We learn pretty early that it is hard to get by without other people’s help. From the time life starts, we depend on others to make it to the next milestone and through the next challenge. Relying on others is a constant, and many people navigate this truth in healthy ways. But when codependency enters the picture, having a healthy relationship is greatly hindered and can warp what a sound relationship is and what it is supposed to look like.

Codependent relationships on their own are unhealthy, but when they involve a person who has a mental illness, things can worsen for both people. Codependent behavior enables people to engage in self-harm, including drug and alcohol addictions. This is a critical reason why it is important to know what codependency is, recognizing when it is happening, and how to live with and manage someone with mental illness and ourselves. If you are in a codependent relationship, we want you to know that there is help, no matter which role you play in it.

What Is Codependency?

Codependency is a relationship dynamic in which people exhibit unhealthy attachment behavior to one another. In many cases, this imbalanced relationship involves a person enabling another person to engage in behavior that is hurtful, irresponsible, damaging, and destructive. This behavior is not only dangerous to themselves but to everyone involved.

As Shawn Meghan Burn, Ph.D., explains to NBC News, “Codependence is an imbalanced relationship pattern where one partner assumes a high-cost ‘giver-rescuer’ role and the other the ‘taker-victim’ role.” Verywell Health says another term for codependency is “relationship addiction,” and it can also be referred to as “enabling.”

The imbalance of codependency can show up in many ways, but any relationship can take on codependent traits. Relationships between friends, family members, coworkers, and romantic partners can all be codependent.

How Does Codependency Happen?

Dysfunction in the family unit is believed to be the root cause of codependency in many cases. It is generally believed that codependency is a learned behavior that can be passed down through the generations. Shawn M. Burn, Ph.D., also wrote a column for Psychology Today explaining that dysfunctional helping and giving are probably passed down through observational learning. This form of learning commonly happens in the home environment. Children often model behavior and repeat what they see their caregivers do.

“In short, growing up watching important adults over-help, rescue, and enable, makes us more prone to it ourselves, especially if we identify with those adults and hear them exalted by others as saintly for all they put up with,” Burn writes.

Many people who grow up in homes where codependency is a way of life often see people ignore their own needs. In a codependent situation, asserting your needs means facing the consequences, and children soon learn this is not desirable. They also see how the family member who is ill, abusive, or addicted gets all the attention while everyone else makes seemingly endless adjustments to accommodate this person. No one talks about what is happening or confronts their feelings about what is happening in a home where codependency rules.

Children, too, soon learn to keep quiet and continue to make sacrifices, doing things they don’t want to do instead of asserting themselves. They may take on roles too mature for their age because of situations in the home, as well. Seeing and experiencing this behavior repeatedly creates a script for a person who is too young to understand the adverse consequences of such maladaptive behaviors in the long term. They likely will grow up to repeat this pattern, including in their own relationships with others, unless something disrupts it. In some cases, it will take some form of therapy to do that, including family therapy. 

Codependency is harmful in many ways. One key issue is it changes how love and concern toward others are expressed. Behaviors that have been normalized in the name of helping or taking care of someone can often lead to situations that do more harm than good. In many situations, it is observed that while a person does the loving and caring, the person on the receiving end of such love and care isn’t improving in their health or actions. They could even be getting worse, yet the enabling behavior continues, benefitting no one.

Signs of Codependency

Realizing when a relationship has become codependent can be challenging for the person who is in it. Sometimes, it is the only behavior they have known while they’ve been in a relationship with the other person. The following are common signs in these kinds of relationships, as shared by Psychology Today:

  • Denying oneself to please someone else. One person puts the other’s needs, thoughts, feelings, schedule, and other things before their own. Rarely will the person on the receiving end of this notice or be motivated to change their behavior.
  • A consistently one-sided relationship. In a one-sided relationship, the scales tend to tip in one direction more than the other. One person benefits while the other person does not. In some relationships, this means one person does all of the work to keep the peace while the other person does not contribute at all or as much. The person doing all of the work is apt to make excuses for the person who isn’t contributing. They often look the other way, even when the other person is doing something that is harmful or dangerous.
  • Constant sacrifices from one person. One partner in the relationship will find themselves sacrificing things that are important to them to make the other person happy. As Psychology Today explains, these sacrifices can be a person’s time, money, energy goals, health, friendships, and other things.
  • Strong need to save another person from themselves. One person is often the “fixer” or “rescuer” in the relationship and may even take on acting like they are a martyr because they feel they have to take care of everyone and everything. They often think, “If I don’t do it, no one else will.” They may express resentment that no one else helps or cares about their well-being. This unhealthy rescuing behavior can take on a controlling nature and alienate others.
  • Fear of rejection, criticism, or abandonment. One person in the relationship feels like they have to do all of these things out of fear that the other person will reject them, leave them, or criticize them. This form of people-pleasing rarely gets the other person to act the way someone else wants them to, but it is common in codependent relationships. 
  • Conflict avoidance at all costs. One person suppresses their thoughts, opinions, interests, requests, and other things that are important to them out of fear of offending the other person or making them upset. They may agree to do things they don’t want to do or adopt perspectives that are not theirs just to avoid being seen as difficult. This can look like “going along to get along” to keep conflict at bay. Not speaking or advocating for oneself can lead to poor communication and assertiveness skills.

Mental Illness and the Codependent Person

codependency and mental illness

Mental illness is common in our society, as there are more than 200 classified mental illnesses, according to Mental Health America. Per the National Alliance on Mental Illness (NAMI), one in 5 U.S. adults experience mental illness every year, and one in 20 U.S. adults experience a serious mental illness every year. 

Common mental health disorders include:

  • Anxiety disorders
  • Depressive disorders
  • Bipolar disorder
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Attention-deficit hyperactivity disorder (ADHD) 
  • Borderline personality disorder
  • Schizophrenia
  • Substance use disorders (SUDs) 
  • Eating disorders
  • Dementia

Not everyone who has a mental illness receives medical or mental health care treatment for it, unfortunately. In 2019, only 44.8% of U.S. adults with a mental health disorder received treatment, and only 65.5% of U.S. adults with serious mental illness received treatment, per NAMI. Some attempt to self-medicate with addictive substances in order to deal with their illness, which can further complicate codependent relationships.

The Link Between Mental Illness and Substance Abuse

Mental health disorders come with their symptoms. If you suspect that you or a loved one has a mental illness, you should seek out a medical and/or mental health professional who can give you the proper assessment and confirm a diagnosis. Some signs and symptoms of these illnesses overlap, so it can be challenging to tell which disorder someone has. It is also possible for people to have more than one mental disorder. In addition to this, it is possible for people with mental disorders to also have substance use disorder (SUD). This is known as having a co-occurring disorder. Self-medicating with drugs and alcohol is very common in people with mental illness.

“Multiple national population surveys have found that about half of those who experience a mental illness during their lives will also experience a substance use disorder and vice versa,” writes the National Institute on Drug Abuse (NIDA).

With millions of people living with a mental health disorder, it is very possible for a spouse, partner, caregiver, supervisor, friend, or family member to be in a relationship with someone who has mental illness. 

Mental disorders affect the moods and behaviors of the people who have them. Because of this, they are likely dealing with challenging emotions that can be too much to bear daily. This is especially true for people who have not been officially diagnosed and those not receiving treatment for their disorder. 

Anyone who is close to someone with mental illness may also find it hard to manage their relationship with the person. Both parties in such a relationship may find themselves using addictive substances to cope. One person may do it to bond with their partner or another person who also uses substances, while some may turn to alcohol or drugs as they try to deal with their codependent relationship and themselves.

How Codependency Harms People with Mental Illness

Many people in relationships have good intentions toward the people they care about, but that doesn’t mean those good intentions aren’t harmful, particularly for people who have a serious mental health disorder. While it is hard to see someone you love or care about struggle in life, shielding them from the effects of their decisions or what they’re going through is often not a long-term solution.

A “rescuer” may go to great lengths to help their loved one with anxiety calm down every time the person is upset. Or, they may do things to make a person with depression feel better, like cook them dinner or buy them gifts. However, if a person goes out of their way every time their loved one has a bad day or doesn’t want to shower or get out of bed to face the world, they are likely hurting that person rather than helping. The answer to chronic anxiety or chronic depression is to seek professional treatment, but in codependent relationships, the people involved may see accommodating behavior as the answer, but it’s not.

Over time, accommodating a person with mental illness instead of encouraging them to get the help they need will keep them from living their best life. Recovering from a mental health disorder requires help from a professional. It could mean the person struggling needs therapy, medication, or both to manage their illness. Codependency keeps people who need help in a helpless position. It could even discourage them from changing their behavior.

Codependent behavior may serve as a short-term benefit, but over time, it will likely become apparent that it is not a healthy way of relating to others or yourself. As mentioned earlier, seeking professional help is an effective way to address mental illness.

Codependency Doesn’t Help When Caring for Someone with Mental Illness

Caring for people with mental illness can be taxing, and it can be challenging to create boundaries to keep expectations reasonable and keep things in perspective. It is easy to get caught up in letting a person’s mental illness overtake you and your relationship with them. Soon, a codependent person will want their loved one to see them as the only person they can trust and rely on. This is not a healthy way to manage this relationship.

In the end, codependency harms everyone in the relationship. The person who makes most or all of the effort to support the other person ends up doing these things in order to be fulfilled and validate themselves. Even though the relationship is toxic, they stay in it because they need to be needed and base their self-worth on this need. Many codependent people equate their personal happiness to caring for someone who does not reciprocate the love and care they show. This, however, does not help them become a healthy, well-adjusted person for themselves or anyone else. 

Staying in a draining, hurtful relationship is not good for one’s mental, emotional, physical, or spiritual health. As a result of being codependent, they may struggle with:

  • Low self-esteem
  • Setting boundaries
  • Rejection
  • Saying no
  • Making decisions
  • Trusting others
  • Perfectionism
  • Guilt
  • Shame
  • Resentment and anger
  • Denial
  • Anxiety
  • Control issues
  • Asking others for help
  • Wanting to leave but feeling like they are unable to

Codependent people may also have problems with intimate relationships, adjusting to change, and knowing when to stop doing for others. They may take their codependent, enabling behavior to their jobs, in social settings, and in romantic relationships. They also may develop a mental health disorder or worsen an existing one due to being in a codependent relationship. The other person who is benefiting is further enabled to carry on as they have been, which is also dangerous for them and others who become involved with them. They also may have no compass for what is appropriate or inappropriate as the relationship feeds whatever shortcomings or toxic behaviors they have.

Is Codependency the Same as Dependent Personality Disorder?

Codependency has been linked with dependent personality disorder, but they are different things. According to the Cleveland Clinic, dependent personality disorder (DPD) is a personality disorder. It is in the category of other personality disorders, such as antisocial personality disorder, narcissistic personality disorder, and paranoid personality disorder. It involves feelings of helplessness and submissiveness, as well as the inability to take care of oneself. People with DPD have a strong need for others to take care of their needs and can have difficulty with making everyday decisions, such as choosing an outfit to wear.

Per the clinic, people with this disorder develop it sometime during childhood up to age 29. DPD can happen if people have experienced abusive relationships, childhood abuse, mental health experts say. The disorder can also develop in people who participate in cultures or religions that require them to rely on outside authority. Family history can also play a role in the development of the disorder.

Symptoms of DPD include:

  • Avoiding personal responsibility
  • Fear of being alone or abandoned
  • Feeling helpless when relationships are over
  • Super-sensitive to criticisms
  • Struggling to make decisions with everyday matters

How DPD Differs from Codependency 

There are few ways to tell codependency and DPD apart. Codependent people want to take care of the person they are in a relationship with, but people with DPD want someone to take care of them. 

Codependent people who assume the role of being the one everyone can trust seek out responsibility as a way of validating themselves and their self-worth. They want people to need them and depend on them. People with DPD run away from responsibility and seek out others who will take on the responsibility or make decisions for them. 

There is professional help for codependency and DPD. Often, treatment is the most effective way to change these behaviors.

Treating Codependency: What Can You Do?

People caring for loved ones with mental illness will need to come to terms with their codependency and seek professional help for it if they can’t change this pattern of behavior on their own. The longer one has been in this kind of relationship, the harder it can be to break these patterns with outside guidance. This guidance may take the form of therapy. Such help can allow someone to make the changes they need for improved relationships with themselves and other people.

A therapist can help codependent people identify codependent patterns and strategies they can use to change them. Therapy can help a person:

  • Identify their attachment style.
  • Symptoms of codependency that are present in their relationships
  • The role they play in their codependency
  • Find ways to assert themselves, such as setting boundaries, asserting themselves, and getting in touch with their needs and wants

Family therapy and couples therapy can help related individuals, as well as married or dating individuals, identify unhealthy communication patterns and ways of relating to one another and work on changing those behaviors.

If you are caring for someone with mental illness, it is important that you think about yourself, too. Seek out support groups that understand the challenges you face as you care for a person with a mental health disorder. Group members may be able to suggest strategies you can try or resources that offer additional insight and help.

You can also find a licensed mental health professional who can advise you on your next steps. You can also try your local library or bookstore to find materials that can help you learn more about codependency as well as your loved one’s mental illness. There are ways you can live with someone who struggles with a mental health disorder without giving up on yourself.

Can rehab help with codependency?

If your loved one has a substance use disorder and a mental health disorder, they need to receive treatment that addresses both conditions at the same time. Treatment that offers interventions for both concurrently can give them the best chance at recovery.

A rehab recovery program can offer someone with mental illness therapy that can help them identify negative codependent behaviors that they use as well as the tools they will need to change their behavior. They can participate in cognitive behavioral therapy sessions that help them recognize unhealthy thoughts, feelings, and patterns of behavior that lead them to engage in codependency. These sessions can help them reverse that way of thinking so that they exhibit positive behaviors that allow them to claim their role and responsibility in all of their relationships.

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