Codependency is an emotional and behavioral condition historically linked to a dysfunctional relationship involving a chemically dependent spouse or family member¹ or a dysfunctional family of origin.² Over time, this concept has broadened to include exposure to a significantly stressful event, environment, or relationship that causes individuals to become externally referenced and overly focused on the needs and expectations of others.³ As a form of maladaption, their happiness, fulfillment, and self-worth can become dependent on their ability to help, care for, or please others, and eventually they may become unaware of their own feelings.^3,4

HOW CODEPENDENCY MAY DEVELOP AND BE REINFORCED IN PHYSICIANS

Prior to a medical career, some physicians may have grown up in a dysfunctional family or a challenging environment, or they may have experienced a difficult relationship. To cope with their circumstances, they may have assumed a “caretaker role.”⁵ This role may serve as a catalyst for drawing them to medicine, particularly the relationship-focused specialties.

The literature on codependency commonly describes those affected as hard-working, determined, and selfless. Medical education, training, and its rigors may attract these individuals.³ The challenges they face may spur a “survivalist” mindset, encouraging students or trainees to adopt an “always-do-better” mentality.⁶ They may put others’ needs and wishes ahead of their own, making it difficult to understand and process their own emotions. They may also focus on grades, scores, feedback, and other tangible measurements as proof of self-worth and value.

Once physicians begin a career in medicine, these survivalist behaviors are often reinforced by challenging workloads, stressful interactions with patients and colleagues, and long hours. Starting early, working late, skipping breaks, and focusing on the patient and the system at the expense of the individual is often encouraged because it improves the bottom line. This culture can lead physicians to judge their self-worth based on productivity, patient satisfaction, supervisory evaluations, and other materialistic and experiential ideals. Decreased self-esteem and self-confidence are common results. In addition, in environments where financial and productivity-based incentives counter patient-centric values and care, physicians commonly suffer from moral distress, emotional exhaustion, depersonalization, and loss of pride in one’s work, the hallmarks of “burnout.”^7,8