Codependency: when caring for others costs you yourself

Codependency is a popular term for a pattern in which your life becomes organised around another person's needs, moods and problems — often someone with an addiction or other serious difficulty — to the point where your own needs, health and identity disappear. Typical features are a compulsive urge to rescue or fix, difficulty saying no, feeling responsible for the other person's behaviour, and a sense of worth that depends on being needed.

It is not a medical diagnosis. It is a loose idea from the self-help and addiction-recovery world that some people find very useful and that researchers have criticised for being vague. For Pakistani families there is an extra caution: the ordinary, healthy closeness of family life should never be mistaken for a disorder.

Where the idea came from

The word grew out of alcoholism treatment in the 1970s and 1980s. Clinicians working with families noticed that wives and children of people with addictionAddictionLosing control over taking, using or doing something to the point where it harms you, and continuing despite that harm. It is a treatable health condition, not a moral failing.Read the full definition often organised their whole lives around the drinker — hiding it, managing crises, taking the blame. Support groups for families, such as Al-Anon, and best-selling self-help books spread the idea widely, and the meaning broadened to cover any relationship in which one person loses themselves in caring for or controlling another.

In 1986 psychiatrist Timmen Cermak proposed formal diagnostic criteria for codependency. They were never adopted: codependency does not appear in the DSMDSM-5The Diagnostic and Statistical Manual of Mental Disorders: the American Psychiatric Association's handbook of criteria for diagnosing mental health conditions. The current edition is DSM-5-TR (2022).Read the full definition or in ICD.

What the research says

• There is no agreed definition. A 2026 review of the literature found at least six different ways of defining codependency and described the field as conceptually fragmented.
• The pattern is linked to distress. Studies consistently connect codependency questionnaire scores with low self esteemSelf-esteemThe overall opinion you hold of your own worth. Low self-esteem is common and can change; it is not a diagnosis, though it often travels with depression and anxiety.Read the full definition, emotional distress, relationship difficulties and lower life satisfaction.
• Critics say it pathologises caring. Feminist scholars argued from the early 1990s that the label targets women for doing the caregiving society expects of them, and blames family members for the addiction of someone else.
• Culture has been neglected. Most research comes from a small number of countries, and the review called for approaches that are culturally sensitive, noting that culture shapes expectations of care, obligation and self-sacrifice.

What it can look like

The features most often described in the literature and by support organisations include:

• Feeling responsible for another adult's feelings, choices and behaviour
• An urge to rescue or fix, even when the help is not wanted or does not work
• Great difficulty saying no, and guilt or anxiety when you do
• Needing to be needed — feeling worthless or empty when you are not looking after someone
• Putting up with disrespect or mistreatment to avoid conflict or abandonment
• Losing track of your own opinions, wants and feelings
• Resentment and exhaustion building up underneath the caring

Why it develops

The patterns are usually learned, not chosen. Growing up with a parent who drank, used drugs, was seriously ill or was violent often teaches a child that keeping the peace and looking after others is the way to stay safe. In many Pakistani families, the eldest daughter in particular takes on adult responsibilities early — cooking, raising siblings, calming a parent's anger. That can build real strength and resilienceResilienceThe ability to adapt and recover after hardship, loss or stress. It is not a fixed trait you either have or lack; it grows from relationships, habits and support.Read the full definition. It can also leave someone who, as an adult, does not know how to rest or to ask for anything. Early adverse childhood experiencesAdverse childhood experiencesPotentially traumatic events in the first 18 years of life, such as abuse, neglect or violence at home. They raise the risk of later health problems, but they do not decide a child's future.Read the full definition and low self-worth both make the pattern more likely.

Healthy interdependence is not codependency

In Pakistan, adult children care for ageing parents, siblings pool money for a wedding or a medical bill, and decisions are often made together. That is interdependence, and it protects people — it is part of why families here pull through illness, unemployment and loss. Western self-help that tells you to put yourself first in every situation does not fit this life, and you do not need to adopt it.

Enabling: the part that most often causes harm

Enabling means shielding someone from the results of their behaviour in a way that allows it to continue. It usually comes from love and fear, not weakness. Common examples in Pakistani households:

• Repeatedly paying a son's or brother's gambling or drug debts
• Making excuses to relatives, employers or the mosque committee for a husband's drinking or heroin or ice use
• Handing over money you know will be spent on drugs, to avoid a scene
• Keeping an addiction hidden for years because of izzat, so treatment never starts
• A mother taking the blame for her son's anger to keep the peace

Stopping enabling does not mean stopping love. It means supporting the person, not the addiction — for example, paying a clinic directly rather than handing over cash, or telling a trusted elder the truth rather than covering up.

Boundaries that work in a close family

Getting help

Help can be aimed at you even if the other person refuses it. CounsellingCounsellingA talking therapy in which a trained counsellor listens without judgement and helps you work through a difficulty and find your own solutions. It suits life problems more than severe mental illness.Read the full definition or CBTCognitive behavioural therapyA structured, time-limited talking therapy that helps you notice and change the thoughts and behaviours that keep a problem going. It is a first-line treatment for depression and most anxiety problems.Read the full definition can help with guilt, people-pleasing, low self-esteem and anxiety. When a family member has an addiction, family-focused approaches teach relatives how to reduce enabling, look after themselves and improve the chance that the person accepts treatment — ask the addiction or psychiatry service about family sessions. Peer support groups for families of people with addiction, including online groups, can also make the load feel less lonely.

If the person you are worried about refuses treatment, that is their decision to make as an adult — but it does not oblige you to keep absorbing the consequences. You can keep loving them, keep the door open to treatment, and still stop covering up, stop paying for the habit and start protecting your own health. If someone overdoses, is unconscious, or is talking about ending their life, call Rescue 1122 or go to the nearest emergency department straight away.

When to see a doctor

• You feel exhausted, hopeless or low most days — caring for someone with addiction or illness carries a real risk of burnoutBurnoutA state of exhaustion, cynicism and reduced effectiveness caused by long-term workplace stress that has not been managed. WHO calls it an occupational phenomenon, not a medical condition.Read the full definition and depressionDepressionA medical condition in which low mood or loss of interest lasts most of the day, nearly every day, for at least two weeks, and affects sleep, energy and daily life.Read the full definition.
• You are not sleeping, have stopped eating properly, or your own illnesses such as diabetes or blood pressure are being neglected.
• You are using sleeping tablets, “nerve” pills or other substances to cope.
• You have thoughts of harming yourself — go to the emergency department or call 1122 if you are in danger now.

What you can do today

• Write down one thing you do for someone else that you actually resent. Ask whether it helps them, or only keeps the peace.
• Tell one other family member the truth about what you are carrying.
• Do one small thing for yourself today without explaining or apologising for it.

Caring for family is one of the best things about the way many Pakistanis live. The aim is not to care less, but to care in a way that you can keep up, that does not quietly destroy your own health, and that helps the person you love rather than protecting their harm.