Cómo diseñar escalas descriptivas (rúbricas)

As discussed previously, Cermak (1986) suggested a possible relationship between codependency and various personality dimensions. Cermak suggested that the codependency construct carried a particular pattern of personality traits, predictably found within individuals who engaged in relationships with people with substance misuse problems (see Appendix A). Four subsequent studies in codependency explored the association of codependency with personality trait factors (Hoeningmann-Lion and Whithead, 2007; Gotham and Sher, 1996; Irwin, 1995; Walfish, Stenmark and Krone, 1992 - please see Table 2.4 above for a summary of these studies). Although these studies also considered other psychological variables such as depression, fear and anger, they had their main focus on the personality variables associated with the construct.

A small study by Walfish, Stenmark and Krone (1992) investigated the personality characteristics of individuals who entered an inpatient treatment centre for codependency in America (n=73 women). Although the study is limited by a

relatively small sample of women for a quantitative study, it was included as it investigated the construct within a group of people who were looking for treatment for codependency, therefore demonstrating better representativeness than previous research conducted with samples of University students. The MMPI (Minesota Multiphasic Personality Inventory; Dahlstrom, Welsh, Dahlstrom, 1972) was used to explore the personality profile of these women who presented themselves for a 10- day residential treatment. The MMPI is a validated personality inventory which assesses the personality traits and mental illness of individuals presenting psychological problems (Greene 2000). A single profile of a ‘typical codependent’ was not shared by these participants as authors found ‘heterogeneity of profiles’. The ‘many types of codependents’ that the authors found contradicted the ‘uniformity myth’ associated with a ‘diagnostic label of codependent’ (p.214), suggested by Cermak. These results reinforce the variety of personal characteristics which are associated with the construct.

Nonetheless, Cermak (1991) also argued that codependency traits complemented narcissism, both being inversely related, a relationship explored in the previous section. In other words, individuals who score high on measures of codependency should score low on measures of narcissism (Marks et al 2011). Cermak (1986, 1991) understood both as disorders with origins in the child’s early formative years, when the child unsuccessfully moves from a symbiotic to the individuation phase.

In order to test this view, Irwin (1995) explored the relationship between codependency and narcissism in a sample of Australian adults (n=190, 100 men and 90 women). The authors reported that participants were recruited as a convenient sample; however there is a lack of information about the specific characteristic of this sample. The survey included a number of validated measures, please see Table 2.4. There is no information about the validation of the Children of Alcoholics Screening Test (Jones, 1983) and the Survey of Traumatic Childhood Events (Council and Edwards, 1987). Additionally the study aimed to test the claim made by Carson & Baker (1994) that codependency in adults was predicted by a childhood traumatic experience.

The authors aimed to investigate two main hypotheses: (1) that codependency scales should predict but be negatively related to the two measures of narcissism, (2) that the scores of the codependency scales would be predicted by the scores of the surveys of childhood trauma and parental alcohol use.

The authors reported that the correlation between the two scales of codependency (SDCS and CDI) was statistically significant (r=0.63), although not impressive. The correlation between the two scales of narcissism (NPI and NPD) was non-significant (r=-0.06). This may have had an implication on the conflicting results revealed by multiple regression analysis between the scores of the codependency and the narcissistic scales. Although the relationship between codependency and narcissism was suggested, it was not entirely clear. They reported that only the NPI scores demonstrated negative regressions, whilst the NPD scores demonstrated positive regressions. Therefore their data offered contradictory support to their hypothesis, as codependency scores related negatively to the NPI and positively to the NPD. These issues may have contributed to the inconsistency found in the results of the study, suggesting also that both psychological constructs (narcissism and codependency) as complex and multifaceted human experiences that may not have been adequately operationalised by the measures used. Although the author confirmed the validation of the measures chosen for this study, the results here raise questions about the validity of the two scales measuring narcissism, as they show opposite correlations with codependency and are not related with each other.

Furthermore, no significant relationship between codependency and reported childhood trauma was demonstrated. A possible problem with the study is related to the scores of the Children of Alcoholics Screening Test (CAST). A large proportion of the scores reported were equal to zero, which means that participants reported no traumatic childhood experiences. The sample become very small once limited to people who did report childhood trauma. There is no information about the validation of this tool. Nonetheless, the findings reported are interesting and contradict early perspectives which suggested traumatic upbringing as possible precursors of codependency, yet are highly limited by small sample size. In spite of these limitations, the findings of the study appear to weaken some of the early theoretical perspectives associated with this complex human experience, especially the suggested role of early upbringing.

Still looking at the personality dimension, Gotham and Sher (1996) conducted a large study (n=467) to establish if the construct of codependency, as measured by their chosen tool, had a singular dimension not overlapping with dimensions of certain psychopathologies (depression and anxiety), or personality dimensions (psychoticism and neuroticism). The sample containing self-identified adult offspring

of people with alcohol problems was screened via the short version of the validated Michigan Alcoholism Screening (Selzer et al 1975), and sections of the Family History and Research Diagnostic Criteria Interview (FH-RDC, Endicott et al 1978). These two reduced scales have not been validated. After the screening, participants were divided into two groups: COA (child of alcoholics, n=238) and non-COA child of non-alcoholics, (n=229). Both groups were invited to complete a set of measures including a personality measure NEO Five-Factor Inventory (Costa & McCrae, 1992), a measure of psychopathology (The Brief symptom Inventory, BSI – Derogatis 1993), and a measure of codependency (Potter-Efron Codependency Assessment Questionnaire, CAQ, Potter-Efron and Potter-Efron 1989). The latter scale is based on a list of characteristics reported to be found in codependent individuals which were extracted from clinical practice. The CAQ scale has 33 items in total, spread across specific subheadings: fear, shame, prolonged despair, anger, denial, rigidity, impaired identity development, and confusion. The psychometric properties of the Potter-Efron codependency assessment (CAQ) were assessed by Gotham and Sher. Factor analysis performed on the CAQ demonstrated that the codependency scale measured a single construct. However further analysis indicated that codependency correlated significantly with neuroticism (r=0.66); psychological symptoms of depression r=0.43, anxiety r=0.40; and modestly with family history of alcoholism (r=0.18). Furthermore, after controlling basic dimensions of personality and psychopathology with simultaneous multiple regression analyses, neuroticism accounted for a large proportion of the variance in the CAQ measure (β=0.57), and was a strong predictor of the overall codependency score (p<0.05). The limitation of the CAQ instrument used in this study may have compromised the reported results. The assumption that codependency was related to personality factors prevailed during the time that Gotham and Sher’s study was performed. The codependency measure used in their study (CAQ) conceptualizes codependency based on Cermak’s (1996) personality model of codependency. The measure does not consider a diverse range of inter-personal factors also suggested to be related to codependency by other authors such as Dear and Roberts (2005), Wright and Wright (1998) and Obrien and Gaborit, (1992). These authors challenged these assumptions, they suggested that codependent individuals tend to become involved in problematic relationships, remaining committed to these in spite of their negative impact in their personal lives.

Research exploring the relationship between codependency and personality traits continues to feature in the current drug and alcohol literature. Hoeningmann-Lion and Whithead (2007) examined the relationship between codependency and the DSM-IV (APA, 1994) descriptions of borderline and dependent personality disorders in a group of undergraduate psychology students in America (n=76). Although this study contains a small number of participants, a decision was made to include it in the review due to its relatively recent date of publication and relevance to current discussions on personality disorder. Participants completed a number of validated

questionnaires including the Potter-Efron Codependency Assessment

Questionnaire (CAQ, Potter-Efron and Potter-Efron 1989), the borderline and dependent scales of the MCMI-II (Millon, 1987/1989) and the Dysfunctional Attitude Behaviour (DAS, Burns 1980/Burns and Spangler 2001). The DAS is a scale used to assess depression, based on the concept that the person may carry a cognitive schema marked by absolutism and perfectionism in several areas (e.g. approval, love, achievement, autonomy).

Correlation results demonstrated a significant positive correlation between traits of codependency and borderline personality disorder (r=0.69), and a weak correlation between codependent and dependent traits as measured by these scales (r=0.31). The results appear to demonstrate that codependency and borderline personality disorder carry similar underlying structures. Additional analysis also revealed that codependent and borderline personality traits were also correlated with the cognitive schema measured by the DAS; thus suggesting that these individuals may carry an underlying psychological structure marked by rigidity, which may lead to depression. These results appear to contradict the positions sustained by O-Brien and Gaborit (1992) that codependency may be a separate disorder in its own right. On the contrary, according to these results, the traits identified by the CAQ measure of codependency appear to overlap with those already identified by personality disorders categorised by the DSM-IV (APA, 1994). Still, one needs to be cautious when interpreting such results, as they are based on a small sample of students. This population is not representative of people more distressed by what they regard as codependency, and it is not likely that these students carry a diagnosable personality disorder profile. However, in the light of the above, one could argue that clinically, codependency may be considered an unnecessary psychological term, as the characteristics associated with the construct are also found in other psychological issues such as personality disorders. In spite of this, as it will be discussed below, qualitative studies suggested that a number of individuals seem to

connect with this term ‘codependency’, finding it meaningful, and seek codependent support groups as part of their recovery processes (Blanco 2013; Irvine 2000; Rice 1992).

Overall, these four studies (Hoeningmann-Lion and Whithead 2007; Gotham and Sher 1996; Irwin, 1995; Walfish, Stenmark and Krone, 1992) attempted to explore the association of codependency with personality factors. Contradicting some of the early views on the topic (Cermak 1986); Walfish Stenmark and Krone (1992) did not find a single personality profile for codependency. Furthermore, some of the results here appear to indicate an overlap between some of the characteristics of codependency identified in the literature and other characteristics present in personality disorders. For example, Gotham and Sher (1996) identified its overlap with neuroticism, Hoeningmann-Lion and Whithead (2007) with borderline personality disorders. Although the association between codependency and inverted narcissism was suggested by Irvin (1995), the results presented were contradictory. The variation in findings here strengthens the argument that there is a lack of understanding about the meaning and experience of codependency.

To conclude, this section included a review of the nine studies exploring the construct of codependency and its relationship to a range of psychological factors. The review demonstrated that the construct of codependency appears to take many forms, and as a result could fit into many different psychological categories such as compulsive disorders, mood and stress-related disorders, and personality disorders. This highlights the need for first person accounts describing individuals’ unique lived experience of what they identify as codependency. This idiographic perspective is needed to complement the nomothetic perspective presented thus far. A qualitative exploration, seeking first-person nuanced accounts going beyond the categories offered by quantitative scales, may be more appropriate to further investigate these important issues. Qualitative research methodologies may be better suited to bring clarity about the circumstances which lead certain individuals to identify their difficulties and the part that these play in their everyday lives.

2. 5. The prevalence of codependency as a perceived psychological

problem among adults

As discussed previously, early theorists in the field of codependency understood codependency as a psychological illness and suggested that it had high indices of prevalence, with epidemic dimensions featuring mostly in partners of substance

misusers and women (Whitfield, 1991; Schaef, 1986). Such claims have undermined the credibility of the concept as there is no valid evidence to confirm these views. Nonetheless researchers have attempted to identify the prevalence or occurrence of what they understood to be codependency among different populations: relatives of substance misusers and women. The literature review presented only five studies investigating the prevalence of codependency within families of alcohol or drug users (Sarkar et al 2013; Bortolon et al 2010 and Bhowmick al 2001; Meyer, 1997; Prest and Storm 1988). A few researchers explored the perceived prevalence of this unclear psychological construct in women (Dear and Roberts 2002; Martsolf et al, 1999, 2000; Cowan and Warren 1994) - please see Appendix B for a review of these studies.