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I . ,u...’$l.4‘17i§f!.vvntif 4. ‘ . , n "I . u'...| .1 £155: 1.: .u u L‘ mr LIBRARIES lllllllll l u 'lm ulllllllllg 3129 This is to certify that the dissertation entitled A Comparative Study of the Aspects of Adjustment Among Adult Children of Alcoholics and Adult Children of Alcoholics and Adult Children of Nonalcoholics in the Form of Personality Char%&%e§}stics and Its Rel- ationship to the Degcrip on of Codependent ‘ Behavior ” Karen D. Biddy has been accepted towards fulfillment of the requirements for Ph.D. degreein Counseling Psychology A Major pra‘essor \~. Date acguj (a; £93 .‘\ MSU ('5 an Affirmative Action/Equal Opportunity Institution 0-12771 LIBRARY Michigan State University PLACE iN RETURN BOX to remove this checkout from your record. TO AVOID FINES return on or before date duo. DATE DUE DATE DUE DATE DUE W5. MSU Is An Affirmative Adlai/Equal Opportunity institution emails-9.1 _ _ __..—.__.... A COMPARATIVE STUDY OF THE ASPECTS OF ADJUSTMENT AMONG ADULT CHILDREN OF ALCOHOLICS AND ADULT CHILDREN OF NONALCOHOLICS IN THE FORM OF PERSONALITY CHARACTERISTICS AND ITS RELATIONSHIP TO THE DESCRIPTION OF CODEPENDENT BEHAVIOR BY KAREN BIDDY A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Counseling Psychology Program Department of Counseling,Educational Psychology, and Special Education. 1993 ABSTRACT A COMPARATIVE STUDY OF ASPECTS OF ADJUSTMENT AMONG ADULT CHILDREN OF ALCOHOLICS AND ADULT CHILDREN OF NONALCOHOLICS IN THE FORM OF PERSONALITY CHARACTERISTICS AND ITS RELATIONSHIP TO THE DESCRIPTION OF CODEPENDENT BEHAVIOR BY Karen Biddy The purpose of this study was to examine aspects of adjustment exhibited in the form of five particular personality characteristics among adult children of alcoholics (ACOA), adult children of alcoholics with alcoholism (ACOAA), and adult children of nonalcoholics (control) to determine the degree to which these three groups differ. The five personality characteristics of concern were passive aggressiveness, dependency, obsessive compulsiveness, depression, and low self-esteem. In addition, each group was analyzed to see the number of significant relationships that existed among the personality characteristics and the extent to which each group was descriptive or not descriptive of the codependent construct. The samples for this study were made up the three groups (ACOAA, ACOA, and control), each containing 30 males and 30 females (N=180). The age range was divided into two categories, 25-34 and 35-45 years old. Each group was tested with four personality inventories which measured the five personality characteristics of interest (passive aggressiveness, dependency, obsessive compulsiveness, depression, and low self-esteem). The inventories consisted of the Minnesota Multiphasic Personality Inventory, the Millon Clinical Multiaxial Inventory, the Coopersmith Self- Esteem Inventory, and the Tennessee Self-Concept Scale. The chi-square test of independence, analysis of covariance, and post hoc two-sample t-tests were used to analyze the data at a .01 alpha level. The results of this research study provide evidence that the ACOAA and the ACOA groups significantly differed from the control group with respect to exhibiting higher indications towards passive aggressiveness, dependency, obsessive compulsiveness, depression, and lower levels of self-esteem but did not significantly differ from each other to be considered separate. In addition the findings support that these five personality characteristics correlate as discriminators that can predict and explain group membership. The results support Cermak’s (1991) notion that diagnostic criteria for codependency be included in the DSM- III-R as an entity for which operational diagnostic criteria can be developed. Implications for clinical applications and further research are discussed. Karen Biddy 1993 All Rights Reserved This dissertation is dedicated to my family, friends, and clients. Their codependent behaviors both inspired this dissertation and supported its end. Their encouragement, love, help, support, and belief in me gave me the determination and stamina to endure this endeavor to its completion. And especially to the family values that were instilled in me by my parents and their culture to value education, knowledge, my freedom, and respect for myself and others. ACKNOWLEDGEMENTS The researcher would like to express gratitude for the continuing inspiration and support of her advisor, John Powell, Ph.D. His unfailing patience, suggestions, and encouragement along with his gentle and kind spirit guided me throughout the entire course of my doctoral study. Sincere appreciation is extended to Dr. Hiram Fitzgerald, Dr. Richard Johnson, and Dr. Lee June who graciously served on my dissertation committee providing support, advice, and well wishes. A special measure of gratitude to all facilities and groups that allowed me to draw my sample and especially to the Bi-County Outpatient Treatment Center. A very special measure of gratitude to Mrs. June Cline for her patience, caring, invaluable suggestions, and kind and effective teaching abilities in statistical analysis and interpretation. Also a very warm-hearted thank-you to Robert Green, Ph.D who did not know me but assisted me patiently and endlessly in analyzing my data. He gave of his time and expertise freely; an act of kindness that will never be forgotten. I offer my appreciation and gratitude to Sue-Ann Kittleson, Michael Matouk, and Melvin Cartwright for their undying help and assistance in completing this dissertation from beginning to end and especially to Sue-Ann who ventured with me at all times back and forth to MSU to meet all ii requirements and who continued to give without reservation. Also to Daria Dozier, Sue-Ann, and Rhoda Lee who stayed up nights in assisting me and to Kim for her encouraging words and Suzanne's help and assistance. A warm-hearted measure of gratitude goes out to all my special friends who were endlessly loving, supportive, and encouraging of me throughout my education. I thank them for their time, sustenance, and comic relief. They are truly special for they held on to hope for me in my darkest days and hours, while celebrating with me in moments of joy, and endlessly loved, supported, and encouraged me to success in this goal and in my future goals. Our special relationship and my gratitude will last a lifetime. And finally, a very special thank-you to my family who supported me. To my mother's nurturing and loving ways that helped to ignite my downtrotted spirits along with her way of giving as much as she can so freely, my sister and her family's support, love, and comic relief, to my Aunt Lolita Hernandez for her help and encouragement, and especially to my father's words of wisdom, value of knowledge, and offer of assistance at times of need as well as the opportunity to be born an American with all its endless opportunities. It was the steadfast belief in me that everyone has given to me that has allowed the unfolding of all my possibilities and the recognition of the gifts God has given to me. I thank God for never leaving me and for enriching my life with so much. iii TABLE OF CONTENTS Dedication . . . . . . . . . . . . . . . Acknowledgements . . . . . . . . . . . . Lists of Tables . . . . . . . . . . . . List of Appendices . . . . . . . . . . . Chapter 1 Introduction: Statement of the Problem . Significance of the Study . . . . Purpose of the Study . . . . . . . Research Questions . . . . . . . . Research Hypothesis . . . . . . . . Chapter 2: Review of the Literature . . . . . . . Historical View of Codependency Characteristics of Codependency . Competing Diagnoses . . Adult Children of Alcoholics Chapter 3: Design of the study . . . . . . . . . . The Sample . . . . . . . . . . . . Variables . . . . . . . . . . . . . Instrumentation . . . . . . . . Research Questions and Hypotheses Hypotheses . . . . . . . . . . . . . Data Collection . . . . . . . . . . Method, Procedures, and Data Analysis iv ii vi ix 12 13 14 16 16 22 35 41 58 58 60 60 67 68 69 71 Chapter 4: Results of Data Analysis . Demographic Characteristics . . . . . . . . Research Questions . . Research Research Research Research Research Research question question question question question question Summary of Results of Chapter 5: Discussion one . . . . . two . . . . . . . . three . . . four . . . . . . . five . . . . . . . . six . . . . . . . . Statistical Analysis Summary of Related Literature . . . . . . . Limitations . Summary of Research Methods . . . . . . . . Descriptive Analysis Conclusions . Recommendations for Further Research . . . . Appendices References 74 74 77 78 84 91 96 103 112 124 135 136 144 145 146 146 157 159 171 TABLE 1. 10. 11. 12. 13. 14. 15. 16. 17. LIST OF TABLES Age Range of Subjects by Group Membership . . Education of Subjects by Group Membership . . Socio-economic Status on Subjects by Group Membership . . . . . . . . . . . . . . . . . . Contingency Table: Passive Aggressive Configurations on the MMPI by Group Membership Chi-Square Contingency Table: Passive Aggressive Configurations on the MMPI by Group Membership Analysis of Covariance: Passive Aggressive Scale on the MCMI by Group Membership . . . . . . . Descriptive Statistics: Passive Aggressive Scale on the MCMI by Group Membership . . . . A Posteriori Testing: Passive Aggressive Scale on the MCMI by Group Membership . . . . Contingency Table: Dependency Configurations on the MMPI by Group Membership . . . . . . . Chi-Square Contingency Table: Dependency Scale on the MCMI by Group Membership . . . . . . . Analysis of Covariance: Dependency Scale on the MMPI by Group Membership . . . . . . . . . Descriptive Statistics: Dependency Scale on the MCMI by Group Membership . . . . . . . A Posteriori Testing: Dependency Scale on the MCMI by Group Membership . . . . . . . Contingency Table: Obsessive Compulsive Configurations on the MMPI by Group Membership Chi-Square Contingency Table: Obsessive Compulsive Configurations on the MMPI by Group Membership Analysis of Covariance: Obsessive Compulsive Scale on the MCMI by Group Membership . . . . Descriptive Statistics: Obsessive Compulsive Scale on the MCMI by Group Membership . . . . vi 75 76 77 79 8O 81 83 83 86 87 88 9O 9O 93 95 96 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. Contingency Table: Depression Configurations on the MMPI by Group Membership . . . . . . . . Chi-Square Contingency Table: Dysthymia Scale on the MCMI by Group Membership . . . . . . . . Analysis of Covariance: Depression Scale on the MMPI by Group Membership . . . . . . . . Descriptive Statistics: Dysthymia Scale on the MCMI by Group Membership . . . . . . . . A Posteriori Testing: Dysthymia Scale on the MCMI by Group Membership . . . . . . . . Analysis of Covariance: Coopersmith Self-Esteem Inventory by Group Membership . . . . . . . . . Analysis of Covariance: Total P Score on the Tennessee Self-Concept Scale by Group Membership Analysis of Covariance: SC Scale on the Tennessee Self-Concept Scale by Group Membership Descriptive Statistics: Coopersmith Self-Esteem Inventory by Group Membership . . . . . . . . . Descriptive Statistics: Total P Score for the Tennessee Self-Concept Scale by Group Membership Descriptive Statistics: SC Scale for Tennessee Self-Concept Scale on the MCMI by Group Membership . . . . . . . . . . . . . . . . A Posteriori Testing: Coopersmith Self-Esteem Inventory by Group Membership . . . . . . . . . A Posteriori Testing: SC Scale for the Tennessee Self-Concept Scale on the MCMI by Group Membership . . . . . . . . . . . . . . . . A Posteriori Testing: Total P Score for the Tennessee Self-Concept Scale by Group Membership Contingency Table: Depression Configurations on the MMPI in the ACOAA Group by Gender . . . . . Analysis of Covariance: Passive Aggressive Scale on the MCMI by Group Membership and Gender . . . Analysis of Covariance: Dependent Scale of MCMI by Group Membership and Gender . . . . . . vii 98 99 100 102 102 105 106 107 108 108 109 110 111 111 116 119 119 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. Analysis of Covariance: Obsessive Compulsive Scale for MCMI by Group Membership and Gender . Analysis of Covariance: Dysthynia Scale MCMI by Group Membership and Gender . . . . . . . . . Analysis of Covariance: Coopersmith Self-Esteem Inventory by Group Membership and Gender . . . . Analysis of Covariance: TPS Score on the Tennessee Self-Concept Scale by Group Membership and Gender 0 O O O O O O O O O 0 O O O O O O O 0 Analysis of Covariance: SC Scale on Tennessee Self-Concept by Group Membership and Gender . . Descriptive Statistics: Passive Aggressive Scale on MCMI by Group Membership and Gender . . . . . Descriptive Statistics: Dependent Scale on the MCMI by Membership and Gender . . . . . . . . . Descriptive Statistics: Obsessive Compulsive Scale on the MCMI by Group Membership and Gender Descriptive Statistics: Dysthymia Scale on the MCMI by Group Membership and Gender . . . . . . Descriptive Statistics: Coopersmith Self- Esteem Inventory Score by Group Membership and Gender . . . . . . . . . . . . . . . . . . . . . Descriptive Statistics: TPS Score of Tennessee Self-Concept Scale by Group Membership and Gender 0 O O O O O O O I O O O O O O O O O O O 0 Descriptive Statistics: SC Scores of Tennessee Self-Concept Scale by Group Membership and Gender Results of Statistical Analysis . . . . . . . . Contingency Table: Dependency Configurations on the MMPI by Group Membership and Gender . . . . 120 120 121 121 122 122 122 123 123 123 124 124 127 167 Contingency Table: Passive Aggressive Configurations on the MMPI by Group Membership an Gender . . . 168 Contingency Table: Obsessive Compulsive Configurations on the MMPI by Group Membership and Gender . . . Contengency Table: Depression Configurations on the MMPI by Group Membership and Gender . . . . . . viii 169 170 LIST OF APPENDICES Appendices A. Human Subject Participation Information Form B. Parental Alcohol Screener . . . . . . . . . C. UCRIHS Letter . . . . . . . . . . . . . . . D. Announcement of Research Study . . . . . . . E. Informed Consent Form . . . . . . . . . . . F. Descriptive Statistics for Gender Effects . ix 159 161 163 164 166 167 CHAPTER ONE INTRODUCTION STATEMENT OF THE PROBLEM Alcoholism has existed for thousands of years, but we are now beginning to accept, assess, and treat the alcoholic (Ackerman, 1987). In 1984 a general population survey was conducted on drinking in the United States which revealed that 18% of all men and 5% of all women were frequent heavy drinkers (Hilton, 1987). It is estimated that 1 in 4 Americans are regular drinkers consuming alcohol virtually every day (Landers, 1990). Approximately 8.63 percent of the population at any given time are alcoholics or abuse alcohol (an estimated 15.3 million). For every alcoholic, it is estimated that, on the average, 2.2 family members (an estimated 28 million who sought help), friends, work associates, or some 20 to 36 million people are affected by the disease (Lender and Martin, 1982; West, 1984). Vaillant and Milofsky (1982) report that one of the strongest predictors for alcoholism developing later in life is an alcoholic relative. Further national studies on parental alcoholism approximately 14% of the adult population (Russell, Henderson, and Blume, 1984) to be alcoholic parents, leaving approximately 22 million adult children of alcoholics (approximately one out of every ten adults) to cope in today’s society (Haack,1990; NIAAA, 1991). Currently we have begun to seriously research this disorder 2 and the magnitude of problems it manifests, not only for the alcoholic but for others closely related to the alcoholic. Many investigators are recognizing that the family plays an essential role in the initiation, maintenance, cessation, and prevention of alcohol and drug use by one or more of its members (Ben-Yehuda and Schindell, 1981; Pardeck et al. 1991; Stanton, 1978; Wilson and Oxford, 1978). In many respects there is a tendency for clinicians and researchers to focus on the problem of the alcoholic and pay too little attention to the impact of alcoholism on the spouse, the children, and adult children of alcoholics (ACOA). Literature concerning the effects of the alcoholic parent on his or her child has concluded that certain risks and problems arise based solely on the fact that one of the child’s parents is an alcoholic (Earl el al., 1988; Knop et al., 1985; Woititz, 1984). Compared to other groups, children of alcoholics have been found to have higher rates of behavioral and emotional problems as well as an increased risk for developing alcoholism (Adler and Raphael, 1983; Black, 1981; El-Guebaly and Offord, 1977; Rubio-Stipec et al., 1991; Scavnicky-Mylant, 1984; Goodwin, 1979). From a family perspective, the critical issue may be the structural and behavioral dimensions that determine both the ACOA’s and the family's coping style along with the prediction of whether family members will be protected from or succumb to the stress of long-term alcoholism. 3 Miller and Tuchfeld (1986) describe the alcoholic home environment as a primary contributor to the problems now seen in adult children of alcoholics. They state that the children of alcoholics (COA) are often raised in homes that lack a consistent role model of adulthood or of healthy relationships which often results in significant problems in developing healthy relationships in the future. Often the environment may be so dysfunctional that it is difficult for the child to distinguish normal from abnormal behaviors. Children or their parents may have difficulty processing and evaluating their experiences or may unintentionally distort reality in order to better cope with their environment. This is best seen in one’s tendency to learn early to distance oneself from the anxiety and pain, as well as from the alcoholic parent, and in so doing learn to deny feelings. In fact, what may appear to be denial of emotions could be an absence of feeling. Such emotional deficits could be misinterpreted as symptomatic of a borderline personality. Henderson and Blume (1988) state that these children and adult children of alcoholics are at high risk for alcoholism and other emotional and behavioral problems, including difficulties with social adjustment, substance abuse, low self-esteem, and greater external locus of control. Further, these children have been found to be at increased risk for externalizing behaviors such as conduct disorder, antisocial behavior, and aggressive behavior, 4 along with the tendency to internalize symptoms by somatic and medical problems (Earls et al., 1988; Guze et al., 1968; Robins, 1966; Rubio-Stipec el al., 1991; Rydelius, 1981). These children have also been found to have an increase for neurological deficits related to perceptual-motor ability, memory language processing, reading comprehension, and hyperactivity, (Cantwell, 1972; Knop et al., 1985; Morrison and Stewart, 1971; Tarter et al., 1985). The lives of children of alcoholics often are filled with unpredictable chaos because they do not know what to expect when they come home. He/She may be confronted with a sober parent or one who is a drunk and out of control. This inconsistency and lack of predictability in the situation may lead to the development of passive aggressive, obsessive compulsive or pleasing-dependent type behaviors. In addition, problems with low self-esteem often arise due to experiencing a lack of attention or neglect from the home (Wegscheider-Cruse, 1985; O’Brien, Woody and McLellan, 1983). It appears that one concept that seems to describe a similar cluster of personality characteristics as adult children of alcoholics is codependent behavior. Clinically many codependents exhibit behaviors from all of these various disorders. It is this researcher’s belief that codependent people tend to exhibit passive aggressive, dependent, depressed, low self-esteem, and obsessive compulsive behaviors. These problems are 5 emotional, developmental, physiological, and social (Weiner,1986). In addition, adult children of alcoholics are currently recognized as a relevant clinical population which manifests symptoms that are often misdiagnosed (Miller and Tuchfeld, 1986). This misdiagnosis often lends itself to inadequate and inefficient treatment plans which can result in increased rates of recidivism and persistence of dysfunctional coping patterns. These problems or so called dysfunctional characteristics that may arise in adult children of alcoholics must first be identified and understood. It appears that one concept that seems to capture these personality problems and dynamics of the alcoholic is referred to as codependent behavior. It has been inferred that the adult children of alcoholics (ACOA) are probably codependent (Beattie, 1987; O'Brien and Gaborit, 1992; Lyon and Greenberg, 1991)). An estimated 80 million people are chemically dependent or in a relationship with someone who is and many of these people are adult children of alcoholics (ACOA) (Beattie 1987). Many definitions of codependence exist; yet the concept and definition are not clear. The concept of codependence is so new that it still suffers from having no set definition. Timmen L. Cermak defines dependence as "being influenced or controlled by something else," and the prefix co- means "mutually." When the two words are combined codependency suggest a person who is dependent on and controlled by 6 others who are themselves dependent on or controlled by forces such as alcoholism, compulsive behavior, or chronic illness. The prototypical example would be someone who sacrifices his or her own needs to accommodate an alcoholic loved one whose life is out of control (Cermak, 1988, p. 111). A.W. Schaef (1986, p.15), who combined Sondra Smalley and Robert Subby's definitions, best conceptualizes codependency as an emotional, psychological, and behavioral condition that is characterized by an exaggerated dependent pattern of learned behavior, beliefs, and feelings within the individual where all focus of their life is on another individual (usually a problemed individual) or addictive agent and in so doing they become consumed so as to lose all sense of self-identity, worth, and feelings. Further, it is a pattern of coping that is born of the dynamics and oppressive rules of a family which prevents the open expression and direct discussion of feelings, needs, and personal as well as interpersonal problems. Thus, codependence is a dependence on people and things outside of the self, along with neglect of the self to the point of having little self-identity. Further, the codependent person (many of whom are ACOAs) may think that others depend on them, yet they are themselves dependent. They may appear strong but deep down feel helpless and powerless. They seem very controlling but in essence are really controlled themselves (Beattie, 1987, p. 28). Whitfield (1989) simply 7 defines codependency as any suffering and/or dysfunction that is associated with or results from focusing on the needs and behaviors of others. It is also an addiction of its own that arises from an individual's focusing so much upon the external environment that internal processes (e.g., emotions, desires) are forgotten or lost. Whitfield’s definition no longer restricts codependency to only the association with an alcoholic. Whitfield’s definition and Cermak's definition combined appear to offer the most parsimonious definition of codependency found in the literature. Schaef’s definition appears to be the best conceptualization. For the purpose of this study, codependency will be defined as an addictive and dysfunctional pattern of coping where a substantial focus of a person's life is on the needs and behaviors of others (or addictive agent) to the extent that ones own internal processes (e.g., emotions and desires) are forgotten or lost. Further, a codependent person is one who fears abandonment by others and is dependent on and controlled by others who are themselves dependent on or controlled by forces such as alcoholism, compulsive behavior, mental illness, abuse, or chronic illness. This fear is so encompassing that it interferes with a person’s every day functioning by making them worry about pleasing others and second guessing others so as to avoid conflict. This results in the person not being genuine and truthful to 8 themselves and others while opening themselves up to being taken advantage of and overextended. Codependence is not particular to a specific age group, type of relationship, or gender. As professionals began to understand codependency better, more groups other than adult children of alcoholics appeared to possess codependent characteristics. Co-dependent characteristics were observed in people who were in relationships with or who had parents who were emotionally or mentally disturbed, parents of children with behavior problems, people in relationships with irresponsible people, professionals (i.e. nurses, social workers), and others in "helping" occupations. Even recovering alcoholics and addicts noticed that they were codependent and perhaps had been long before becoming chemically dependent. Codependents seemed to be everywhere (Beattie, 1987)! In addition, codependents seemed to manifest certain personality characteristics that interfered with functioning effectively in life and that also made life painful. The most cardinal features of codependent behaviors are caretaking, rescuing, dependency, depression, passive aggressiveness, obsessive compulsiveness, low self-esteem, cognitive inflexibility, and issues of control (Beattie, 1987). For the focus of this study, passive aggressiveness, dependency, obsessive compulsiveness, depression, and self-esteem are the features of interest. 9 SIGNIFICANCE OF THE STUDY The concerns about the effects of an alcoholic parent on children as they become adults have provided theories and research about personality characteristics that develop as a result of trying to cope in an alcoholic home. As mentioned, these characteristics have paralleled the description of codependent behavior. Codependence is considered a part of treatment center jargon and related to ”pop psychology" and is not yet recognized as a clinically legitimate construct within the mental health field. It has received little scrutiny from clinicians and researchers perhaps due to the lack of an operational definition. An overabundance of varying definitions makes the construct validity of the term suspect (O’Brien and Gaborot, 1992; Cermak, 1986; Gierymski and Williams, 1986; Gomberg, 1989). For the most part mental health professionals do not get in-depth exposure about addictions not to mention the construct of co-dependency in their graduate training. Charles Whitfield (1984), a clinician and writer in the fields of chemical dependency and the family, states, "I estimate that today, conservatively, 89 percent of all helping professionals remain untrained in this crucial area. ...As a result of this lack of knowledge we find many individuals coming back into treatment or leaving treatment still in pain" (p. 7). However, as discussed earlier, the concept of 10 codependency is new and still suffers from having no precise definition. The research about adult children of alcoholics and codependency is scant, and there exist no formal diagnostic grouping for affected people nor any movement toward creating more precision in defining and treating codependents as a legitimate problem and disorder. Therefore, the most that we can do is to communicate to clinicians typical problems and personality characteristics that cluster together to form evidence of co-dependent behavior. Then we can try to identify, address, and effectively treat someone with a history that reveals the existence of alcoholism during childhood or adolescence. This is an essential point in that many times these people come in for help and are labelled using diagnostic groups from the DSM III-R or ICD-9 which do not adequately address all areas of dysfunction that adult children of alcoholics experience. Therefore, in recognizing that alcoholism can have an effect on adult children of alcoholics, it has been the hope of this researcher to investigate if particular personality characteristics in adult children of alcoholics which might differentiate them from adult children of nonalcoholics. Thereby, a more precise definition of codependency may be created. In addition, it is hoped that results from this study may be useful in the creation of a recognized and clinical diagnostic category under the name 11 of Codependent Personality Disorder which can lead to more effective treatment planning. 12 PURPOSE OF THE STUDY The central aim of this study was to examine certain aspects of adjustment exhibited in the form of personality characteristics among adult children of alcoholics (ACOA) and adult children of alcoholics with an alcoholic diagnosis (ACOAA) to determine the degree to which particular personality characteristics in each group differ from one another and from a peer group of adult children of nonalcoholics (control). In addition, the study examined these characteristics to see if there existed a pattern within the groups that would be descriptive of a codependent construct. The study compared five personality characteristics identified as codependent (e.g. dependency, depression, passive aggressiveness, obsessive compulsiveness, and low self-esteem) among adult children of alcoholics (ACOA) and adult children of alcoholics with a clinical diagnosis of alcoholism (ACOAA) with a control group of peers who were adult children of nonalcoholics. The subjects from all three groups had no parental or family history of substance abuse (excluding alcoholism), mental illness, physical handicaps, or chronic illness in their medical history. The study attempted to answer two important research questions with six specific questions explored and eleven hypotheses tested. 13 Research Questions: I. II. Among the personality characteristics measured how do adult children of alcoholics with alcoholism (ACOAA) and adult children of alcoholics (ACOA) compare to a peer group of adult children of nonalcoholics (control)? To what extent do these personality characteristics exhibit significant correlations within each group (ACOAA, ACOA, control), and to what extent in each group are these descriptive of the codependent construct? Specific questions to be explored in terms of identifying the personality characteristics of interest were as follows: 1. Are there differences among the ACOAA, ACOA, and control groups in terms of Passive Aggressiveness? 2. Are there differences among the ACOAA, ACOA, and control groups in terms of Dependency? 3. Are there differences among the ACOAA, ACOA, and control groups in terms of Obsessive Compulsiveness? 14 4. Are there differences among the ACOAA, ACOA, and control groups in terms of Depression? 5. Are there differences among the ACOAA, ACOA, and control groups in terms of Self-Esteem? 6. Do these personality characteristics correlate within each group to suggest a particular pattern that may be descriptive of a codependency construct? The following are hypotheses tested in the study. EXEQEEE§1§_1 The ACOAA and ACOA groups will demonstrate a level of passive aggressiveness that is greater than that of the control group. HYPOTHESIS 2 The ACOAA and ACOA groups will demonstrate a level of dependency that is greater than that of the control group. 15 fiYPOTHESIS 3 The ACOAA and ACOA groups will demonstrate a level of obsessive compulsiveness that is greater than that of the control group. EYPOTHESIS 1 The ACOAA and ACOA groups will demonstrate a level of depression that is greater than that of the control group. HYPOTHESIS 5 The ACOAA and ACOA groups will demonstrate a level of self-esteem that is lower than that of the control group. HYPOTHESIS 6 There will exist significant correlationships within the ACOAA and ACOA groups that will predict and explain group membership and be descriptive of the codependent concept. CHAPTER TWO REVIEW OF THE LITERATURE HISTORICAL VIEW OF CODEPENDENCY The term "codependent behavior" emerged simultaneously in several Minnesota treatment centers in the late seventies and was labeled by 1979 (Beattie, 1987). Exactly how or who coined the name is a mystery. Robert Subby and John Friel wrote, "originally it was used to describe the person or persons whose lives were affected as a result of their being involved with someone who was chemically dependent. The codependent spouse or child or lover of someone who was chemically dependent was seen as having developed a pattern of coping with life that was not healthy, as a reaction to someone else’s drug or alcohol abuse" (Beattie,1987, p. 28). Since then other definitions have emerged defining codependency in various ways. The following are a few of these definitions found in the literature. Earnie Larsen defines codependency as those self-defeating, learned behaviors or character defects that result in a diminished capacity to initiate or to participate in loving relationships (Beattie, 1987, p. 28). Sondra Smalley refers to co-dependency as a pattern of learned behavior, feelings, and beliefs that make life painful; it is human- relationship-dependent on and focuses their lives around an addictive agent (Schaef,1986, p. 14). She rejects a disease model of codependency, thus viewing it as a personality 16 17 disorder that still allows a person to be functional within society like most neurotics. Later, Robert Subby revised his definition to say that, codependency is an emotional, psychological, and behavioral condition that develops as a result of an individual’s prolonged exposure to, and practice of, a set of oppressive rules- rules which prevent the open expression of feelings as well as the direct discussion of personal and interpersonal problems...it is a pattern of coping that is born of the rules of a family and not as a result of alcoholism (Schaef,1986, p. 15). For the purpose of this study codependency will be defined as an addictive and dysfunctional pattern of coping where all focus of a person’s life is on the needs and behaviors of others (or addictive agent) to the extent that one's own internal processes (e.g., emotions and desires) are forgotten or lost. Further, one who is codependent is a person who fears abandonment and is dependent on and controlled by others who are themselves dependent on or controlled by forces such as alcoholism, compulsive behavior, mental illness, abuse, or chronic illness. This fear is so encompassing that it interferes with a person's every day functioning by making him/her worry about pleasing others and second guessing others so as to avoid conflict. This results in the person not being genuine and truthful to himself/herself and others while opening oneself to being taken advantage of and overextended. 18 In order to better understand codependency we must first briefly describe its history. After the creation of Alcoholics Anonymous in the 1940’s, a group comprised primarily of wives of alcoholics came together to form their own self-help group to deal with ways their spouses' alcoholism affected them. They created their own twelve- step program and formed what is known today as Al-Anon. Many have benefitted from this program. The basic thought in 1979 was that codependents were people whose lives seemed unmanageable due to living with an alcoholic. Gierymski and Williams (1986) state that the codependent term originally designated the spouse of the alcoholic but is now generalized to all family members and their close social network. Professionals and researchers have long surmised that something significantly different was happening to the people who lived with an alcoholic. Something that seemed to be physical, mental, emotional, and spiritual. Words such as co-alcoholic, non-alcoholic, and para-alcoholic began to surface. However, the definition later expanded to include other compulsive disorders such as overeating, undereating, gambling, and certain sexual disorders. These compulsive and addictive disorders paralleled the addictive and compulsive disorder of alcoholism. Professionals began to notice many people in close relationships with these compulsive and addicted people who had also developed patterns of reacting and coping that resembled the coping 19 patterns of people in relationships with alcoholics. Something peculiar had happened to these families; and they too had felt the effects of codependency long before it was given a label (Beattie,1987). Though apparently no empirical data exist to define codependency, it seems from much of the clinical literature and the above history that Smalley and Subby best conceptualize this construct. Codependency can best be viewed according to Schaef (1986, p. 22) as being an emotional, psychological, and behavioral condition that is characterized by an exaggerated dependent pattern of behaviors, beliefs, and feelings within the individual where all focus of their life is on another individual (usually a problemed individual) or addictive agent, and in so doing they become consumed in such a way as to lose all sense of self-identity, worth, and feelings. Further, it is a pattern of coping that is born out of the dynamics and oppressive rules of a family which prevents the open expression and direct discussion of feelings, needs, and personal as well as interpersonal problems. A more parsimonious definition by Timmen L. Cermak (1988) defines a codependent person as one who is dependent on and controlled by forces such as alcoholism, compulsive behavior, or chronic illness (p. 112). Thus, as professionals began to understand codependency better more groups other than adult children of alcoholics appeared to possess codependent 20 characteristics. The fact that codependency is not restricted to alcoholism is now being documented. Co- dependent characteristics were observed in people who were in relationships with or who had parents while growing up with emotionally or mentally disturbed illnesses, handicapped and chronic illness, parents of children with behavior problems, people in relationships with irresponsible people, professionals (i.e. nurses, social workers), and others in "helping" occupations (Fausel,1988; O'Brien and Gaborit, 1992; Schaef, 1986; Whitfield, 1983). Pest and Storm (1988) researched the relationship of compulsive eaters and drinkers and found no significant difference between married couples in which one spouse was married to a compulsive eater or drinker. They found that all couples, whether married to compulsive eaters or to alcoholics, resembled each other and demonstrated the same codependent effects. Even recovering alcoholics and addicts noticed that they were co-dependent and perhaps had been long before becoming chemically dependent. Codependents started cropping up everywhere (Beattie,1987, p. 30). It appears that these codependent behaviors, or coping mechanisms, seemed to prevail or cycle throughout the co- dependent's life if that person doesn't change or seek help. Characteristically, as a codependent discontinued a relationship with a troubled person, the codependent frequently sought another troubled person to repeat the 21 codependent relationship. Codependent people derive their sense of wholeness by receiving liking and approval from others and by solving the problems of, relieving the pain of, and protecting others. Because the codependents pay more attention to the feelings and desires of other people than to their own... they then sacrifice their own values, feelings, and desires to be close to others. They trust the opinions of others more that their own, and they believe that the quality of their lives depends upon the lives of other people (Whitfield, 1989). Further, the rules or learned coping mechanisms of an alcoholic family prohibit discussion about problems, open expression of feelings, direct, honest communication, realistic expectations (such as being human, vulnerable, or imperfect), selfishness, trust in other people and one's self, playing and having fun, and rocking the delicately balanced family canoe through growth or change- however healthy and beneficial that movement might be. As mentioned earlier though these rules are common to alcoholic family systems, they can emerge in other families, too (Schaef,1986). 22 CHARACTERISTICS OF CODEPENDENCE Codependency throughout the literature exhibits itself in various personality characteristics; namely low self- esteem, caretaking, dependency, a need for control, denial, depression, worrying, anxiety, non-assertiveness, weak boundaries, powerlessness, repressed hostility, and cognitive inflexibility. It is often diagnosed as dependent personality disorder, passive aggressive personality disorder, or obsessive compulsive personality disorder. The following description of characteristics of co— dependency are adapted from Beattie’s book, Codependent Hg More, (1987) and Schaef’s book, Codependence Misunderstood- nistreated, (1986). W SEL -ESTEEM Coopersmith (1987), defines self-esteem as "judgement of worthiness that is expressed by the attitudes one holds towards the self" (p. 5). It is a confidence and satisfaction in oneself along with having respect and value for oneself. It is to have dignity and knowledge of one's own feelings, beliefs, behaviors, and attitudes, and respecting them. To have self-esteem is to have enough confidence in who you are and what you feel to value and stand up for yourself. However, codependents have low self- esteem and low self-worth. Rosenberg (1965) defines low self-esteem as a sense of self-dissatisfaction and rejection 23 while high self-esteem is defined as a sense of self-respect and worthiness. Persons with low self-esteem tend to not like, respect, or value themselves by feeling ashamed, embarrassed, and critical of themselves. They often feel that they are not good enough, yet have difficulty accepting criticism and compliments. Codependents have difficulty in decision-making because they are unsure of what they want along with their need to please and be liked by everyone. This pleasing behavior serves to give an artificial sense of self-worth because they do not believe that others can genuinely love or like them for themselves and therefore settle for just being needed. QABEIAKIHQ Caretaking and rescuing are synonymous and closely related to enabling. They are destructive forms of helping. It is any help to the alcoholic that prevents him/her from suffering the consequences of his/her drinking or contributes to making it easier to continue drinking. Caretakers rescue the alcoholic from the consequences of his/her actions by taking care of responsibilities or mistakes even without being asked. As mentioned earlier, codependents suffer from feelings of low self-esteem and worth, and rescuing or caretaking gives an artificial sense of worth. It provides a temporary feeling of elation, self- 24 worth, and power to someone who doesn’t feel good about him/herself. "Just as a drink helps an alcoholic momentarily feel better, a rescue move momentarily distracts us from the pain of being who we are. We don't feel loveable, so we settle for being needed. We don’t feel good about ourselves, so we feel compelled to do a particular 4 thing to prove how good we are (Beattie, 1987, p. 84)". Codependents doubt that someone could accept, love, or want them around for their own intrinsic worth, so they have to make themselves indispensable even to the point of inconveniencing themselves or giving up their own desires. Codependents accomplish this by doing for others or by taking care of everything that others may need to do for themselves. In this way they facilitate dependence and can forestall their own sense of abandonment. There is no one more indispensable in an alcoholic family than the codependent spouse. In addition, the co-dependent person thinks that the person they are taking care of is helpless and unable to do for themselves and as a result cannot be held responsible for themselves. They will think, speak, and problem-solve for the other person. Although this helplessness on the part of the alcoholic may appear true, it is not a fact. "Unless a person has brain damage, a serious physical impairment, or is an infant, that person can be responsible for him or herself (Beattie, 1987, p. 84)". Scott Egleston states that,"we rescue any time we 25 take responsibility for another human being— for that person's thoughts, feelings, decisions, behaviors, growth, well-being, problems, or destiny (Beattie,1987, p. 78). The codependent finds safety and self-esteem in giving and rescuing others and will stand up and assert for the rights and injustices done to others but not for themselves. This giving and rescuing is so addictive that they appear controlling and smothering and are enmeshed into others lives and neglect their own individuality, thus allowing others to hurt and take advantage of them. They often find themselves attracted to needy people and the cycle is continued. QEEENDENCY Codependents not only create a dependency in others for their help but are in their own way dependent on others to give their lives meaning and worth. Dependence, according to Cermak (1988), is defined as "being influenced or controlled by something else" (p. 111). Many codependents tend to lack happiness by being alone and within themselves, thus centering their lives around outside things and people. They feel threatened and desperate with loss and feel anguish when they are not liked or accepted. As a result they desperately seek the love and approval from others because they fear they can not function nor be happy alone. 26 Unfortunately they tend to seek love from those who are emotionally inaccessible. QQEIBQLLIEQ Kalat (1990) describes control as that which has influence, power or rule over one's actions or life. Codependents are excellent controllers and manipulators. They believe they can control others’ perceptions, feelings, behaviors, and thoughts. They feel they should control everything in hopes of making everything turn out right. They believe they know what's best, how things should be and how others should behave and act to the point of trying to control others by manipulation, guilt, helplessness, threats, coercion, advice giving, or domination. They also believe with just a little bit more effort they can change and fix everything. As things become increasingly more intense and chaotic the codependent exerts more and more control. There isn't really anything they wouldn't do to not try to control. As a result they are fearful to let events unfold naturally or let others take control or be who they are. Thus the codependent does not deal with nor recognize loss of control or helplessness. Ironically they tend to feel controlled by others and by events. 27 DEEBB§§IQE Depression is a condition in which the person experiences overwhelming sadness while taking little pleasure in life and experiences feelings of worthlessness, powerlessness, and guilt (Kalat, 1990). All these attempts to control everything and everyone lead to tremendous disappointment and eventually to depression often related to the codependent’s feelings of failure. Repeated experience with these failures results in greater depression and pessimism. DEHIAL Denial is the refusal to acknowledge, admit to or believe information that provokes anxiety (Kalat, 1990). Codependents live painful and fearful lives and rely on denial and repression to defend against the impending threat on their egos. Codependents often push their feelings, wants, desires, and thoughts out of awareness because of fear and guilt resulting in believing and telling themselves lies. They try not to acknowledge problems or their severity, often telling themselves things will be better tomorrow. They often try to stay busy to avoid problems or pain. They are afraid to be who they are while appearing to be in control and unbending. 28 SS N The DSM III-R defines obsessions as recurrent, persistent ideas, thoughts, images, or impulses that are not experienced voluntarily but rather are thoughts that invade consciousness. Many codependents tend to obsess, worry, and ruminate over loved one’s problems, and experience the need to be in control and perfect. These feelings are so intense that many times they are the cause of great stress, anxiety, and guilt. This hampers the individual’s way of coping effectively. They will feel anxious and uneasy, often losing sleep over other’s and problems even if concerns do not involve them. They continually ruminate about people and constantly talk about concerns and worries. Codependents will focus all their energies into concerns while complaining that they can't take the time out to do anything for themselves nor have they any energy left. IBQEI Trust is defined as having assured reliance on or faith in the character, ability, or truth of someone or something (Webster,1988). Codependents frequently don't know who or when to trust. Many times they are unable to explain how to develop and maintain trust because of never properly developing trust when growing up. What they have learned is that others can not be relied upon to be truthful or consistent. In addition to their lack of faith in others, 29 they have learned not to trust their own feelings, thoughts, or perceptions. "Codependents tend to dismiss their own perceptions of situations unless and until they are verified externally by others. Even though they might have a very clear intuitive impression of a person or a situation, they will often dismiss it as crazy or off the wall" (Schaef,1986, p. 51). Codependents often don’t believe others will remain loyal and continue to like them in spite of either temporary disagreements or not needing them for specific reasons. They don’t believe that others will not abandon or like them if they don't please. They tend to trust untrustworthy people and lose faith and trust in God if they believe and feel He has abandoned them. BOUNDARIES Boundaries are certain limits and expectations we have about what we would or wouldn’t tolerate from others (Beattie,1987). Co-dependents often do not know where they end as individuals and where others begin. They will tend to take on emotions such as anger, depression, and confusion without knowing if they are their own or others. Whatever others think, feel, or do the codependent will also think, feel, or do. They tend to live in a society (i.e. family, school, and church) that conditions them to think, feel, or know what is taught to them. Ironically, notes Beattie (1987), they learn at a time that their referent point to 30 all that they think, feel, behave, and know is external to themselves thus not producing proper boundaries. In order to have and experience boundary-making they need to know how they think and feel inside (tapping into an internal referent) and then relate it to the outside world from that perspective. Not knowing boundaries from others and themselves does not allow them to develop healthy intimate relationships. This deficit of boundaries lead to symbiotic, dependent relationships that destroy their sense of self, esteem, and others sense of self, esteem, and independence. It allows others to take advantage of and hurt them by tolerating most everything, including violation of their own basic rights. In the alcoholic family nearly everyone focuses on and takes on the alcoholic's problem. The entire household often revolves around and defines itself with reference to the alcoholic. The family learns to take on the general mood, feelings, and attitudes of the one who drinks. As the codependent relationship intensifies, the boundaries become more and more blurred. Thus, letting go, allowing others to separate, and to be independent and different is made difficult. A§SEBTIV§NES§ Assertiveness is the ability to express feelings in a direct and honest way that neither humiliates nor degrades other people (Crider, Goethals, Kavanaugh, and Soloman, 31 1989). Codependents often exhibit poor communication skills. They tend to be indirect or unassertive for fear of displeasing others and causing conflict or rejection. They carefully choose words to please, manipulate, control, conceal, or even to avoid guilt and pain. The codependent is often filled with hurt, pain, worry, repressed hostility, ulterior motives, low self-esteem, and shame. They laugh when they want to cry; cry when they are angry, and say they're fine when they are not. They allow themselves to be bullied, ruled, and dominated by others. Often they get overwhelmed and burdened with responsibilities and worries. They sometimes react inappropriately due to these feelings but later learn to justify, rationalize, deny, or over- compensate for them. They may nag or threaten only to back down or lie later. Codependents will apologize for everything, take responsibility for everything, and hint around at what they need or want. They tend to be indirect in voicing their needs and feelings. They hardly ever use the word "NO" in their vocabulary. Often they avoid decision-making where others may want them to decide for both parties. They do this because in childhood it was wrong to talk or express feelings, desires, and attitudes. They had to please to keep peace and not stand up for themselves so as to survive. Thus they learn not to be sure of what they think, feel, want, or believe. They are inhibited and controlled though they appear to be in 32 control. They tend to be afraid to let others know and see who they really are for fear of not being seen as okay or accepted by others. Codependents tend to repress and deny their anger and hurt, often possessing passive aggressive behaviors. They fear their own anger and feel shame and guilt when angry or hurt while on the other hand may feel controlled by others’ anger and hurt. EQWEBLESSNESS Codependents are likely to feel a strong sense of powerlessness. Powerlessness is to feel devoid of resources to alleviate one's pain and the alcoholic's drinking. There is an encompassing sense and fear of loss of control. There exists, a "there is nothing I can do" attitude because of a lack of an identity that they can value. Often there is a failure to see that their achievements can be separate from those of the alcoholic, because of the belief that since they cannot stop the alcoholic from drinking, they cannot help themselves. Codependents need to establish a valued identity and sense of achievement independent of their identities as children of alcoholics (Ackerman, 1983). QQQHIIIZE IHELEXIBILIT! Codependents tend to possess cognitive inflexibility which is an inability to generate different ways of perceiving. They tend to see the world and think 33 dichotomously. Dichotomous thought is a rigid, either/or; black or white perception. Codependents tend to judge things from either poles; either it is right or wrong, black or white. They usually allow themselves two options which results in an avoidance/avoidance or approach/approach conflict. Often compromise or having many alternatives is not an option for them. This way of thinking can greatly affect the codependent's decision-making abilities, opportunities, and sense of freedom. Codependency exhibits itself in a variation of the above indicators. O’Brien and Gaborit (1992) sum up codependency in five major characteristics based on the work of Cermak and others. First, the codependent displays a continual investment of self-esteem in the ability to influence or control feelings and behavior in the self and in others despite painful consequences. Second, the codependent assumes responsibility for meeting the needs of others to the exclusion of his or her own needs. next, the codependent suffers anxiety in periods of intimacy or separation because of poor personal boundaries. Eourth, the codependent enters into emotionally enmeshed relationships with personality disordered, drug dependent, and/or compulsive people. Finally, the codependent can exhibit {constriction of emotions, depression, hyper-vigilance, (nampulsive, anxiety, excessive reliance on denial, substance labuse, stress-related medical illness, and/or a primary 34 relationship with an active substance abuser. Some professionals say it is not an illness but a normal reaction to abnormal behavior. However, the result often is dysfunctional. Others view it as a disease that is progressive and chronic. It tends, according to Schaef (1986), to fit the disease concept in that it has an onset (a point at which the person's life is just not working, usually as a result of an addiction), a definable course (the person continues to deteriorate mentally, physically, psychologically, and spiritually), and, untreated, has a predictable outcome (death, physical illness, or depression). Perhaps the reason why many professionals call codependency a disease is because it is progressive and habitual like many other self-destructive behaviors that repeat habits without thinking. It is also a reactionary process; one of overreacting or underreacting, but seldom do they act on the basis of their own responsiveness. However, they react to an illness such as alcoholism. Codependent behaviors are self-destructive (Schaef, 1986, p. 26). Codependence can lead to such physical complications as gastrointestinal problems, ulcers, high blood pressure, and even cancer. The codependent will often die sooner than the chemically dependent person (Subby and Friel, 1984 and Whitfield, 1984). It is for these reasons that Cermak (1988) writes that careful and accurate identification, diagnosis, and treatment be given to these individuals. 35 QQEEEELEQ DIAQBOSEQ Many professionals argue that codependence should not exist as a diagnostic category in and of itself because of other diagnostic categories from the DSM III-R, or the ICD-9 such as Dependent Personality Disorder, Passive Aggressive Personality Disorder, and Compulsive Personality Disorder. However, when one compares the characteristics of each of these disorders to the characteristics of codependent behavior, it can seen that the above mentioned disorders do not exclusively encompass or accurately addresses the clusters of personality characteristics referred to as codependency. Cermak (1986) agreed that codependency most resembles the Dependent Personality Disorder, but rejected that diagnostic framework on the basis that it oversimplifies the disorder. Codependency is so conceptually complex that it requires characteristics from at least four separate DSM categories: Alcoholism, Dependent, Borderline, and Histrionic Personality Disorders, as well as an additional category made up of associated features (Cermak, 1986). Following are DSM-III-R descriptions that this researcher believes apply to but do not completely describe codependency. 36 232232331 PERSONALITY DISORDER * Dependent Personality Disorder is described by the DSM-III-R (1987) as a pervasive pattern of dependent and submissive behavior, beginning early in adulthood and is present in a variety of contexts, as indicated by at least five of the following: 1) 2) 3) 4) 5) 6) 7) 8) 9) is unable to make everyday decisions without an excessive amount of advice or reassurance from others allows others to make the most of his or her important decisions, e.g., where to live, what job to take agrees with people even when he or she believes they are wrong, because of fear of being rejected has difficulty initiating projects or doing things on his or her own volunteers to do things that are unpleasant or demeaning in order to get other people to like him or her feels uncomfortable or helpless when alone, or goes to great lengths to avoid being alone feels devastated or helpless when close relationships end is frequently preoccupied with fears of being abandoned is easily hurt by criticism or disapproval. 37 GGRESS ERSONALIT DISORDER * Passive Aggressive Personality Disorder is described by the DSM III-R (1987) as a pervasive pattern of passive resistance to demands for adequate social and occupational performance, beginning by early adulthood and present in a variety of contexts, as indicated by at least five of the following: 1) 2) 3) 4) 5) 5) 7) 8) 9) procrastinates, i.e., puts off things that need to be done so that deadlines are not met becomes sulky, irritable, or argumentative when asked to do something he or she does not want to do seems to work deliberately slow or does a bad job on tasks that he or she really does not want to do protests, without justification, that others make unreasonable demands on him or her avoids obligations by claiming to have "forgotten" believes that he or she is doing a much better job than others think he or she is doing resents useful suggestions from others concerning how he or she could be more productive obstructs the efforts of others by failing to do his or her share of the work unreasonably criticizes or scorns people in positions of authority. 38 QBSESSIVE COMPULSIVE PERSONALITY DISORDER Compulsive Personality Disorder as described by the DSM-III-R (1987) is a pervasive pattern of perfectionism and inflexibility, beginning by early adulthood and present in a variety of contexts, as indicated by at least five of the following: 1) perfectionism that interferes with task completion, e.g., inability to complete a project because overly strict standards are not met 2) preoccupation with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost 3) unreasonable insistence that others submit to exactly his or her way of doing things, or unreasonable reluctance to allow others to do things because of conviction that they will not do them correctly 4) excessive devotion to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessitary) 5) indecisiveness: decision-making is either avoided postponed, or protracted, e.g., the person cannot get assignments done on time because of ruminating about priorities (do not include if indecision is due to excessive need for advice or reassurance from others) 6) over conscientiousness, scrupulousness, and inflexibility about matters of morality, ethics, or values (not accounted for by cultural or religious identification) 7) restricted expression of affection 8) lack of generosity in giving time, money, or gifts when no personal gain is likely to result 9) inability to discard worn-out or worthless objects even when they have no sentimental value. 39 Cermak (1991) has proposed, for the clinical assessment of individual clients, that codependence be seen as a disease entity for which operational diagnostic criteria can be developed. He first presented the criteria in 1986. The following is the diagnostic criteria for codependency to be use by professionals followed by a list of symptoms commonly understood by lay men (Cermak, 1991). Diagnostic Criteria for Codependence A. Continued investment of self-esteem in the ability to influence/control feelings and behaviors, both in oneself and in others, in the face of serious adverse consequences. Assumption of responsibility for meeting other’s needs, to the exclusion of acknowledging one's own needs. Anxiety and boundary distortions around intimacy and separation. Enmeshment in relationships with personality- disordered, chemically dependent, and impulse- disordered individuals. Exhibits at least three of the following: 1. Excessive reliance on denial 2. Constriction of emotions (=/- dramatic outbursts) 3. Depression 4. Hypervigilance 5. Compulsions 6. Anxiety 7. Substance abuse 8. Recurrent victim of physical or sexual abuse 40 9. Stress-related medical illnesses 10. Has remained in a primary relationship with an active substance abuser for at least 2 years without seeking outside support LaviSvmptoms of Codependence 1. Changing who you are to please others. 2. Feeling responsible for meeting others people's needs at the expense of your own. 3. Low self-esteem. 4. Driven by compulsions. 5. Denial (Cermak, 1991, p. 270). Though each of the above personality disorders have characteristics that are shared in the description of codependent behavior neither one encompasses and adequately describes co-dependency. Therefore, it is the view of this researcher that many aspects of this behavior are overlooked and not addressed in the treatment plans. This results in inadequate and inefficient treatment as well as an increased rate of recidivism and/or personality dysfunction. Thus, an additional classification is essential if adequate, efficient, and effective diagnosis and treatment is to be accomplished. Upon examining the above descriptions of personality traits one observes a similar cluster of personality characteristics between adult children of alcoholics and codependent behavior; namely passive aggressiveness, dependency, obsessive compulsiveness, 41 depression, and low self-esteem. To further understand this similarity a discussion of adult children of alcoholics is presented. ADULT CHILDREN OF ALCOHOLICS Sharon 8. Sloboda (1974), indicates that alcoholism is undoubtedly one of the most widespread, destructive, and costly health problems facing our country; one that directly or indirectly affects the lives of millions of Americans. It is impossible, she states to estimate its cost in human suffering resulting from broken homes, deserted families, and the psychological problems commonly found in the children of alcoholics. During the last 20 years research around alcoholic- related issues has grown immensely. Research endeavors in this field have focused attention on the alcoholic, the spouse, and the effects of alcoholism on children and the family unit. Miller and Tuchfeld (1986) conclude, however, that the literature is relatively small and methodologically weak with few well-controlled studies available. Empirical research on the spouse has been done in the early 40's, 60’s, and 70’s; while the more current literature tends to be clinical and descriptive. In the past several years attention has been on parental alcoholism as an important factor in children’s current and future adjustment. Children of alcoholics have 42 been found to have higher rates of behavioral and emotional problems (Adler and Raphael, 1983; El-Guebaly and Offord, 1977; Scavnicky-Mylant, 1984) along with an increased risk for developing alcoholism (Black, 1981 Goodwin, 1979; Dinning and Berk, 1989). Much of what is known about adult children of alcoholics is based on clinical reports and anecdotal information in which most hypotheses are drawn from individual testimony (Woititz, 1983). However, the MMPI has been utilized more recently as an assessment technique for understanding differences among alcoholics and for designing treatment interventions that are more effective. These studies, however, have shown inconsistent results and indicate that no single personality type is characteristic of all alcoholics or adult children of alcoholics (Graham and Strenger, 1988; Knowles and Schroeder, 1990). McKenna and Pickens (1983) compared 1,929 MMPI's on male and female alcoholics and found that the sons of the alcoholics showed significantly higher scores on one validity scale and on five clinical scales (4, 5, 7, 8, and 9), with Scale 4 (Psychopathic Deviate) showing a clinically significant elevation (T.70 or above). On the Wiggins Content scales, alcoholic sons of (alcoholics scored higher than controls on measures of family ‘problems, authority conflict, poor morale, and psychoticism. Bradley and Schneider (1990) found adult children of 43 alcoholics to have significantly higher scores on the MMPI control scale reflecting a higher need for control in their interactions with others. The most consistent finding across several studies revealed elevations on Scale 4 in outpatient and inpatient settings, and across race and gender differences (Butcher and Owen, 1978; Donovan, 1986; McKenna, 1986; McKenna and Pickens, 1983; Mayo, 1985; MacAndrew, 1978; Miller, 1976; Page and Bozlee, 1982; Walfish, Shealy, and Krone, 1992). The research consistently suggests the mean profile for groups of alcoholics is characterized by a 4-2 two-point code type (Graham, 1978; Levi and Watson, 1981; McKenna and Pickens, 1981). Page and Bozlee (1982) found the 4-9 code type characteristic of white alcoholics, the 2-4 code type for Hispanics, and the 9-6 code type for American Indians. Kammeier et al. (1973) and Loper et al. (1973) reported that young men who later became alcoholics were of the 4-9/9-4 code type. After admission for health care they tended to exhibit 4-2 code types. Graham (1987) describes individuals with the 2-4/4-2 code type (at or above a T score of 70) as persons who create a favorable first impression displaying, energetic, sociable, and outgoing dispositions, but who harbor feelings of inadequacy, self-consciousness, passive dependency, and discomfort in social interactions. They are likely to be in trouble with the law or with their families due to a lack of respect for social standards and authority. 44 They display hyperactive and acting-out behaviors. They are insincere about their depression and can be manipulative. The prognosis for traditional treatment is not good due to premature terminations. Whipple and Noble (1991) conducted a discriminate analysis on personality characteristics using several personality measures, including the MMPI. An index resulting from combinations of best personality discriminators was significantly correlated in father-son pairs. In sum, the evidence to date suggests that a parental history of alcohol abuse is associated with significant elevations on personality measures in clinical samples namely those personality characteristics that depict tendencies toward dependency, depression, passive aggressiveness, obsessive compulsiveness, and low self- esteem. Miller and Tuchfeld (1986) have found that adult children of alcoholics are increasingly recognized as a relevant clinical population who may manifest symptoms that are subject to misdiagnosis. They assert that this error in diagnosis often leads to inadequate and ineffective treatment planning and inefficient recovery as well as pain for both the individual and the family. Consequently, one can understand that the presence of a complex cluster of personality characteristics can lead to misdiagnosis or insufficient treatment planning. 45 Children of alcoholics have three times the divorce rate of their controls (Goodwin et al., 1974). Kroll, Stock, and James (1985) reviewed the charts of 411 patients hospitalized for alcoholism treatment and found 13% had been abused as children and that they had themselves demonstrated more legal difficulties, domestic violence, suicidal attempts, and increased levels of pervasive and situational anxiety. Other studies indicate an increased incidence of anxiety and panic disorder in alcoholic patients (Bibb- Chambless, 1986; Haack, 1990). Whether anxiety is a complication of alcoholism or a contributor to the need for self medication that leads to alcohol abuse is not known. There tend to be psychological as well as biomedical components to alcohol and anxiety disorders (Haack, 1990). Haack (1990) compared ACOAs with a comparison group and found significantly higher elevated scores on anxiety and depression, though the vast majority of them were not clinically depressed or anxious. This finding coincides with the clinical literature that describes ACOAs as more depressed and anxious than non-ACOA controls (Brown, 1988; Clair and Genest, 1987; Gravitz and Bowden, 1986; Tweed and Ryft, 1989; Williams and Corrigan, 1992; Woititz, 1983;). ACOAs also tend to be troubled by concerns of trust, difficulties acknowledging their needs, excessive feelings of responsibility, lack of autonomous identification, problems identifying and expressing feelings, concerns over 46 their own alcoholism or the likelihood of becoming an alcoholic as well as having feelings of helplessness and depression (Cutter and Cutter,1987; Beletsis and Brown,1981; Cermak and Brown, 1982; Greenleaf,1983). Not only have there been assumptions that biomedical and psychological components to alcoholism exist, but also a genetic component as well. Currently empirical data has directed much attention on a developmental perspective which particularly focuses on the genetic and environmental influence of alcoholism on the child and the alcoholic. Schuckit (1986,1988), Goodwin (1984,1985), and Cotton (1979) are among theorists postulating a genetic factor or predisposition to alcoholism in persons with one or both parents having histories of alcoholism. Twin and adoption studies have been powerful in investigating such issues. Studies by Goodwin et al.,(1973, 1974,1983, and 1985), Kaija (1960), and Bohman, Sigvardsson, and Cloninger (1981) have shown that the identical twin of an alcoholic is significantly more likely than the fraternal twin to exhibit alcoholism, while sons of alcoholic biological fathers were significantly more likely to develop alcoholism than sons of non-alcoholic biological fathers, both groups of which were adopted out early in their lives. .Adopted-out sons and daughters of alcoholics have a risk of becoming alcoholic at least four times greater than adopted-