal. They go back and forth, approach avoidance.

This is why co-dependence rarely initiate causes or do anything of their own. Co-dependence typically go around eliciting constant and repeated reassurances and advice from myriad sources. And this recurrent solicitation of sakura is proof that the co-dependence seeks to transfer responsibility for his or her life to other people, whether they have agreed to assume this responsibility or not. It's coercive. It's blackmail.

This recoil and studious avoidance of challenges may give the wrong impression that the dependent is intimate or insipid, yet most dependents are neither. They are often fired by repressed ambition, energy and imagination. It is the lack of 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, one hand and a realistic assessment of their 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, never criticized. They are afraid to lose their support and emotional nurturance, but also their calibration, their place in the world.

Knowing and realizing what's right and what's wrong crucially depends on input from others.

They don't have self-regulation. They are disregulated.

Consequently, the co-dependent modulates himself or herself and bends over backwards to cater to the needs of his nearest and dearest and satisfied every whim, every wish, expectation and demand.

Nothing is too unpleasant or unacceptable if it serves to secure the uninterrupted presence of the co-dependent's family, inference and the emotional sustenance that you can extract from them.

The co-dependent does not feel fully alive when she is alone. She feels helpless, threatened, ill at ease and childlike.

This acute discomfort drives the co-dependent to walk from one relationship to another and even sometimes lead to promiscuity.

The sources of nurturance are interchangeable to the co-dependent being with someone, with anyone, no matter who, is always preferable to solidity.

Parents of co-dependence had taught their offspring to expect only conditional transactional love. The child is supposed to render a service or fulfill the parents' wishes and dreams in return for affection and compassion, tension and emotion and so on.

Inevitably, the hurt child reacts with rage to this unjust, capricious, arbitrary, conditional mistreatment. With no recourse to the offending parent, these furies either directed outwards to others who stand in for the dead parent or inwards.

The former solution yields a psychopath or a passive-aggressive, mechativistic, personalitivist. And the second solution, internalizing the aggression, results in a masochist or in a person with depressive illness.

Similarly, with an unavailable parent, the child, reserved with love can be directed inward at himself and yield a narcissist or it can be directed outward towards others and create co-dependence.

All these choices retard personal growth, result in arrested development and are ultimately self-relativizing, self-defeating at least.


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 and the abandonment of the parent with whom he had merged so thoroughly, so early on.

When the co-dependent 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 disciplinary 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 rest with the internalized parent, not with the newfound love.

Concurrently, she punishes herself as she tries to preempt the merciless onslaught of her sadistic parental interjects and super-legal. She engages in a binocular of self-destructive, reckless and self-defeating behaviors.

Acutely aware of the risk of losing her partner owing to her abusive misconduct, the co-dependent experiences extreme abandonment anxiety. She swings wildly between self-effacing and clinging, being a doormat, behaviors on the one hand and explosive vituperative, infective behaviors on the other, the former being the manifestations of her eternal child and internal 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, maybe a bipolar disorder, but where dependent personality disorder is diagnosed, these pendular electronic upheavals are indicative of an underlying personality structure rather than of any biochemically-induced perturbations.

I came to addiction. Dependence of other people fulfills important mental health functions.

First, it is an organizing principle. It serves to explain behaviors and events within a coherent narrative, fictional story, a frame of reference. I acted this way because I'm dependent.

Second, it gives meaning to life. Third, the constant ups and downs satisfy the need for excitement and thrills. Fourth, and most crucially, the addiction and emotional ability plays the dependent and the central attention, allows her to manipulate people around her to do her bidding.

Indeed, co-dependent is convinced that she cannot live without her dependence.

This is a subtle and important distinction. She can survive without him or her intimate partner, but she believes profoundly, erroneously as it happens, that she cannot go on living without her addiction to her partner. She's in love with love, not with the partner. She experiences her independence as her best friend, her comfort zone, as familiar and warm and fitting as an old pair of sleepers. She is addicted to and dependent on her dependence, but she attributes the source of his dependence to her boyfriend, to her mates, spouse, children, parents, anyone who happens to fit the bill in the plot of her narrative.

But these people come and go. Her addictions remain intact. They are interchangeable. Her addiction is immutable.

So extreme cases of co-dependency dependent personality disorder, borderline personality disorder, they require professional help. Luckily, dependency is a spectrum. And most people with dependent traits and behaviors are clustered somewhere in the middle. They can help themselves by realizing that the world never comes to an end when our relationship does. It is the dependence in you, in the patient that reacts with desperation, not a patient as so.

And next, the patient can analyze her addiction. What are the stories and narratives that underlie the addiction? Does she tend to idealize her intimate partner? And if so, can she see him in a more realistic light? Is she anxious about being abandoned? Why? Has she been traumatically abandoned in the past as a child perhaps?

She should write down the worst possible scenario. The relationship is over. She's abandoned. And is her physical survival at stake? Of course it's not. She should make a list of the consequences of the breakup and write next to each one what she can do and intends to do about it.

And so armed with this blend of action, she is bound to feel safer and more confident. And she must share her thoughts, fears, and emotions with friends and family.

Social support is indispensable. One good friend is sometimes worth a hundred therapy sessions. And this is a secret that we should keep between us or we'll all go on and on. Clinging and smoldering behaviors are the unsavory 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 control her anxieties head on. This can be done by 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 exploring and personal growth and form a modicum of self-automacy, a psychiatrist may wish to prescribe anti-anxiety medication.

Transference should be encouraged in certain places. Self-help is also an option.

Sleep, meditation, yoga, the elimination of any and all addictions such as walk-out racing, binge eating. Feelings of emptiness and loneliness at the core of abandonment anxiety and other dysfunctional attachment styles. These feelings can be countered with meaningful activities, maybe altruistic, charitable, and with true stable friends who provide a safe haven and are unlikely to abandon the patient and therefore they constitute a holding, supportive, and nourishing environment.

The codependence reflexive responses to your 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 world. The world is hostile, it is hostile about to hit her. These are negative automatic thoughts which can be easily and profitably tackled in a variety of cognitive behavioral therapies.

She needs to sustain her Cotton- ZONE, abuse and abandonment of familial doom.

At least I know the ropes and how to cope with them. And this also is a form of complex negative thought. This is why she needs to exit this realm of mirror fears and fearsome mental tumors. She should adopt newer vocations, new hobbies, meet new people, maybe relocate, move to any place, engage in non-committal, dispensable relationships and in general take life much more lightly.

Some codependents develop a type of militant independence as a defense against their own sorely felt vulnerability and dependence.

But even these daring rebels tend to view their relationships in terms of black and white, an infantile psychological defense mechanism known as flitting. They tend to regard their relationships as either doomed to failure or as everlasting and they tend to regard their intimate partners as both unique and indispensable, soul-made, twin, or completely interchangeable and objective.

These of course are misperceptions, cognitive deficits grounded in emotional immaturity and thwarted personal development.

All relationships have a life expectancy, a sell-by could be for or expiring it. No one is irreplaceable or completely interchangeable.

Codependence 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 counter-dependent, firstly independent, defined intimacy, retarding behaviors, all these can be modified.

If you fear abandonment to the point of phobia, I advise you to adhere to a regime of therapy and a series of steps which can be easily implemented and are listed on my website.

Having implemented this mini-therapy, you should then seek longer-term therapy in a structured therapeutic alliance.

Codependency can be overcome, can be cured if you wish, can be altered and changed into a much healthier pattern of attachment, bonding, and relationships.

So I advise you to head to my website www.lossistic-abuse.com and there's a search engine there, type the word codependent and you will find a mini-theraporetical, mini-theraporetic self-administered regime which should be perhaps a first aid kit in your case.

Thank you for listening. I wish you a very good conference.

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Co-dependence is a complex multi-faceted and multi-dimensional defense against the co-dependence fears and needs. There are four types of co-dependence: abandonment, control, vicarious, and counter-dependent. The dependent personality disorder is a much disputed mental health diagnosis, and clinicians use subjective terms such as craving, clinging, stifling, humiliating, and submissive. Codependents are possessed with fantastic worries and concerns and are paralyzed by their abandonment anxiety and fear of separation.


Codependency State Of Mind, Not State Of Affairs

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Masochistic Personality Disorder (Masochism)

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Codependent's Inner Voice: "I Can’t Live Without Him/Her"

Co-dependence is an addiction that gives meaning to life and satisfies the need for excitement and thrills. It places the individual at the center of attention and allows them to manipulate people around them to do their bidding. Extreme cases require professional help, but most people with dependent traits and behaviors can help themselves by realizing that the world never comes to an end when relationships do. Analyzing addiction, writing down the worst possible scenario, making a list of all the consequences of the breakup, and sharing thoughts, fears, and emotions with friends and family can help.


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