Codependency: Signs, Causes and Treatment

What Is Codependency?

Multiple definitions of codependency exist, although none has been empirically derived (Dear et al., 2004). Lack of agreement has hampered both testing and its inclusion in the DSM diagnostic manual. Codependency is still not a diagnosis in the DSM-5-TR, although people who identify as codependent describe it as a real and recurring pattern in their lives (Bacon et al., 2020). Some definitions focus on interpersonal behavior, some on their childhood, and others on the individual. In 1989, experts at a National Conference on Codependency arrived at a consensual definition:

“A pattern of painful dependency on compulsive behaviors and on approval from others in an attempt to find safety, self-worth and identity” (Wegscheider-Cruse & Cruse, 1990, p. 8).

Wegscheider-Cruse and Cruse (1990) saw codependency as a brain disorder that leads codependents to seek the relief of soothing brain chemicals, which are released through substance abuse and compulsive behaviors, including addiction to work, gambling, food, sex, and/or relationships. For relief, “we get into self-defeating behaviors that keep the rush coming. . . The living problems are ‘results of having the disease of co-dependency not the cause’” (p. 13).

Codependents have been described as having a “lost self.” John Bradshaw (1988) defined codependency as “a loss of one’s inner reality and an addiction to outer reality” (p. 166). Darlene Lancer (2012) refers to a codependent “as a person who can’t function from his or her innate self, and instead, organizes thinking and behavior around a substance, process, or other person(s)” (p. 30). The disorder exists in the person whether or not they are in a relationship.

Codependents become dependent on other people in unhealthy ways, even though they might do fine on their own. The degree of codependency varies on a spectrum. Some experts consider codependency a disease and addiction because, like alcoholism, the behavior is compulsive and worsens over time if untreated. It progresses through stages of degeneration and regeneration during its decline and recovery.

Where the name comes from: Codependency has been studied for nearly fifty years. It grew out of research on alcoholism. The term “co-alcoholic” referred to people close to someone with substance abuse issues. Researchers ultimately discovered that the dysfunctional behavior of co-alcoholics both pre-dated and continued after the alcoholic attained sobriety. Co-Dependents Anonymous (CoDA) was founded in Phoenix, Arizona, in 1986.

What Are the Signs of Codependency?

Core symptoms of codependency include:

• Denial
• Shame, which leads to low self-esteem, anxiety, fear, and irrational guilt
• Intimacy problems
• Dependency
• Dysfunctional communication
• Dysfunctional boundaries
• Control of oneself and/or others

These core symptoms interact to create other dysfunctional behavior, such as people-pleasing, indecisiveness, enabling, or obsessing about, helping, or managing someone else. Fear of being alone or abandoned causes codependents to stay in abusive or one-sided relationships. They often put their relationships and other people’s needs and feelings before their own. They sacrifice their individuality and become dependent upon another person. Keeping those around them happy appeases their anxiety about rejection and abandonment, even when they’re unhappy themselves. Over time, their self-esteem declines due to prolonged abuse or from sacrificing themselves for others.

While having some of these traits is normal, when they become extreme or compulsive, codependents often find themselves struggling throughout their adult life to find happiness that’s not tied to another person (often in intimate relationships). Examples include spouses who stay in abusive relationships because they believe they’re the cause of the problem, those who never seem happy without a spouse or romantic partner to please, and parents who “live” through the lives of their children and only experience happiness through them.

People with addictions are often codependent, too. Once they’re sober or abstinent, their relationship issues are more apparent. Some codependents avoid commitment due to shame or fear of losing themselves in a relationship. While these examples fit the definition of codependency, the actual condition can present itself in a myriad of ways and no two cases are exactly alike.

Researchers have also found that codependency is linked to elevated levels of stress and anxiety as well as higher instances of depression and physical symptoms, including stress-related illnesses (Molina et al., 2026). The good news is that codependency is treatable, and often reversible with the right therapist and a willing patient.

What Causes Codependency?

The traits of codependency were described decades before the term existed by psychoanalyst Karen Horney (1950), whose ideas later shaped humanistic psychology. She wrote that faulty parenting can alienate people from their real self and lead to neurosis. Researchers later found that codependency was also prevalent in adult children of depressed or mentally ill parents and those who grew up in dysfunctional families. Codependency was more widespread in modern society than anyone had initially realized. Deleterious patterns from childhood usually get repeated in unhealthy adult relationships.

How Is Codependency Treated?

Left untreated, codependency tends to get worse over time, and it can lead to severe anxiety, depression, or even suicidal thoughts. However, codependency is treatable, and many people recover with individual therapy and 12-Step meetings. Therapists often combine approaches. Medication doesn’t treat codependency itself, but a doctor may prescribe it for co-occurring depression or anxiety.

Cognitive-behavioral therapy and person-centered therapy can both help. Twelve-Step groups, such as Al-Anon Family Groups and Co-Dependents Anonymous, are beneficial in the treatment of codependency. Therapy to address trauma may also be indicated in cases where the patient has experienced abuse or abandonment. It’s important that a therapist is knowledgeable about codependency and treating issues of shame and self-esteem, as well as teaching healthier behavioral and communication skills.

Early recovery often starts with small shifts: noticing the urge to fix someone else’s problem, pausing, and asking what you need instead. Lancer (2015) describes recovery as turning your focus back to yourself, which also respects other people’s right to make their own choices. Keeping a journal, meditating, and pursuing your own interests help build that inner steadiness.

Codependency and Boundaries

We all need both closeness and independence. For codependent people, that balance is hard to find. They may feel responsible for other people’s feelings and choices, struggle to say no, or lose track of their own needs (Lancer, 2014). Healthy boundaries aren’t walls. They’re a clear sense of where you end and someone else begins, and research links codependency to a disrupted sense of self and strained relationships (Molina et al., 2026).

Setting boundaries can start small:

• Notice resentment or exhaustion, which often signals a boundary that needs attention
• Pause before saying yes, and give yourself time to decide
• Use short, direct “I” statements, such as “I’m not available tonight”
• Let others have their feelings about your boundary without fixing them or overexplaining
• Practice in lower-stakes situations before harder conversations

How to Find Help for Codependency

Due to denial, most codependents aren’t consciously aware of their low self-esteem and dysfunctional behavior. It often takes a third party to recognize these patterns as well as to offer alternatives that could lead to improved interactions with a spouse, loved ones, friends, or co-workers. This is why therapy is important. Additionally, making the changes required to recover increases anxiety. Hence, it’s necessary to have a good support system to reinforce the new behavior. Therapy and 12-Step programs provide this support.

Frequently Asked Questions

Is codependency a mental health diagnosis?

No. Codependency isn’t a diagnosis in the DSM-5-TR, and researchers still don’t agree on a single definition (Molina et al., 2026). Even so, people who identify as codependent describe a real, recurring pattern that affects their relationships and well-being (Bacon et al., 2020), and therapists treat it as a serious relational issue.

Can codependency be treated?

Yes. Individual therapy, including cognitive-behavioral and person-centered approaches, helps people recognize old patterns, build self-esteem, and practice new ways of relating. Twelve-Step groups such as Co-Dependents Anonymous and Al-Anon add ongoing support, and trauma-focused therapy can help when abuse or abandonment is part of the history.

What’s the difference between codependency and caring for someone?

Caring is a choice, and it leaves room for both people’s needs. Codependent caretaking is driven by anxiety, guilt, or fear of rejection, so helping feels compulsive and often costs you your own health, needs, or values (Lancer, 2015). A useful test is whether you could say no without feeling panic or shame.

Can you be codependent without being in a relationship?

Yes. Codependency lives in the person, not the relationship, so the patterns can show up with friends, family, and coworkers, or when you’re single (Lancer, 2015). Some people avoid relationships altogether because they fear losing themselves in one.

If you’re in crisis or thinking about suicide, call or text 988 (US and Canada), or see our crisis helplines for other countries. If you’re in an abusive relationship, the National Domestic Violence Hotline is available at 800-799-7233.

Find a Therapist for Codependency: Search TherapyTribe for a licensed therapist near you who specializes in codependency.

This article is for information only and is not a substitute for professional diagnosis or treatment. If you have concerns about your mental health, talk with a licensed mental health professional.

References

Bacon, I., McKay, E., & Reynolds, F. (2020). The lived experience of codependency: An interpretative phenomenological analysis. International Journal of Mental Health and Addiction, 18, 754–771. https://doi.org/10.1007/s11469-018-9983-8

Bradshaw, J. (1988). Bradshaw on: The family: A revolutionary way of self-discovery. Health Communications.

Dear, G. E., Roberts, C., & Lange, L. (2004). Defining codependency: A thematic analysis of published definitions. In S. Shohov (Ed.), Advances in psychology (Vol. 34, pp. 189–205). Nova Science.

Horney, K. (1950). Neurosis and human growth: The struggle toward self-realization. W. W. Norton.

Lancer, D. (2014). Conquering shame and codependency: 8 steps to freeing the true you. Hazelden Publishing.

Lancer, D. (2012). Codependency for dummies. John Wiley & Sons.

Lancer, D. (2015). Codependency for dummies (2nd ed.). John Wiley & Sons.

Molina, E., Taiwo, A. O., & Grey, B. (2026). Co-dependency revisited: An integrative review of conceptualisations and mental health outcomes. Clinical Psychology and Psychotherapy, 33(2), e70265. https://doi.org/10.1002/cpp.70265

Wegscheider-Cruse, S., & Cruse, J. (1990). Understanding co-dependency. Health Communications.