Los diferentes tipos de escalas y su utilidad en la evaluación educativa educativa

Early theorists (Hemfelt, et al 1989; Friel, 1985; Whitfield, 1984) suggested that individuals with codependency were likely to experience mental health problems such as depression, compulsive behaviours, stress-related disorders and personality disorders. As a result of such assumptions, researchers have sought to identify the psychological correlates of codependency, and to understand its relationship with other psychological problems (Reyome and Ward 2007). The relationship between codependency with various mental health problems has been explored by a number of studies (Mark et al, 2011; Well et al, 2000; Hughes- Hammer, 1998; Carson & Baker, 1994; O’Brien, 1992). A review of the five main studies which met the quality criteria is presented in this section (Mark et al, 2011; Hughes-Hammer, 1998; Carson & Baker, 1994; O’Brien, 1992). The paper presented by Wells et al (2000) contained an evaluation of codependency traits based on a list of attributes drawn from a popular psychology book (Beattie 2011, 1987) and was therefore considered inadequate to meet the quality criteria chosen for this study. The scale is based on opinion, not on empirical research, and therefore was found to be unsuitable to be included in this study.

The possible relationship between codependency, depression and substance misuse has been explored by O’Brien and Gaborit (1992), who investigated this correlation in a study with Australian university students (n=115). Three measures were used in the survey: the Significant Others Drug Use Survey (SODS), the validated Beck’s Depression Instrument (BDI-II, Beck et al 1996) and the

Codependency Inventory, a measure created by the authors. The Beck’s

Depression Inventory is a well-known measure, with sound psychometric properties (Beck, 1996). However there is no psychometric information available on the other measures used. Correlational analysis demonstrated no significant relationship between self-identified codependency and self-reported depression (r=0.06); however a significant correlation was found between being in a relationship with a substance misuser and developing depression (r =0.34). Similar to other research considering the precursors of codependency, the study is limited as it investigated codependency in a population of students. Only a minority scored highly on the measure, operationalised as codependency, and it is unclear that any of the participants self-identified themselves as codependent.

Similarly, Carson & Baker (1994) studied the relationship of codependency with these variables: depression, object relations, reality testing, parental substance misuse and child abuse. It is not clear if the participants were students as the authors reported recruiting female volunteers from an American university (n=171). Within this group, 100 participants reported a history of child abuse. Codependency was assessed with the Beck Codependency Scale (BCAS, Beck 1998), a 35 item self-administered tool using a Likert Scale (1-5). Validated measures used in the study were Center for Epidemiologic Studies Depressed Mood Scale (CES-D, Radloff, 1977), the Bell Object Relations and Reality testing Inventory (BORRTI, Bell et al 1986), the Depressive Experiences questionnaire (DEQ, Blatt et al 1976) and the Alcohol, Drug Use and the Family Questionnaire (Bucky, 1990). The Bell Object Relations and Reality Testing Inventory is a validated self-report measure which covers the following types of object relations: alienation, insecure attachment, egocentricity, social incompetence, reality distortion, uncertainty of perceptions, hallucinations and delusions.

The authors conducted multiple regression analysis including all the subscales of the BORRTI (object relations: alienation, insecure attachment, egocentricity, social incompetence and reality testing: reality distortion, uncertainty of perception, hallucinations and delusions) and a section of the BCAS, which they titled the Codependency Group score COGP. Multiple regression analysis revealed that the individual factors of the BORRTI did not significantly predict the codependency scores identified by the COPG in the BCAS. However, the items ‘insecure attachment’ and ‘uncertainty of perception’, when combined, significantly predicted the COPG scores. The BORRTI ‘insecure attachment’ item demonstrates a person’s sensitivity to rejection, whilst the ‘uncertainty of perception’ item ‘demonstrates the presence of doubt about the person’s perception of reality (Bell et al 1986). These results suggest that individuals identified as codependents could perceive themselves as socially incompetent, are uncertain about how to relate to others or whether they are accepted by others, and may engage in dysfunctional relationships as a defensive process. The authors suggested that these individuals may enter into controlling and self-sacrificing interpersonal relationships as a coping strategy for managing inaccurate perceptions of self and others, and to increase their fragile self-esteem. Further to this, the results contradicted the results presented by O’Brien and Gaborit (1992) above, and indicated a significant relationship between codependency and depression (p<0.001), more specifically the intensity of the depressive symptoms (p<0.01).

Carson and Baker’s results also confirmed the association of codependency with perceptions of dysfunctional family patterns such as childhood abuse and parental alcoholism (p<0.001). In relation to parental alcoholism, these results were later challenged by research conducted among other samples of students (Crothers and Warren, 1996; Fuller and Warner, 2000; Ancel and Kabakci, 2009; Knudson and Terrell, 2012),

Overall, despite the psychometric limitations of the measure of codependency used by the authors, Carson & Baker’s study revealed important results concerning the relationship between their codependency measure and object relations, reality testing, depression, reported parental alcoholism and child abuse, using more complex predictive statistical analysis than the studies reported above. Furthermore, although in relation to depression, the results of this study disagree with the results demonstrated by O’Brien and Gaborit (1992), it is possible to infer that the association of codependency with depression could be associated with internalized self-criticism, feelings of worthlessness, guilt and inadequacy often suggested to be a characteristic of depression (National Collaborating Centre for Mental Health 2010).

A similar result to Carson & Baker (1994) was obtained by a descriptive exploratory study developed by Hughes-Hammer et al (1998). The study investigated the strength of the relationship between codependency assessed by the CODAT, an assessment tool devised by the authors (please see section below) and depression, based on the validated BDI-II (Beck, Steer and Brown 1999). The procedure of the study involved the categorization of all participants (n=105 women recruited from a university but not clearly stated if these were students) according to their depression and codependency scores (minimal, mild, moderate and severe). Like Carson & Baker (1994), multiple regression analysis revealed that codependency had a strong relationship with depression (p<0.001). In this study, the authors also attempted to test the CODAT measure, a tool composed of 5 factors: other focus/ self-neglect, low self-worth, hiding self, medical problems and family of origin issues.

They concluded that among women who were categorized as moderately to severely codependent, 88% were severely depressed, and for those who were minimally codependent, only 20% were severely depressed. The analysis also demonstrated that most of the individual dimensions of the codependency scale had a significant positive relationship with depression, with correlation scores ranging

from r=0.50 to 0.72. This study identified statistical similarities between codependency and depression, suggesting a link between both. The similarities shared by both conditions, according to these researchers, strengthens the critical argument that the concept of codependency encompasses a diverse range of traits without much conceptual clarity.

The various results demonstrated by these studies (O’Brien and Gaborit 1992; Carson & Baker 1994; Hughes-Hammer et al 1998) raise concerns about the overall conceptualization of codependency as a distinctive psychological disorder. This discrepancy also highlights that quantitative research methodologies may not have been successful in determining the distinct features of the construct as a psychological illness.

Springer, Thomas and Barry (1998) investigated a much larger number of correlates of codependency based on the characteristics of codependency provided by an early measure - the ‘Codependency Assessment Inventory’ (CAI, Friel 1985 – see table in the Appendix C). The variables considered were attachment (avoidance, anxious/ambivalent, secure), self-esteem, interpersonal connectedness, cognitive and emotional empathy, caring for others, supportiveness of others, competitiveness, locus of control, impression management, public and private self- consciousness and social anxiety. A number of measures were used to investigate these variables. Most of the measures used in the study were validated, please see table 2.4. However there is no information available on the validation of the Attachment Styles (A.S - Simpsom, Tholes and Neligan 1992) and Interpersonal Locus of Control (Paulhus, 1991) measures. Furthermore the non-clinical participant group chosen for the study posed a limitation (n= 217 undergraduate students). The authors reported that codependency was negatively correlated with self- esteem, as measured by the CAI and Rosenberg scales. Data analysis also demonstrated that codependency was positively correlated with anxious/ambivalent and avoidant attachment styles, and negatively correlated with secure attachment. These findings indicate that people who have the codependent traits measured by the CAI and the AS could be perceived as typically anxious, insecure and avoidant about relationships. Interestingly and contrary to expected, according to the results related to the RQQ, codependency was not associated with greater personal involvement, specifically in measures of supportiveness, caring, private connectedness, or public connectedness. Surprisingly, codependency was associated with competitiveness in relationships. The authors argue that these

issues of competitiveness may be associated with the persons’ insecurities and anxieties. Still, according to this measure, a small but significant association was found between codependency and empathy.

When considering the selected personality measures, codependency was negatively associated with interpersonal locus of control, indicating that these individuals may feel that they have little control over their relationships. Codependency was positively associated with public consciousness, social anxiety and self-consciousness. A negative correlation was found between codependency and impression management. Based on the findings above, the authors attempted to offer what they termed as a ‘portrait of the codependent’ and compared this with traditional portraits provided by early authors in the field (Cermak 1991, Schaef 1986). They presented a picture of a self-conscious person with low self-worth, experiencing limited control over interpersonal relationships. Although this person is aware and sensitive to other people’s opinions and reactions, attempting to make a good impression, they focus much on their own personal limitations. They suggested also that although these individuals may have an intense desire for an intimate relationship, they may fear real intimacy, and are competitive. Overall although some of the traits presented by this group of participants are congruent with the characteristics more widely associated with the construct, others are not. For example, they explain that it does not fit in with the ‘submissive victim who caters for the partner’ (Schaef 1986, p.10) described by early authors.

The study has several limitations, for example the use of self-report measures, which forces people into answering a great number of pre-determined questions with single responses. Moreover, the codependency scale used (CAI) was an early attempt to categorise the construct, carrying limited psychometric information. Since these initial attempts, other instruments have come forth. These have been well used in research suggesting other more complex dimensions associated with the construct. The article lacks detailed information on the statistical analysis carried out by the researchers. From the article’s description, it appears that the researchers performed multiple correlations between pairs of variables rather than understanding the combined influence of sets of the variables through more complex statistics such as multiple regression. This increases the likelihood of getting ‘significant’ correlations by chance, and making a Type 1 error. Furthermore, the study is carried out in a sample of students, not representative of individuals who regard themselves as troubled by codependency.

A study from Marks et al (2011), using more complex statistical analysis, explored the psychometric properties of a more recent codependency measure, the Holyoake Codependency Index (HCI, Dear et al 2004), with a sample of 301 adults from the general population and 49 attendees of CODA (Codependents Anonymous). A group of psychological variables was tested: self-esteem, narcissism, family dysfunction, depression, anxiety, stress, and emotional expressivity. A revised version of the Holyoke Codependency Index, entitled the CCS (Composite Codependency Scale) was used. The other validated measures included in the survey are described in Table 2.4. The authors used a section of the McMaster Family Assessment Device (FAD, Epstein et al 1983) for evaluating families’ general functioning. There is no information about the validation of this measurement tool.

Multiple regression analyses demonstrated that codependency scores were significantly associated with depression, anxiety, stress, and family dysfunction. Analysis also demonstrated an association between codependency and low levels of narcissism, self-esteem, and emotional expressivity. Additionally, members of the codependent group (CODA) scored significantly higher on the measures of codependency, depression, anxiety and stress and significantly lower on the self– esteem and emotional expressivity measures than the general population not identified as codependents. These results indicate that individuals identified as codependents and currently seeking help or support may have low narcissistic traits characterized as a low levels in terms of their sense of grandiosity, need for admiration, lack of empathy, exaggerated sense of importance, sense of entitlement, arrogant, haughty behaviours and attitudes (DSM V, American Psychiatric Association, 2013). These findings are important as they suggest a significant difference between people who identify themselves as codependents and those who do not perceive themselves as codependents. These authors used a better recruitment route than most other studies and a more complex statistical analysis and validated scales. Although the study appeared methodologically sound, further research is needed before one can establish a relationship of causality between the variables considered.

Summarizing, based on self-report questionnaires, some of the research analysed here proposes that codependency may be associated with depression, which is a finding worthy of note. It is interesting to highlight also that two of these studies agreed on the positive association between what these authors indicated as

codependency and low self-esteem (Marks et al 2011; Springer at al 1998). Some of the findings also suggest that the construct of codependency could be associated with uncertainty of perceptions, child abuse (Carson & Baker, 1994), shame, guilt, low levels of self-expressivity, traits related to low levels of narcissism (Marks et al, 2011). Overall, the results of these studies reviewed here, appear to indicate that codependency could be seen as an all-encompassing term linked with many different forms of psychological distress and difficulty. On the other hand, a possible codependency cycle has been identified. The cycle may be characterized by low self-esteem, difficulties in emotional expressivity and low narcissistic traits, which can affect mood and anxiety levels (depression and anxiety), leading to compulsive behaviours and neglect of own needs. However there are still contradictions and debates about these conclusions. For example, O’Brien and Gaborit (1992) found no significant relationship between codependency and depression, whilst Carson and Baker (1994) did. Highly structured and categorized studies may have lost sight of the individual and their unique characteristics, experience and comprehension of codependency. Irvine (2000) suggests that the individual is a narrative in progress, and this dynamic process does not fit into pre-defined categories of quantitative measures. Further studies are needed considering the wholeness and individuality of the person, capturing the depth of their views, experiences, personal contexts and narratives.