The Neuroscience of Codependency for Client Understanding and Treatment

Professional Resource Article

Abstract: Research on codependency is scant as it is not a formal disorder in Diagnostic and Statistical Manual of the American Psychiatric Association, 5th Edition. There is also not a specific medication to treat it, hence funding may be challenging but is necessary as most of us exhibit codependent behaviors at some time throughout our lifespan. Codependents who seek mental health treatment are likely to be involved with those who have disorders such as substance abuse or Cluster B personality disorders. People who are narcissistic, antisocial or who have borderline personality disorder manipulate and exploit others and codependents are altruistic and enjoy giving to others. This creates a dysfunctional foundation of attraction. The fear of abandonment drives both the codependent and the narcissist or borderline. In this context, codependency will be viewed as narcissism in reverse. Narcissists are hyper-focused on themselves, and codependents derive physiological pleasure focusing on others. Assisting the client with psychoeducation will help them to understand their maladaptive physiological reactivity. Nonjudgmental mentoring of why and how they give to be of benefit to others and a detriment to themselves expedites the therapeutic process. Helping a codependent understand the neuroscience of their behaviors will cause them to feel less embarrassment or shame that impairs positive outcomes in therapy.

Help your client with neuroscience education:

Codependent clients can be resistant to treatment because they believe they are being selfless and kind, but they are relieving their anxiety by people pleasing and approval seeking. Teaching a client about the neuroscience of this issue can be a turning point in codependent recovery. Imparting the complex cause and effect of how a codependent brain maladapts can help the clinician guide the client to healthier relationships and selfcompassion.

Early development, attachment, and trauma bonds

The brain develops early in the womb, beginning with the neural plate and the neurons we have from birth remain through life. Newborns have instincts and reflexes to guide them to receive love and nurturing and are fundamental for safety. We are born to reach and grasp for love by innate reflexes to seek security and a sense of belonging. In receiving attention, a clinging infant trusts the person who loves and cares for them. If you gently touch a baby’s cheek, they turn their head and begin sucking to get nourishment. It is the root reflex, but infants need more than food.

Proper nurturing is needed in all stages of early development. If a child does not experience nurturing, the brain can develop maladaptive attachment styles. Codependents are often called, “clingy and “needy” and suffer from anxious-preoccupied attachment. They may have experienced trauma bonding through intermittent reinforcement with an early caregiver. As an adult, a person gets hooked by feeling the chemical sensations of love, but when kindness is intermittently or abruptly withdrawn, intense anxiety occurs. If this was a pattern in childhood, it can wreak havoc in adult relationships.

At Harvard University, Dr. Edward Tronick, performed “still-face mother” experiments. A baby is fully engaged with an attentive mother. The infant smiles, reaches, and appears safely connected. When the mother is cued to have a blank expression, within moments, the baby is agitated, and attempts to re-engage her with anxious smiles and distress sounds. The child frantically flaps his fingers to get a response. When the mother pays attention to her infant again, the child is soothed.

Mirror neurons

We learn by mirroring our caregivers and people subliminally “read” each other. Mirror neurons helped humans successfully evolve as an intelligent species. Affection and proper attention are necessary to develop into confident adults. A sense of belonging in a dysfunctional family is restored if an anxious child performs in ways that result in everyone being happy or “fixed”, even if temporarily. They morph into imposed gender roles such as “the little man of the house” or the “the good little girl”. They can become the family clown, hoping that entertaining the family will help them maintain connectivity.

When a parent and baby bond properly, oxytocin, the trust hormone, is released, and the child feels safe, and adulthood is navigated with secure attachment. Brains develop in sequence, so it is vital for a child to receive proper affection in the developmental order needed. Erik Erickson, Abraham Maslow, Carl Jung, Sigmund Freud, and John Bowlby were pioneers in this field of human development and concur, what happens to a child from birth to age six is crucial for healthy development.

Attentive parenting is how we learn to trust and become autonomous adults. In 2012, Viladarga and Hayes did extensive research on developmental codependency.

“Codependence can be viewed as a dysfunctional empathic response, a displaced mutual aid endeavor in which the main defect is an inability to tolerate negative affect in the important other…Evidence is pointing to the newborn human entering the world already innately primed to engage. There is reason to believe that prosocial skills develop early, in tandem with other capacities, such as conscience and empathy…Very likely, there are evolutionarily early neurological systems or pathways for emotional empathy…Empathy is clearly an advantageous facet of human cognition. Where the codependent individual may stray is in the modulation of the affect it generates in the observer.”

It can be deduced, if the child experiences a dysfunctional frame of reference, codependency is fostered. Abandonment, abuse, neglect, parental addiction, death of a parent or any childhood trauma can result in a lifetime of grasping for love like a frantic infant or to become submissive to a narcissistic or demanding partner.

When a child detaches from their family in adolescence, they may develop relationship reenactment. It is a subconscious compulsion to gain mastery over the past and is seldom successful. Trauma bonds may have been established early and repeated later in life by more intermittent reinforcement. Cycles of giving and withholding affection or approval is a tool of manipulation that traps a codependent and keeps them biochemically addicted. When treated well, dopamine, serotonin and oxytocin create a sense of wellbeing. When they are treated poorly, cortisol and adrenaline flood the codependent with feeling of intense anxiety. This makes it feel impossible to leave a perpetrator. Without recognition of this chemical exchange in therapy, clients may continue to seek safety from the same people who hurt them or are like them as the brain seeks the familiar.

When we develop, memory centers of the brain including the hippocampus, amygdala (fight/flight/frozen) and limbic system work together to form consciousness. Suppressed wounds from childhood may result in crossed circuitry and can damage the hypothalamus and adrenal system and cause brain synapses to malfunction.

We have biological needs to receive dopamine, oxytocin, vasopressin, serotonin and other hormones and peptides for proper attachment. The same attachment hormones that made us fall in love go awry when a person is devalued or discarded. Trauma can cause shrinkage of the hippocampus and create false signals of safety. What feels “right” or “love at first sight” may be a trauma triggered reaction. Codependency and trauma are closely related. Making connections between the past and present are crucial to help a client enjoy a better future.

We can, in a sense, “watch” what we say by understanding mirror neurons. Reaction shots in films are a way to understand this principle. The reaction of the listening actor is showing the audience how to feel. This same theory applies to codependents and the characters in their life. Subliminal messages are processed in the brain and emotions can be negatively manipulated if the codependent is unaware. Their fixated awareness of others and a lack of it for themselves makes them a vulnerable target.

Empathy and codependency

People who are born highly empathetic, have more capacity to sense the needs of others through mirror neurons and other brain connections. Mirror neurons are essential for empathy to enhance the greater good of society. There is a correlation that the greater someone experiences empathy, the more they will be inclined to help others and receive pleasure in return. Empathy and heightened conscience reside in the most evolved part of our brain, which primarily is in the prefrontal cortex. Conscience and empathy display significant activity in PET scans.

In “The Empathic Brain: How the discovery of mirror neurons changes our understanding of human nature” neuroscientist Christian Keysers, PhD states:

“By charting the detailed machinery of empathy…shared circuits have started to reveal, we might be in a position to…prevent atrocities.”

Keysers diagramed the empathic brain and noted authentic, altruistic giving is good for humankind, but can be misused by predatory people. Keysers warns overly empathic codependents.

“We all suffer from an egocentric bias. Shared circuits are not magic; they make us interpret other individuals in the light of our own actions, solutions, and emotions. If your life is fundamentally different from that of the person in front of you, shared circuits will make you feel something the other person is not feeling. In these cases, in the mirror of shared circuits lies to us.”

Teaching a codependent to be aware of their mirror neurons they project to others will help them see what may be what attracted those who exploit them.

Viladarga and Hayes developed these key concepts of the biological connections in codependency.

-Codependency is an inability to tolerate a perceived negative affect in others that leads to a dysfunctional empathic response.

-Codependency likely shares roots with pathological altruism.

-There are evolutionary, genetic, and neurobiological components to the expression and propagation to codependent behaviors.

Giving feels good

Feel good chemicals such as dopamine, serotonin, oxytocin (the trust hormone) and endorphins elevate when we give. Generosity is more than a learned trait and is healthy if the motives are based on fear or guilt.

In May 2018, The John Templeton Society at UC Berkeley presented, “The Science of Generosity”.

“There is growing evidence the human brain is wired for generosity… Acting generously appears to stimulate neural circuits involved in reward, the same circuits that are activated when we eat food or have sex, which helps to explain why giving feels good…This neural response is also a sign that generosity is important for survival. When an act feels good, we’re more likely to do it again and…thanks to evolution, the behaviors that are most fundamental to our survival also tend to make us feel good…the mesolimbic reward system, which are activated by stimuli like sex, drugs, food, and receiving money, are also engaged when people make charitable donations….brains showed activity in reward-processing areas even when they were forced to give to others… Generosity also triggers a part of the brain called the orbitofrontal cortex, which not only activates when we receive rewards but is thought to be involved in assessing the subjective value of our decisions…some of the anatomical and functional differences seen in extreme altruists are the opposite of those seen in psychopaths… Oxytocin also has wide-ranging effects on social behavior, from supporting maternal care to encouraging pair bonding.”

Not giving feels bad to the client

Guilt and empathy are closely related in the brain and neural responses. If you are in a park, about to take a bite out of a sandwich and see someone sorting through rubbish to find a morsel, you feel empathy and give them your meal. That is not coerced guilt; it is empathic kindness. Kindness helps both giver and receiver to feel good.

“Neural Systems for Guilt from Actions Affecting Self, Versus Others”, a 2018 study by R.A. Morey et al, reported how guilt and social connection are symbiotic. In a codependent, this could be catastrophic.

“Guilt is a core emotion governing social behavior by promoting compliance with social norms or self-imposed standards…actions with social consequences are hypothesized to yield greater guilt…Our results suggest these regions intensify guilt where harm to others may incur a greater social cost.”

Clients can become angry when it is proposed it is a form of selfharm to allow people to use or abuse them. Helping them to understand their subconsciously driven need for connection enhances self-awareness, acceptance, and redirection. Intermittently reinforced conditioning can be reconditioned with positive methods to forge new neural pathways.

Healing physiological reactivity

Donald Hebb, PhD said, “neurons that fire together, wire together”. This Hebbian principle is related to the term “neuroplasticity”. It was once thought that if you were born thinking a certain way, you couldn’t change it but now we know differently. Cognitive behavioral therapy promotes changing perspectives, beliefs, and thoughts so the brain will change in a positive way.

Codependent recovery can also be expedited by what we know about how our emotions affect our autonomic nervous system (ANS) of fight/flight/freeze reactions. This involves our limbic system and amygdala and our reactions and emotions set the vagus nerve into motion. This parasympathetic nervous system (PNS) comes out of the brain stem and begins at the space outside the forehead. It travels down through the face, throat, heart, lungs, vital organs and abdomen and lower back.

The vagus nerve is partially responsible for facial expression which is how mirror neurons are cued. This physiologic exchange is what gives us, “gut feelings” and codependents often ignore these feelings. They have faulty interoception from traumatic conditioning. Price and Hooven explored this in 2018.

“Individual ability to detect interoceptive signals may be influenced by stress and adverse life experiences that negatively affect willingness, tolerance, interest, and practice with attending to the language of the body. People who have experienced undue stress or trauma may have ceased to trust or listen to their bodily cues, making it difficult for them to predict their emotional responses and to regulate them…Mindful attention to inner body awareness, or interoceptive experience, reconnects the individual to deep bodily states of equilibrium, helping to override and rescript maladaptive stress responses and automatic patterns…Interoceptive awareness skills facilitate optimal emotional responding and the individual’s ability to process and interpret feelings, or to plan ahead and strategize at the onset of small cues before becoming overwhelmed or entering an unmanageable situation, thus…providing clients with self-care skills critical for emotion regulation.”

Codependents who care more for others than they do themselves often misinterpret their own physical and emotional signals. Without mindful self-awareness, a codependent may believe the best of the worst of people.

Sigmund Freud believed a person has an “optimal homeostatic level of psychic energy” called the “comfort level”. The mind and body perpetually seek the comfort level of “homeostasis”. Holistic tools such as polyvagal exercises and meditation can assist the client reach homeostasis more quickly. By guiding your codependent client to understand their brain, he or she can become more proactive than reactive. Choosing therapeutic interventions combined with neuroscientific evidence will be an addition to other cognitive behavioral or eclectic modalities of therapy.

References

1. Tronick, Ed. The Neurobehavioral and Social-Emotional Developments of Infants and Children. New York: W.W. Norton & Company, 2007.

2. Bowlby, John. Separation: Anxiety and Anger Attachment and Loss. Basic Books, 1976.

3. Vilardaga, Roger & Steven Hayes, “A Contextual Behavioral Approach to Pathological Altruism,” Pathological Altruism (December 2011): 25-37, 10.1093 /acprof:oso/9780199738571.003.0033.

4. Hebb, D. O. The Organization of Behavior. New York: John Wiley and Sons, 1949.

5. https://ggsc.berkeley.edu/images/uploads/GGSC- JTF_White_Paper-Generosity-FINAL.pdf Greater Good Science Center, May 2018

6. Keysers, C. (2011). The Empathic Brain. Chicago: University of Chicago Press.

7. Price, C. J., & C. Hooven. “Interoceptive Awareness Skills for Emotion Regula- tion: Theory and Approach of Mindful Awareness in Body-Oriented Therapy (MABT).” Frontiers in Psychology, 9 (2018): 798. doi:10.3389/fpsyg.2018.00798.

8. Morey RA, McCarthy G, Selgrade ES, Seth S, Nasser JD, LaBar KS. Neural systems for guilt from actions affecting self versus others. Neuroimage. 2012 Mar;60(1):683-92. doi: 10.1016/j.neuroimage.2011.12.069. Epub 2012 Jan 2. PMID: 22230947; PMCID: PMC3288150.

Written By: Mary Joye, LMHC

Mary Joye is a Licensed Mental Health Counselor, Life Coach and Florida Supreme Court Certified Family Mediator. Her recent book, “Codependent Discovery and Recovery 2.0: A Holistic Guide to Healing and Freeing Yourself on HCI/Simon and Schuster has been well received. Her transformative journey was featured in "O" Magazine. She is a best-selling writer for DailyOM.com and her most popular course, "From Codependent to Independent" has sold tens of thousands of copies. She contributes as a guest author and interviewer to OpentoHope.com, Huffington Post, Prevention, ThriveGlobal, UpJourney, Psychology Today, PsychCentral, Central Florida Health News and many other publications.