Codependency gets criticized for one main reason: it isn’t a formal diagnosis in the DSM. And on paper, that is true. But the leap people then make,“so it isn’t real”,doesn’t hold up clinically, relationally, or practically.

The DSM, for anyone who doesn’t know it is a manual for classification. It names clusters of symptoms that reliably fit together, helps mental health professionals diagnose and communicate with patients and satisfies insurance processes. What it isn’t is a judge of lived human experience or a map of human distress. Many of the issues that arise in therapy are not neat “box type” diagnosable conditions so much as patterns, even if many clinicians who see the DSM as a bible tend to make the glove fit the hand.

These patterns that are often seen are chronic self-abandonment, relational distress and over-functioning, compulsive fixing and caretaking, difficulty tolerating discomfort without external reassurance and fear driven control mechanisms around being needed. These patterns have a name and it’s codependency.

When therapists dismiss codependency (often through lack of knowledge or adherence to the DSM), it makes little difference to the wellness of the patient and they don’t suddenly become well, they just end up with a new label. People who are hypervigilant around other’s moods might get told they have generalized anxiety. People who deal badly with shame, over-function and over-apologize might be framed as having low self-esteem due to dependent personality disorder. Others who are exhausted by over-giving and losing their identity might be labeled as having major depressive disorder. Some even are misread as having a personality disorder when the real issue is a long history of relational adaptation, pleasing to stay safe, managing others to prevent abandonment and losing themselves to keep connection. None of these labels are wrong but they miss the relational aspect driving the suffering.

Codependency is not a medical disease of a personality disorder. This is the main reason it is not included in the DSM. I personally hope it never is, opening the door to a medical model that will include the inevitable medication that will go with it. Codependency is a relational strategy built for survival in environments where love was conditional, feelings were unsafe or caretaking was rewarded. Over time, this means a child learns “If you’re ok, I’m ok” or “If I can manage you, I can be safe”. Codependency in relationships is consolidated daily in adult relationships. When one over-functions, the other under-functions, the more someone rescues, the more rescue is needed. The cycle may feel like love or loyalty or even altruism but over time, it erodes personal autonomy, intimacy and self-respect. In effect, there is nothing to cure, just new lessons to be learnt.

The fact that codependency “is not in the DSM” and so dismissed by therapists and the medical profession, often hides the truth that codependency is socially rewarded. Self-sacrifice is praised, we romanticize endurance in relationships and having no boundaries, devotion. In many couples, the codependent is the invisible mortar holding the house together, organizing, smoothing, anticipating and apologizing. This carries on until they burn out and everyone acts as if they are surprised by it all. Bringing codependency into a therapeutic discussion isn’t pathologising love, it is rescuing love from collapsing by bringing the question of autonomy into the discussion.

So, codependency is real and the defense of it is simple. Whether it is labeled in the DSM or not, it describes a coherent, treatable relationship dynamic that therapists should be more aware of. If they do, they will see that is is not a character flaw of a personality disorder, it is a learned survival tactic that can be easily unlearnt.