In favor or against the codependency concept: A narrative review of arguments in scientific literature

Background

Codependency is a controversial concept. It seeks to explain the relationship between a person who has an addiction and his family members (FM). However, criticisms about it mention the lack of an official definition, the risk of pathologizing the relationship between the FMs and their loved ones, as well as making FMs feel guilty for normal and expected behaviors. On the other side, studies mentioned that many treatments offered to FMs are linked to the reduction of codependent behaviors, which can also be called enabling behaviors. Moreover, phenomenological studies report that FMs adhere to the concept of codependency and his principles give meaning to their experience. Both supporters and opponents of the concept mention that codependency is popular in social and clinical spheres, emphasizing the importance for the public and professionals to understand the issues raised by the concept and to be well informed of the arguments in favor and against its use in assisting family members.

Methods

This research presents the results of a narrative review of the arguments in favor and against the utilization of the codependency concept in the scientific literature. Inspired by the guidelines for scoping reviews proposed by Arksey and O'Malley, Levac et al., and the PRISMA Extension for Scoping Reviews. The inclusion criteria were that the articles had to: (1) be written in English or French, (2) address the psychological concept of codependency, and (3) have been published after the year 2000. The search strategy retrieved 24 relevant studies. A descriptive quantitative analysis and a thematic qualitative analysis were used to synthesize the results.

Results

In total, ten arguments have been classified into five categories, each having both a theme in favor and against the concept of codependency: (1) lack of a clear definition vs. benefits of a broad definition, (2) limitations of hypotheses and etiological theories of codependency vs. support for etiological hypotheses and theories, (3) clinical issues vs. clinical usefulness of the concept, (4) concept taken up by popular psychology vs. popularity of the concept and (5) feminist criticism vs. evolution of the concept. The rationale and justification provided by the authors for each theme in favor and against codependency will be presented to enable the audience to better understand the concept and make informed choices about its use in a clinical or research context.

Conclusions

No studies reported that family members themselves felt pathologized or stigmatized by the concept, but stigmatizing or guilt-inducing language was found in some studies. There seems to be a consensus that codependency is a popular concept and that family members can adopt enabling behaviors. Finally, research needs more studies that focus on the experience directly reported by family members.