Codependency

Codependent family dynamics have been observed in areas of psychological difficulty other than in families with chemical dependency. For example, Scaturo and his colleagues (Scaturo and Hardoby 1988; Scaturo and Hayman 1992) have observed codependent relationships, discussed in terms of "interlocking pathology" (Ackerman 1958), in families of military veterans suffering from Posttraumatic Stress Disorder (PTSD) following traumatic combat experiences in war. PTSD is a psychiatric disorder in which someone who has been exposed to a psychologically traumatic experience, such as combat, experiences an array of disabling symptoms, including intrusive distressing recollections of the experience or recurrent traumatic nightmares, an avoidance of anything that might be associated with the trauma, a numbing of emotional responsiveness to significant others, and a hypervigilance or an exaggerated startle response to the over-anticipation of danger (American Psychiatric Association 1994). In marriages prior to the wartime traumatization, the spouses of combat veterans seem to experience a genuine change in the character of the person that they knew before the war, and returning to an emotionally intimate relationship required a substantial adjustment of mutual expectations. However, in relationships that began after the trauma, something much more like codependency, or interlocking pathology, becomes part of the couple's relationship. The post-traumatic disability is already a known quantity to both parties at the outset of their relationship. The "helper" and "sick" roles are already established as a part of the mutual attraction to one another, and the codependency of the "helper" is an integral part of the relationship's development. The same observation is applicable to forms of traumatic experience other than military trauma, such as the survivors of rape.

Similarly, the psychiatric maladies of panic disorder and agoraphobia are another such example of where the "helper" versus "sick" roles play a part in coping with what ultimately becomes a family problem (Scaturo 1994). Panic attacks are brief periods of intense fear without a clear precipitant (i.e., objective threat) with various psychophysiological symptoms of disabling severity, including heart palpitations, trembling, abdominal distress, and possible fears of dying (American Psychiatric Association 1994). When the fear, or anxiety, is accompanied by fear of being outside one's home, being in a crowd or public place, and such situations are avoided and travel restricted, then agoraphobia may be said to go along with the panic disorder. Again, if the syndrome of panic disorder is a known quantity at the outset of marital relationship, a codependent situation in which clearly defined "helper" and "sick" roles may be easily established. Such a codependent marital dynamic may be one of the reasons that what has been termed "spouse-assisted behavior therapy" (Scaturo 1994)—in which the spouse is included in the anxiety patient's treatment—has been demonstrated to have superior effectiveness over the use of individual behavior therapy with the patient alone (Barlow, O'Brien, and Last 1984; Cerney et al. 1987).