The theme of affective dependence has very distant roots, already Ovid (Amores, 19-24 B.C.) introduced the theme with a famous phrase "I can't live with you, nor without you", a phrase that continues to return to our common language even with variations such as "I need you to live", "I can't stay away from you".
However, the term emotional dependence only entered the lexicon of psychopathology in 1986 thanks to the American psychotherapist Robin Nor wood and his book Women who love too much, in which he refers to the characteristics of what, according to the author, is a "dangerous" love.
Affective addiction, or love addiction, is considered a form of obsessive, symbiotic and fusion love; it is an "unhealthy" way of living the relationship and generally develops between two adult partners, but it can also arise between therapist/medical and patient or between parent and child (Borgioni, 2015).
Nosographic framework
To date, affective dependence does not appear in diagnostic manuals as a disorder in itself, even if within the DSM 5 (American Psychiatric Association, 2014), in the chapter on disorders related to substances and addiction disorders, love addiction is mentioned, but without referring to either the diagnostic criteria or the characteristics of the disorder.
Affective addiction, therefore, falls within the New Addiction, i.e. those behavioral addictions in which there are no chemicals of abuse or alcohol. One of the characteristics common to all new addictions is the fact that often, precisely because of the absence of substances of abuse, they can remain in the shade throughout the patient's life (Guerreschi, 2011).
An important aspect is a distinction between emotional dependence and personality disorder, as the two conditions often tend to be the same. In fact, as Borgioni also points out (2015), the two conditions must be considered separately for various reasons:
- In the personality dependent disorder the need for protection and care prevails, in the affective dependence such need is not only prevalent but exasperated;
- People with personality dependent disorders allow others to take possession and manage the areas of their lives, while in emotional dependence this does not happen;
- In personality dependent disorder, the addiction figure is immediately replaced with another or with a substance, while in emotional dependence the patient "fixes" on the previous relationship and tries to recover it in any way;
- In the personality dependent disorder, the dependence on other people is constant, being a personality trait, while in the effective dependence it develops only in some relationships.
We can therefore consider affective dependence as a relational disorder of the "here and now", not necessarily referable to childhood traumatic events (Secci, 2014).
Is emotional dependence a real dependence?
To answer this question, we must, first of all, examine whether the typical symptoms of addiction are present in affective dependence (bewilderment, tolerance, abstinence, inability to control one's own behavior) and, if so, in what ways they are carried out.
Euphoria: the patient feels a sense of well-being when he is with his partner, such a feeling is indispensable to be well and not obtainable in any other way.
Tolerance: the patient feels the need to increase the amount of time to spend with the partner, reducing more and more the time devoted to himself and his independence. This behavior is fuelled by the inability to maintain the internalized presence of the other.
Abstinence: the absence of the partner leads to a state of despair that can only be alleviated by the physical presence of the other.
Inability to control one's own behavior: reduction of the critical capacity related to oneself, to the other and to the situation.
This creates a circle that feeds itself by reinforcing addictive behavior:
- Immediate gratification and pleasure (positive reinforcement)
- Relief from abandoned suffering (negative reinforcement)
- The feeling of kindness and value
Etiopathogenetic Theories
The evolutionary-social hypothesis
Ghezzani (2015) argues that emotional dependence should not be considered a real disease for two reasons: for its evolutionary and survival value and for the innate cooperative qualities of the human species. The author explains that, while in the animal world the dependence of puppies on their caregivers is functional but only for short periods, in the human species this dependence has much longer periods and therefore it is unthinkable that the bond of dependence that is created can then dissolve. Moreover, in human beings, cooperation is fundamental for survival and, as Aronson and his colleagues claim (2013), instead of dependence, we should speak of interdependence to underline the affective reciprocity of human relations.
The neurobiological hypothesis
It has been amply demonstrated in the literature (Bottaccioli, 2005) that if a child is removed from caregivers' cares, it increases its production of endorphins and cortisol, the so-called "stress hormones"; this secretion can damage the areas of the limbic system, that portion of the Central Nervous System that allows us to get excited and create feelings that can last in time and memory.
The reward system
We prefer to use the term "addiction" in the sense of "slavery" because any situation, relationship or substance that creates pleasure in the subject and relieves his pain can make him "slave" by it (Fisher, Xu, Aron, & Brown, 2016).
Behavior motivated by gratifying stimuli is composed of an appetitive phase, in which the object of pleasure is sought and a consumer phase in which the behaviour manifests itself according to rigid patterns linked to the specific activity. Pleasure disorders concern the appetitive phase: the repetition of the search for pleasant stimuli creates dependence (Aron, Fisher, Mashek, Strong, Li & Brown, 2005).
Attachment style
Analysing the characteristics of individuals with various types of attachment, it is evident that people with insecure-ambivalent attachment reflect the typical traits of individuals with affective dependence: obsessive control of oneself, of the other and of the relationship; the conviction of not being worthy of love; the continuous search for symbiotic relationships with idealized people; the terror of separation and loss.
The experience of the affective employee has therefore been characterized by reference figures present but intermittently, often arriving at a reversal of roles that sees the adult child and the parent-child (Borgioni, 2015).
Treatment
Before talking about the treatment of love addiction, you need to understand if it is ethical and necessary to intervene. In this regard, there are two different camps: in the "narrow view" love becomes addiction only when the circuit of reward is activated or when the individual has a preexisting disorder; in the "broad view" anyone who is in love falls within the spectrum of emotional dependence, which is therefore not considered a disease, but simply an innate gift of man.
If we refer to the "narrow view" there are situations in which it is necessary to intervene for emotional dependence. This intervention can be pharmacological (given all the demonstrations on the neurobiological causes of the disease) or psychological. In this case, we can refer to the cognitive-behavioral therapy that will intervene on some fundamental points:
- Restructuring of irrational thoughts
- Social skills training
- Pulse control
- Prevention relapse
In conclusion, we underline that the therapeutic relationship has been shown to be one of the major predictors of effectiveness of psychotherapy (Safran & Muran, 2000) and this appears even more important when the issue addressed is purely relational, as in the case of emotional dependence.