Correspondence:Cíntia Maria Rosa Faria da Costa
cintiarosacosta@gmail.com
ARTIGOS
Adolescence, co-dependence, and parental attachment: correlations and considerations
Adolescência, co-dependência e vinculação parental: correlações e apontamentos
Adolescencia, codependencia y vinculación parental: correlaciones y apuntes
Cíntia Maria Rosa Faria da CostaI; Nancy Ramacciotti de Oliveira-MonteiroII
IUniversidade Federal de São Paulo (Unifesp). Environmental Psychology Laboratory and Human Development. São Paulo. State of São Paulo. Brazil. https://orcid.org/0000-0001-7423-4297
IIProfessor. Universidade Federal de São Paulo (Unifesp). São Paulo. State of São Paulo. Brazil. https://orcid.org/0000-0002-8963-5162
ABSTRACT
Co-dependence is a concept related to emotional and behavioral difficulties of relatives of individuals addicted to psychoactive substances; however, it involves other contexts not directly associated to dependency. Thirty adolescents, children of dependent parents, from a city of São Paulo, participated in the study. This study used the Spann-Fischer and EMBU scales, as well as Pearson's correlation coefficient. From the results, a significant correlation was found between the co-dependence degree and the types of parental attachment, especially overprotection and rejection. This leads to the comprehension of co-dependence as a multivariate phenomenon that may also be associated with the type of attachment established with parents or caregivers.
Keywords: Co-dependence; Adolescent; Parental Attachment.
RESUMO
Co-dependência é um conceito relacionado a dificuldades emocionais e comportamentais de familiares de dependentes de substâncias psicoativas, porém envolvendo outros contextos não diretamente associados a essa dependência. Participaram do estudo 30 adolescentes, filhos de pais dependentes, de um município paulista. Com o uso das escalas Spann Fischer e EMBU e, por meio do teste de correlação de Pearson, foi constatada significativa correlação entre o grau de co-dependência e os estilos de vinculação parental, em especial, de superproteção e de rejeição. Compreende-se a co-dependência como um fenômeno multivariado que pode estar também associado ao tipo de vínculo estabelecido com os pais ou cuidadores.
Palavras-chave: Co-dependência; Adolescente; Vinculação Parental.
RESUMEN
La codependencia es un concepto relacionado con las dificultades emocionales y conductuales de los familiares de dependientes de sustancias psicoactivas, pero que involucra otros contextos no directamente asociados a esta dependencia. Treinta adolescentes, hijos de padres dependientes, de una ciudad de São Paulo participaron del estudio. Utilizando las escalas Spann Fischer y EMBU, y por medio de la prueba de correlación de Pearson, se encontró una correlación significativa entre el grado de codependencia y los estilos de vinculación parental, especialmente de sobreprotección y de rechazo. La codependencia se entiende como un fenómeno multivariante que también puede estar asociado al tipo de vínculo que se establece con los padres o cuidadores.
Palabras clave: Co-dependencia; Adolescente; Vinculación Parental.
Introduction
The term co-dependence was first used in the late 1970s, when alcoholism and dependence on other drugs were called "chemical dependencies". The theme was initially discussed as the compulsive need of wives to monitor their alcoholic spouses. The term co-dependence was then broadened to include the children of addicts to psychoactive substances, as well as any individual who was involved in a relationship with them. The concept underwent several approaches over the last three decades, among them, the proposition that co-dependence is related to factors other than exposure to or living with a relative who is dependent on psychoactive substances. This proposition, however, is still controversial among researchers. In this sense, Bortolon et al. (2016) argue that the concept of co-dependence can be used to define a multidimensional problem influenced by factors that may begin in childhood with a compulsive need to take on a caregiver role, producing paradoxical affective links that reinforce patterns of maladaptive behaviors. Co-dependent individuals would thus compulsively maintain ties with their children or partners, despite the suffering and lack of compensation that would characterize these relationships. Co-dependent family members often have difficulty to set boundaries and affirm their own needs because of low self-esteem, poor emotional control, and self-blame.
In this article, co-dependence is understood from the conception proposed by Bution and Wechsler (2016), who define it as a problem inserted in the domain of dependencies unrelated to a substance, sharing several similarities with other types of dependency. Thus, similar to a psychoactive substance-dependent individual who is attached to a drug (obsessively), the co-dependent would become attached with the dependent individual, in an attempt to reduce their pain. Such pain would be related to an anguish feeling that evokes a primordial helplessness. In this sense, Bowlby's (1946) contributions related to studying maternal deprivation (in the crucial period from zero to five years of the child) and understanding it as a significant experience of loss, are fundamental. The author considered the possibility that facing such a painful situation would favor antisocial behaviors and the emergence of emotional problems, as well as the lack of empathy towards others and the inability to sustain meaningful and lasting relationships. Moreover, by shedding light on the mother and baby relationship, Bowlby developed from 1950 onward the Attachment Theory, proposing that a strong emotional attachment to at least one primary caregiver would be crucial for healthy social and emotional development, considering attachment as a deep and long-lasting affective relationship that ties one individual to another in time and space.
According to Silva (2014), a central idea of the theoretical construct of attachment is that differences in the quality of mother-baby interaction during the baby's growth would result in the formation of varied internal representations - in general, such representations would become models that children would use later in their lives to predict and relate with the external environment. Thus, a safe child would construct the model of a responsive and dependable caregiver, while creating a model of the self as an individual who deserves attention and love. On the other hand, an unsafe child would see the world as a dangerous place, where people should be looked at carefully, while seeing the self as undeserving of attention and love. Furthermore, the author argues that the quality of the attachment has been consistently related to several aspects of the child's functioning, including one's sociability, self-esteem and cognitive skills, having the type of attachment established as an indicator for future relationships that will be developed in childhood, adolescence and adulthood. Considering the importance of the attachment to the individual's development process, the understanding of how the presence of co-dependence could be related to the types of attachment established between parents or caregivers and the child is fundamental.
Thus, this study sought to evaluate co-dependence in adolescents whose parents are psychoactive substance dependents, first by verifying the co-dependence indices in the sample according to gender, as well as the types of attachment established between adolescents and their parents or caregivers, also according to gender. Moreover, the objectives were to verify a possible correlation between the variables described: co-dependence and types of parental attachment.
Method
This is a quantitative, descriptive and correlational study. Data collection was conducted in a Social Care Referral Center (in Portuguese: Centro de Referência de Assistência Social [CRAS]) located in the neighborhood where the participants lived, in a medium-sized municipality in the countryside of the state of São Paulo.
Participants
Study participants were 30 adolescents (from 12 to 18 years and 11 months old), being 11 girls and 19 boys, children of fathers and/or mothers with history of dependency to psychoactive substances (alcohol and/or illicit drugs), with 15.7 years as the mean age and belonging to a family under social vulnerability situation.
According to the Brazilian Economic Classification Criteria (CCEB) (ABEP, 2014), all the girls belonged to families in economic classes C1, C2 and D. Regarding the boys, 18 belonged to families in economic classes C1, C2 and D, and only one belonged to a family in the B2 class. Among the boys, 15 had the father as the parent with substance dependency history, and four had both parents, i.e., mother and father. Among the girls, for five it was the father, for four both parents, for one the mother, and for one, more than two family members.
Exclusion criteria were illiterate adolescents, individuals with severe cognitive/mental impairment, or who had a history of substance dependency (considering the researcher's evaluation).
Instruments
Spann-Fischer Co-dependence Scale
This instrument is used to verify the co-dependence indices in a sample. Their reliability and validity were examined by Fischer and Spann (1991) from the correlations established with constructs associated to the concept, such as depression, anxiety, external control locus, and self-esteem. This scale is composed by 16 items such as "it is difficult for me to say 'no'" and "I often put the needs of others before mine", with answers ranging from 1 to 6 points, from "strongly disagree" to "strongly agree". The final score ranges from 16 to 96, considering that the higher the score, the higher the level of co-dependence; 52 was the cutoff point to establish it.
Egna Minnen Betraffande Uppfostran Scale (EMBU)
This scale is used to verify the types of attachment, being an instrument about parental practices memories. This instrument was validated in Brazil by Kobarg, Vieira and Vieira (2010) with 447 participants, who were undergraduate students in public or private universities in the state of Santa Catarina.
This instrument is composed of 23 items that measure the frequency of occurrence of certain practices during the individual's childhood and adolescence, with regard to their father and mother separately. This study also considered the occurrence of practices related to the grandparents, and other characters who were significant to the participants (uncles and siblings), as well as the general mean of the occurrence of practices among all evaluated characters (father, mother, grandparents and others). The answers are recorded on a four-point Likert scale, ranging from "No, never" to "Yes, most of the time".
From attachment patterns, the instrument covers the following proximal processes:
• Rejection Pattern: associated with the frequency of disapproval practices such as physical punishment, deprivation of objects or privileges, or direct application of force with the purpose of influencing the child's behavior.
• Emotional Support Pattern: related to behaviors and practices that convey feelings of security, acceptance as a person, and the feeling of comfort in the presence of those relatives.
• Overprotection Pattern: behaviors characterized by excessive protection regarding experiences that induce stress and adversity, high intrusion level in the activities of individuals, high expectations regarding achievements in certain areas, and imposition of strict rules that require total obedience.
Procedures
This project was approved by the Research Ethics Committee of Universidade Federal de São Paulo (CEP/Unifesp), opinion no.: 1,282,132 and authorized by the Municipal Social Services Department.
Forty adolescents and/or their relatives were contacted by phone and/or personally after selection of entries in the CRAS files. The sampling procedure was non-probabilistic, using the criteria of convenience and accessibility. Of the 40 adolescents and/or family members, 35 adolescents attended the study interview and from these, 33 participants were selected. There were three withdrawals, resulting in 30 participants in total. Parents and caregivers signed the Informed Consent Form, and the adolescents signed the Term of Assent.
The first meeting encompassed the collection of information about the characteristics of the sample, using the CCEB and the Spann-Fischer Co-dependence Scale. The EMBU Scale was applied during the second meeting.
Data regarding the degree of co-dependence present in the sample and the types of attachment by type of kinship were described according to gender, by percentage, and the means and standard were deviations obtained. A differential analysis of the exposed variables (co-dependence degree, type of attachment by kinship) was performed to verify the differences between boys and girls. Student's t test was used for unrelated samples. Finally, Pearson's linear correlation coefficient was used to determine correlation between the same variables and the co-dependence indices in the sample according to the participant's gender.
Results
In percentage, 63% of the sample presented a co-dependence profile, with 53% of co-dependent boys and 82% of co-dependent girls. Still considering this variable, the means obtained by gender were: for males, 52.58 with a 10.99 standard deviation, 36.00 minimum and 78.00 maximum; for females, 64.82 mean, 11.51 standard deviation, 50.00 minimum and 89.00 maximum.
Table 1 presents the descriptive measures of the variables of type of emotional attachment - support, rejection and overprotection -, according to the type of relationship, in terms of mean and standard deviation values obtained. Student's t test was used to compare boys and girls for each of the studied variables, being applied on unrelated samples. From the data obtained it can be observed that there was a difference between boys and girls regarding the variables: degree of co-dependence, overprotection (by the mother) and rejection (general). Significant values were considered as p<0.05.
Pearson's linear correlation coefficient was used to study the possibility of association between the degree of co-dependence and each of the other variables of interest. The results obtained indicate associations of different intensities for boys and girls and are shown in Table 2.
Regarding the father, the significant associations were of moderate intensity between the degree of co-dependence and emotional support attachment for females, as well as between the degree of co-dependence and overprotection attachment for both males and females. Regarding the grandmother, it was observed a strong association between the degree of co-dependence and emotional support attachment for males, and of moderate intensity between co-dependence degree and overprotection attachment for females.
With regard to other caregivers, significant associations of strong intensity were found between the co-dependence degree and emotional support attachment for both females and males, considering that in this case the association was reversed, i.e., the stronger the emotional support, the lower the co-dependence degree. Still regarding the other caregivers, a strong association between the co-dependence degree and rejection attachment for females and males was also considered significant, as well as a strong association between co-dependence degree and overprotection attachment for females.
Discussion
This study found a difference between boys and girls regarding the co-dependence degree, being higher in girls. It also corroborates the results found by Salazar, Rodríguez, Cerón, Orjuela and Chacón (2013). Such results raise questions regarding the socioculturally constructed roles based on gender differences (Ferreira, 2016).
Positive correlation was found for both boys and girls between co-dependence and types of attachment, both rejection and overprotection, considering that overprotection was more strongly correlated (positively) with co-dependence than rejection for both sexes. Regarding the father, positive moderate correlation was observed for the overprotection attachment and co-dependence for both boys and girls. When such overprotective type referred to the grandmother, moderate correlation with co-dependence was only found for girls. On the other hand, when overprotection was coming from the grandfather, there was a strong positive correlation with co-dependence but only for males. However, we must emphasize that the data collected for the grandparents were in small number, thus making the generalization of these findings impossible.
Furthermore, regarding the overprotection attachment type, there were indicators of a strong positive correlation between co-dependence and overprotection in girls when such attachment came from other caregivers and, in general, there was a moderate positive correlation with co-dependence for both males and females. This result refers to the possible association between co-dependence and a symbiotic attachment pattern. Such pattern would be marked by excessive care and protection with the other, who under frail conditions, would become dependent on the established attachment (co-dependent attachment), reproducing later in life relationships that follow this very model (Bortolon et al., 2016).
Strong positive correlation between rejection and co-dependence was found in the attachment patterns with other caregivers. This data leads to an indicator that co-dependence may be associated with disruptions in the family, as suggested in research developed by Lockwood (2018), given that other relatives would take on caregiving roles (formerly parental roles). This suggestion is also based on the fact that the rejection rates shown by the adolescents did not differ significantly when referring to the parents or to other caregivers. However, the correlation between co-dependence and the rejection pattern, when referring to other caregivers, was stronger as already mentioned.
Moreover, a strong positive correlation was found between emotional support and co-dependence when this type of attachment referred to the grandmother; however, only for males. And when referring to the father, there was a moderate positive correlation, and only for females. When emotional support attachment was related to other caregivers, a strong positive correlation was observed for girls, and a strong negative correlation with co-dependence for boys. Regarding other caregivers, these results indicated that, for boys, co-dependence decreased as the emotional support pattern intensified. Regarding girls, the more the emotional support pattern intensified, the more co-dependence rates increased. This interesting result may suggest that the significance of the emotional support attachment pattern may differ for the sexes in this case, especially for girls, possibly approaching the overprotection pattern.
In both the boys and the girls investigated, the data found showed the phenomenon of co-dependence more strongly correlated with certain styles of parental attachment such as overprotection, suggesting that this could be a repeating attachment pattern. On the other hand, rejection attachment was also strongly associated with co-dependence in boys and girls, but only when referred to other caregivers (not to parents). This pattern also suggested that a possible disruption in the family (with care demands from outside the nuclear family) and the condition of being rejected may also be related to the phenomenon. This leads to the assumption that being rejected by others would have a greater impact than being rejected by the parents, or that rejection would have been more noticeable after leaving the family. Caring in a co-dependent manner could be, in these cases, an attempt to compensate for absences and loss of loving care.
This study enabled the verification of the weights of the variables related to the established types of attachment that would be involved in the phenomenon of co-dependence in 30 adolescents, children of parents with a history of psychoactive substance dependency. Sample composition can be considered a limitation of this study, since all participants were from a single small group and no generalizations were expected. We suggest that new studies can be developed from larger and more diverse samples of children of dependent parents, or even from the participation of individuals from other family arrangements that do not have only children of dependent parents in their composition.
References
Associação Brasileira de Empresas de Pesquisa - ABEP. (2014). Critério de classificação econômica Brasil. São Paulo: o autor. Recuperado de http://www.abep.org/criterioBrasil.aspx
Bortolon, C. B., Ferigolo, M., Machado, C. A., Benchaya, M. C., Figueiró, L. R., Moreira, T. C. et al. (2016). Funcionamento familiar e questões de saúde associados com codependência em familiares de usuários de drogas. Ciência & Saúde Coletiva, 21(1), 101-107. https://doi.org/10.1590/1413-81232015211.20662014
Bowlby, J. (1946). Forty-four juvenile thieves: Their characters and home lives. London: Baillière, Tindall & Cox.
Bution, D. C., & Wechsler, A. M. (2016). Dependência emocional: Uma revisão sistemática da literatura. Estudos Interdisciplinares em Psicologia, 7(1), 77-101.
Ferreira, C. B. C. (2016). O gênero do amor: Cultura terapêutica e feminismos. Cadernos Pagu, (47), 1-44. https://doi.org/10.1590/18094449201600470002
Fischer, J. L., & Spann, L. (1991). Measuring codependency. Alcoholism Treatment Quarterly, 8(1), 86-100. https://doi.org/10.1300/J020V08N01_06
Kobarg, A. P. R., Vieira, V., & Vieira, M. L. (2010). Validação da escala de lembranças sobre práticas parentais (EMBU). Avaliação psicológica, 9(1), 77-85.
Lockwood, D. (2018). The codependent field. Journal of Heart Centered Therapies, 21(1), 1-7.
Salazar, J. J. A., Rodríguez, M. D., Cerón, J. J., Orjuela, C. R., & Chacón, C. A. R. (2013). Indicadores de codependencia en 60 familiares de consumidores de sustancias psicoactivas en el municipio de Armenia - Quíndio. Revista Psicologia Cientifica, 15(7).
Silva, N. F. F. (2014). Teoria da vinculação (Dissertação de mestrado). Faculdade de Medicina, Universidade do Porto, Porto, Portugal. Recuperado de https://core.ac.uk/download/pdf/143404073.pdf
Correspondence:
Cíntia Maria Rosa Faria da Costa
cintiarosacosta@gmail.com
Nancy Ramacciotti de Oliveira-Monteiro
nancy.unifesp@gmail.com
Submission: 06/07/2019
Accept: 07/14/2020