# Core Source Evidence Register

## When Love Narrows the Future / כשהאהבה מצמצמת את המחר

**Status:** final adjudicated core register, evidence cutoff 22 September 2026  
**Verified unique core sources:** **110**  
**Domain composition:** codependency history/measurement 21; Borrowed Self 25; dyadic regulation/dynamical systems 24; care/accommodation/control 19 additional sources; healthy interdependence 6 additional sources; addiction family/partner systems 15  
**Not counted as core:** diagnostic-system pages, mutual-aid history pages, popular books, or records retained only as classification/history authorities

This is the final bibliographic control document for the review. A source remains core only if removing it would materially weaken a construct judgment, mechanism, contradiction, boundary condition, or methodological warning. Every record preserves: full citation; DOI, PMID, or stable link where available; study type; population and sample size where relevant; principal finding; major limitation; and the exact reason for retention. Sources appearing in more than one conceptual stream are recorded once, under the domain where they do the most distinctive work.

### Evidence-access key

- **FT:** full report directly consulted.
- **OA-FT:** open full report directly consulted.
- **A+:** abstract/metadata checked and the reported result cross-checked against a full review, author manuscript, or publisher record.
- **ABS:** abstract-level conclusions only; not used for unreported detail.

### Deduplication rule

DOI is the primary identifier; PMID and normalized author–year–title are secondary identifiers. Multiple publications from one research program remain separate only when they answer different questions. Reviews and the primary studies they summarize may both remain when the review supplies scope or pooled magnitude and the primary study supplies a decisive design, mechanism, or contradiction.

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## Domain A. Codependency: history, definition, measurement, and construct validity (21)

The records below are ordered by argumentative function rather than year: current synthesis; diagnostic proposal and critical history; measurement programs; discriminant and etiological tests; lived-experience corrective.

### R1. Current synthesis

**Molina, E., Taiwo, A. O., & Grey, B. (2026).** Co-dependency revisited: An integrative review of conceptualisations and mental health outcomes. *Clinical Psychology & Psychotherapy, 33*(2), e70265. [https://doi.org/10.1002/cpp.70265](https://doi.org/10.1002/cpp.70265). PMID 41958380; PROSPERO CRD42024575573. **[Full text]**

- **Design/population/N:** Integrative systematic review of 30 publications dated 2013–2024; study Ns 38–664; quantitative samples collectively 76% female.
- **Principal finding:** Six conceptual perspectives and continuing fragmentation; associations with distress and adverse mental-health outcomes appear repeatedly.
- **Major limitation:** Mostly cross-sectional self-report primary evidence; explicit-term inclusion excludes adjacent constructs; pre-2013 foundations excluded; cultural concentration; appraisal by one reviewer; internal discrepancy in study-type counts.
- **Why retained:** Best current map and clearest evidence that fragmentation persists.

### R2. Diagnostic proposal

**Cermak, T. L. (1986).** Diagnostic criteria for codependency. *Journal of Psychoactive Drugs, 18*(1), 15–20. [https://doi.org/10.1080/02791072.1986.10524475](https://doi.org/10.1080/02791072.1986.10524475). PMID 3701499. **[Abstract/verified secondary full-text reconstruction of criteria]**

- **Design/population/N:** Clinical-conceptual diagnostic proposal; no study sample.
- **Principal contribution:** Proposed formal personality-disorder-style criteria.
- **Major limitation:** Criteria were proposed, not validated; no epidemiology, comparator diagnosis, course, or treatment-response evidence.
- **Why retained:** Landmark attempt to turn a clinical idiom into a diagnosis.

### R3. Historical and feminist critique

**Haaken, J. (1990).** A critical analysis of the co-dependence construct. *Psychiatry, 53*(4), 396–406. [https://doi.org/10.1080/00332747.1990.11024522](https://doi.org/10.1080/00332747.1990.11024522). PMID 2263680. **[Full text]**

- **Design/population/N:** Historical, social-psychological, and psychodynamic review; no study sample.
- **Principal contribution:** Dates appearance in mental-health literature to the late 1970s; documents expansion into an overinclusive caretaking identity and its gender implications.
- **Major limitation:** Interpretive review, not primary archival lexicography; psychodynamic analysis is theoretical.
- **Why retained:** Strongest accessible history and an early mechanism-sensitive critique.

### R4. Definitional critical review

**Hands, M., & Dear, G. E. (1994).** Co-dependency: A critical review. *Drug and Alcohol Review, 13*(4), 437–445. [https://doi.org/10.1080/09595239400185571](https://doi.org/10.1080/09595239400185571). PMID 16818359. **[Full text]**

- **Design/population/N:** Narrative review of clinical, popular, and early empirical literature; no participant sample.
- **Principal finding:** Some agreement on broad characteristics but virtually no workable definitional agreement; documents the shift from co-alcoholic/contextual response to broader disease and self-help meanings.
- **Major limitation:** Non-systematic and historically bounded to 1994.
- **Why retained:** Best compact separation of clinical, addiction-family, and self-help meanings; also acknowledges benefits.

### R5. Social-work critique

**Anderson, S. C. (1994).** A critical analysis of the concept of codependency. *Social Work, 39*(6), 677–685. [https://doi.org/10.1093/sw/39.6.677](https://doi.org/10.1093/sw/39.6.677). PMID 7992137. **[Abstract only]**

- **Design/population/N:** Conceptual critical analysis; no sample.
- **Principal contribution:** Challenges disease/addiction framings of interpersonal behavior, pathologizing of women, neglect of power/resources, and blurred responsibility.
- **Major limitation:** Conceptual rather than empirical; claims must not be presented as outcome data.
- **Why retained:** Essential ethical and causal critique of person-blaming.

### R6. Spann–Fischer scale

**Fischer, J. L., Spann, L., & Crawford, D. (1991).** Measuring codependency. *Alcoholism Treatment Quarterly, 8*(1), 87–100. [https://doi.org/10.1300/J020V08N01_06](https://doi.org/10.1300/J020V08N01_06). **[Full text visually inspected]**

- **Design/population/N:** Instrument development; 38-item pilot administered twice to 40 undergraduates about three weeks apart, followed by item reduction to the 16-item SFCS; additional known-group/concurrent analyses reported.
- **Principal finding:** Early internal-consistency, test–retest, known-group, and expected-correlation evidence for a broad externally focused relating score.
- **Major limitation:** Very small convenience pilot; known-group circularity; limited evidence that the total is distinct from distress or other traits.
- **Why retained:** Most widely used early brief measure and anchor for later empirical studies.

### R7. Thematic definition audit

**Dear, G. E., Roberts, C. M., & Lange, L. (2004).** Defining codependency: A thematic analysis of published definitions. In S. P. Shohov (Ed.), *Advances in Psychology Research* (Vol. 34, pp. 189–205). Nova Science Publishers. Institutional record: [https://ro.ecu.edu.au/ecuworks/7153/](https://ro.ecu.edu.au/ecuworks/7153/). **[Institutional abstract]**

- **Design/population/N:** Systematic thematic analysis of 11 published definitions.
- **Principal finding:** Four recurrent elements: external focus, self-sacrifice, attempts to control others, and emotional suppression.
- **Major limitation:** Convergence among selected definitions is literature consensus, not empirical proof of a disorder; full methods were unavailable. Bibliographies vary between 2004 and 2005; the authors’ institutional record gives 2004.
- **Why retained:** Best explicit map from semantic sprawl to testable components.

### R8. HCI initial development

**Dear, G. E., & Roberts, C. M. (2000).** The Holyoake Codependency Index: Investigation of the factor structure and psychometric properties. *Psychological Reports, 87*(3), 991–1002. [https://doi.org/10.2466/pr0.2000.87.3.991](https://doi.org/10.2466/pr0.2000.87.3.991). PMID 11191419. **[Abstract only]**

- **Design/population/N:** EFA of a 28-item pilot in 307 family-counseling clients (39 men, 268 women); replication of the 13-item form in 303 community women.
- **Principal finding:** External focus, self-sacrifice, and reactivity factors replicated; expected correlations supported initial construct validity.
- **Major limitation:** Female-heavy Australian samples; self-report; same article/team; expected correlations do not establish distinctness.
- **Why retained:** Strongest early component-level alternative to a single broad score.

### R9. HCI factorial replication

**Dear, G. E. (2002).** The Holyoake Codependency Index: Further evidence of factorial validity. *Drug and Alcohol Review, 21*(1), 47–52. [https://doi.org/10.1080/09595230220119354](https://doi.org/10.1080/09595230220119354). PMID 12189004. **[Abstract only]**

- **Design/population/N:** Cross-sectional factor study, N=485 (107 undergraduates; 378 snowball-recruited community contacts), mixed sex.
- **Principal finding:** Three-factor structure replicated and was similar across women and men.
- **Major limitation:** Convenience and network recruitment; same developer; no prospective or criterion validity.
- **Why retained:** Replication and sex-structure test for HCI.

### R10. HCI broader validation

**Dear, G. E., & Roberts, C. M. (2005).** Validation of the Holyoake Codependency Index. *The Journal of Psychology, 139*(4), 293–314. [https://doi.org/10.3200/JRLP.139.4.293-314](https://doi.org/10.3200/JRLP.139.4.293-314). PMID 16097271. **[Abstract only]**

- **Design/population/N:** Four cross-sectional studies using CFA and concurrent construct-validity tests; individual Ns are not reported in the accessible abstract and are therefore not asserted here.
- **Principal finding:** CFA supported the internal structure and subscales related meaningfully to other psychological/demographic variables.
- **Major limitation:** Same research program; abstract-only access; concurrent association remains weaker than discriminant or predictive validity.
- **Why retained:** The main published CFA/validation extension for HCI.

### R11. CODAT development

**Hughes-Hammer, C., Martsolf, D. S., & Zeller, R. A. (1998).** Development and testing of the Codependency Assessment Tool. *Archives of Psychiatric Nursing, 12*(5), 264–272. [https://doi.org/10.1016/S0883-9417(98)80036-8](https://doi.org/10.1016/S0883-9417(98)80036-8). PMID 9793213. **[Abstract only]**

- **Design/population/N:** Instrument development/psychometrics; sample size is not reported in the accessible abstract and was not recovered from a verified full text.
- **Principal finding:** Five proposed factors; test–retest .78–.94 and alpha .78–.91; known-groups and depression comparisons.
- **Major limitation:** Criterion group circularity; depression comparison is weak evidence of uniqueness; factor content mixes traits, physical symptoms, and family history.
- **Why retained:** Major competing operationalization and explicit example of construct contamination.

### R12. CODAT cross-language test

**Ançel, G., & Kabakçi, E. (2009).** Psychometric properties of the Turkish form of Codependency Assessment Tool. *Archives of Psychiatric Nursing, 23*(6), 441–453. [https://doi.org/10.1016/j.apnu.2008.10.004](https://doi.org/10.1016/j.apnu.2008.10.004). PMID 19926026. **[Abstract only]**

- **Design/population/N:** Translation, factor analysis, and concurrent validity in 400 Turkish female nursing students.
- **Principal finding:** Similar five-factor pattern, 48.38% variance; total alpha .75, subscale alpha .62–.78; higher scores accompanied attachment anxiety and family problems after controlling depressive symptoms.
- **Major limitation:** All-female occupation/student sample; several marginal reliabilities; cross-sectional; statistical control does not establish distinct causal processes.
- **Why retained:** Useful cross-cultural and overlap test; also shows limits of generalization.

### R13. Composite Codependency Scale

**Marks, A. D. G., Blore, R. L., Hine, D. W., & Dear, G. E. (2012).** Development and validation of a revised measure of codependency. *Australian Journal of Psychology, 64*(3), 119–127. [https://doi.org/10.1111/j.1742-9536.2011.00034.x](https://doi.org/10.1111/j.1742-9536.2011.00034.x). **[Extended abstract/publisher preview]**

- **Design/population/N:** EFA/concurrent and known-groups validation, N=350 (301 community; 49 CoDA participants).
- **Principal finding:** A 19-item CCS with self-sacrifice, interpersonal control, and emotional suppression factors; expected links to distress/family dysfunction and group discrimination.
- **Major limitation:** Derivation and apparent validation in the same sample; small self-selected CoDA group; common-method cross-sectional data.
- **Why retained:** Best match to the four-theme definitional audit and foundation for the independent CFA challenge.

### R14. Independent CCS test and shortening

**Vederhus, J.-K., Kristensen, Ø., & Timko, C. (2019).** How do psychological characteristics of family members affected by substance use influence quality of life? *Quality of Life Research, 28*(8), 2161–2170. [https://doi.org/10.1007/s11136-019-02169-x](https://doi.org/10.1007/s11136-019-02169-x). PMID 30895489; PMCID PMC6620238. **[Full text]**

- **Design/population/N:** Cross-sectional multigroup CFA; 271 relatives in a four-day psychoeducation program and 393 general-community Facebook respondents (N=664).
- **Principal finding:** Original 19-item CCS fit poorly; a post-hoc 9-item SCCS fit better with partial scalar invariance. Affected relatives scored higher; scores correlated with family dysfunction (r=.49) and lower quality of life (r=−.54).
- **Major limitation:** Recruitment/mode and education differences, treatment selection, post-hoc item deletion in the same data, self-report, no temporal direction.
- **Why retained:** Strongest direct challenge to original CCS structure and largest careful psychometric comparison in this set.

### R15. Discriminant-validity challenge

**Gotham, H. J., & Sher, K. J. (1996).** Do codependent traits involve more than basic dimensions of personality and psychopathology? *Journal of Studies on Alcohol, 57*(1), 34–39. [https://doi.org/10.15288/jsa.1996.57.34](https://doi.org/10.15288/jsa.1996.57.34). PMID 8747499. **[Abstract only]**

- **Design/population/N:** Cross-sectional analysis at wave 4 of an alcohol-risk cohort, N=467 young adults (246 men, 221 women), including children of alcoholics and controls.
- **Principal finding:** Codependency measure was reliable/unidimensional; neuroticism and general psychopathology explained most of the family-history association, though a small residual association remained.
- **Major limitation:** One measure and age/risk cohort; same-time associations; residual confounding possible.
- **Why retained:** Most direct test of distinctness from broad personality and psychopathology.

### R16. Etiological contradiction

**Irwin, H. J. (1995).** Codependence, narcissism, and childhood trauma. *Journal of Clinical Psychology, 51*(5), 658–665. [https://doi.org/10.1002/1097-4679(199509)51:5%3C658::AID-JCLP2270510511%3E3.0.CO;2-N](https://doi.org/10.1002/1097-4679(199509)51:5%3C658::AID-JCLP2270510511%3E3.0.CO;2-N). PMID 8801242. **[Abstract only]**

- **Design/population/N:** Cross-sectional multi-measure study of 190 Australian adults.
- **Principal finding:** Childhood trauma did not predict codependence; narcissism relations were more complex than expected.
- **Major limitation:** Retrospective self-report, modest convenience sample, measure dependence, no prospective causal test.
- **Why retained:** Direct negative evidence against a common universal-origin claim.

### R17. Systemic empirical study

**Cullen, J., & Carr, A. (1999).** Codependency: An empirical study from a systemic perspective. *Contemporary Family Therapy, 21*(4), 505–526. [https://doi.org/10.1023/A:1021627205565](https://doi.org/10.1023/A:1021627205565). **[Full text]**

- **Design/population/N:** Cross-sectional comparison of 284 psychology students (72 men, 212 women; mean age 20.5) split into sample-tertile high (96), medium (88), and low (100) SFCS groups.
- **Principal finding:** Higher groups reported more family/relationship problems, distress, low self-esteem, compulsivity, and chemically dependent partners; they did not report more parental alcohol/drug problems, childhood physical/sexual abuse, or female sex.
- **Major limitation:** Student-only, common-method self-report; tertile grouping creates categories; many comparisons; no independent family/partner reports or causal sequence.
- **Why retained:** Rich contradiction of addiction-specific, trauma-specific, and female-specific accounts.

### R18. Nonspecific family stress

**Fuller, J. A., & Warner, R. M. (2000).** Family stressors as predictors of codependency. *Genetic, Social, and General Psychology Monographs, 126*(1), 5–22. [https://pubmed.ncbi.nlm.nih.gov/10713899/](https://pubmed.ncbi.nlm.nih.gov/10713899/). PMID 10713899; no DOI located. **[Abstract only]**

- **Design/population/N:** Cross-sectional survey of 257 students using SFCS and Potter–Efron measures.
- **Principal finding:** Histories of an alcoholic, mentally ill, or physically ill parent were associated with higher scores on both; women were higher only on SFCS.
- **Major limitation:** Retrospective student self-report; no temporal/causal inference; measure-dependent gender effect.
- **Why retained:** Shows family-stress association is broader than addiction and that results vary by instrument.

### R19. Autonomy/predictor challenge

**Lindley, N. R., Giordano, P. J., & Hammer, E. D. (1999).** Codependency: Predictors and psychometric issues. *Journal of Clinical Psychology, 55*(1), 59–64. [https://doi.org/10.1002/(SICI)1097-4679(199901)55:1%3C59::AID-JCLP5%3E3.0.CO;2-M](https://doi.org/10.1002/(SICI)1097-4679(199901)55:1%3C59::AID-JCLP5%3E3.0.CO;2-M). PMID 10100831. **[Abstract only]**

- **Design/population/N:** Cross-sectional study of 95 undergraduates.
- **Principal finding:** Low self-confidence was the strongest predictor and succorance was positive; predicted negative autonomy relation was not found.
- **Major limitation:** Small student sample, self-report, multiple overlapping indicators.
- **Why retained:** Direct falsification of an often-assumed autonomy relation.

### R20. Gender contradiction and CODAT replication

**Martsolf, D. S., Hughes-Hammer, C., Estok, P., & Zeller, R. A. (1999).** Codependency in male and female helping professionals. *Archives of Psychiatric Nursing, 13*(2), 97–103. [https://doi.org/10.1016/S0883-9417(99)80026-0](https://doi.org/10.1016/S0883-9417(99)80026-0). PMID 10222638. **[Abstract only]**

- **Design/population/N:** Cross-sectional study of 149 helping professionals (77 women, 72 men).
- **Principal finding:** Low rates overall; five CODAT factors replicated; men scored slightly higher on total, Hiding Self, and Family-of-Origin Issues.
- **Major limitation:** Occupation-specific convenience sample; same instrument team; no population inference.
- **Why retained:** Direct counterexample to a female-only construct and a replication attempt for CODAT.

### R21. Lived meaning (qualitative corrective to the predominantly psychometric core)

**Bacon, I., McKay, E., Reynolds, F., & McIntyre, A. (2020).** The lived experience of codependency: An interpretative phenomenological analysis. *International Journal of Mental Health and Addiction, 18*(3), 754–771. [https://doi.org/10.1007/s11469-018-9983-8](https://doi.org/10.1007/s11469-018-9983-8). **[Full text]**

- **Design/population/N:** Interpretative phenomenological analysis, N=8 self-identified codependents recruited through UK recovery/support settings.
- **Principal finding:** Participants described a “chameleon” self, imbalance, and the label as a meaningful account of lived difficulty.
- **Major limitation:** Tiny, concept-selected sample; cannot validate a disorder, prevalence, or developmental etiology; recruitment favors people who find the term useful.
- **Why retained:** Prevents a validity critique from erasing experiential utility.

---

## Domain B. The Borrowed Self: differentiation, contingent worth, self-excluding care, dependency, and reassurance (25)

The table preserves the source file's access notation: **A-FT/OA-FT/P-FT** indicate full-text or open/full publisher access; **ABS** restricts use to abstract-reported conclusions. Each row states why the paper is indispensable to this review rather than merely adjacent.

## Curated source register (25 core sources)

**Access codes:** OA-FT = open full text reviewed; A-FT = author/repository full text reviewed; P-FT = publisher full text reviewed; ABS = abstract plus complete metadata reviewed, retained only for the stated design-level finding and not for fine-grained interpretation.

### A. Differentiation, enmeshment, autonomy, and relational identity

| # | Full citation / identifier | Design, population, N | Finding retained | Main limitation / why retained / access |
|---:|---|---|---|---|
| 1 | Calatrava, M., Martins, M. V., Schweer-Collins, M., Duch-Ceballos, C., & Rodríguez-González, M. (2022). Differentiation of self: A scoping review of Bowen Family Systems Theory’s core construct. *Clinical Psychology Review, 91*, 102101. [doi:10.1016/j.cpr.2021.102101](https://doi.org/10.1016/j.cpr.2021.102101); PMID 34823190. | Scoping review, 295 primary studies: 250 cross-sectional, 33 longitudinal, 1 RCT in which DoS was not the main outcome; most N<500. | Most associations favored higher DoS, but couple-similarity evidence was mostly unsupported and stability/intergenerational evidence sparse. | No risk-of-bias appraisal/meta-analysis; all DoS measurement self-report; US/Israel, White, heterosexual, convenience bias. **Retained as the best field map and causal restraint. A-FT.** |
| 2 | Skowron, E. A., & Friedlander, M. L. (1998). The Differentiation of Self Inventory: Development and initial validation. *Journal of Counseling Psychology, 45*(3), 235–246. [doi:10.1037/0022-0167.45.3.235](https://doi.org/10.1037/0022-0167.45.3.235). | Three psychometric studies, total N=609 adults aged 25+. | Operationalized emotional reactivity, cutoff, fusion, and I-position; scores correlated with anxiety/adjustment and marital satisfaction. | Initial correlational self-report validation; Fusion subscale later revised; scoring-key erratum: doi:10.1037/a0016709. **Retained as foundational operationalization, not causal proof. A-FT.** |
| 3 | Skowron, E. A., & Schmitt, T. A. (2003). Assessing interpersonal fusion: Reliability and validity of a new DSI Fusion With Others subscale. *Journal of Marital and Family Therapy, 29*(2), 209–222. [doi:10.1111/j.1752-0606.2003.tb01201.x](https://doi.org/10.1111/j.1752-0606.2003.tb01201.x); PMID 12728779. | Psychometric revision, N=225 adults; 79% women, 86.6% European American. | Original fusion reliability was weak and items partly blurred fusion with adaptive concern; revised FO α=.86, DSI-R total α=.92. | Volunteer, cross-sectional, mono-method; attachment overlap persists. **Retained because it directly exposes construct instability. A-FT.** |
| 4 | Jankowski, P. J., & Hooper, L. M. (2012). Differentiation of self: A validation study of the Bowen theory construct. *Couple and Family Psychology: Research and Practice, 1*(3), 226–243. [doi:10.1037/a0027469](https://doi.org/10.1037/a0027469). | CFA/construct validation, N=749 university students. | Supported three first-order factors and two higher-order dimensions: affect regulation and interdependent relating. | Student convenience sample, self-report, cross-sectional. **Retained because it argues against treating differentiation as a simple one-factor essence. A-FT.** |
| 5 | Manzi, C., Vignoles, V. L., Regalia, C., & Scabini, E. (2006). Cohesion and enmeshment revisited: Differentiation, identity, and well-being in two European cultures. *Journal of Marriage and Family, 68*(3), 673–689. [doi:10.1111/j.1741-3737.2006.00282.x](https://doi.org/10.1111/j.1741-3737.2006.00282.x). | Cross-sectional CFA/SEM; 124 Italian and 109 UK late adolescents (N=233). | Cohesion and enmeshment were distinct; cohesion predicted well-being in both cultures, enmeshment poorer well-being only in UK. | Small adolescent samples, only two cultures; cross-sectional mediation. **Retained as direct cultural contradiction to “closeness=enmeshment.” P-FT.** |
| 6 | Marsac, M. L., & Alderfer, M. A. (2011). Psychometric properties of the FACES-IV in a pediatric oncology population. *Journal of Pediatric Psychology, 36*(5), 528–538. [doi:10.1093/jpepsy/jsq003](https://doi.org/10.1093/jpepsy/jsq003); PMID 20147435; PMCID PMC3131703. | Psychometric study; 147 mothers and 40 fathers from 162 pediatric-oncology families. | Enmeshed α=.65 and intercorrelations created construct-validity problems for Enmeshed/Rigid scales. | Illness-specific, 86% White, mostly two-parent/middle–upper-class; 40 fathers. **Retained as a measurement warning, not general prevalence evidence. OA-FT.** |
| 7 | Werner, P. D., Green, R.-J., Greenberg, J., Browne, T. L., & McKenna, T. E. (2001). Beyond enmeshment: Evidence for the independence of intrusiveness and closeness-caregiving in married couples. *Journal of Marital and Family Therapy, 27*(4), 459–471. [doi:10.1111/j.1752-0606.2001.tb00340.x](https://doi.org/10.1111/j.1752-0606.2001.tb00340.x); PMID 11594014. | Couple self-report/factor analyses; 264 married couples. | Intrusiveness and closeness-caregiving were distinct; many spouse behavior factors were not reciprocal. | Cross-sectional couple self-report; dated marital sample. **Retained as the cleanest direct test against conflating warmth with intrusion and assuming mutuality. A-FT.** |
| 8 | Rodríguez-González, M., Bell, C. A., Pereyra, S. B., Martínez-Díaz, M. P., Schweer-Collins, M., & Bean, R. A. (2023). Differentiation of self and relationship attachment, quality, and stability: A path analysis of dyadic and longitudinal data from Spanish and U.S. couples. *PLOS ONE, 18*(3), e0282482. [doi:10.1371/journal.pone.0282482](https://doi.org/10.1371/journal.pone.0282482); PMID 36862686; PMCID PMC9980780. | Two-wave dyadic panel; 479 heterosexual couples (137 Spain, 342 US), followed 7 and 4 years respectively. | Baseline couple DoS predicted later relationship quality and lower attachment anxiety in both countries; stability/avoidance effects differed. | Different DSI versions/intervals precluded equivalence tests; only two waves; shared-self-report “couple DoS” sum. **Retained as rare longitudinal/dyadic evidence with explicit limits. OA-FT.** |
| 9 | Chirkov, V. I., Ryan, R. M., Kim, Y., & Kaplan, U. (2003). Differentiating autonomy from individualism and independence: A self-determination theory perspective on internalization of cultural orientations and well-being. *Journal of Personality and Social Psychology, 84*(1), 97–110. [doi:10.1037/0022-3514.84.1.97](https://doi.org/10.1037/0022-3514.84.1.97); PMID 12518973. | Cross-cultural survey, N=559 students: US 195, Russia 159, Turkey 94, South Korea 111. | Autonomous motivation for both collectivist and individualist practices predicted well-being across settings. | Students, cross-sectional, four countries, some comparability issues. **Retained as core guardrail: autonomy is volition, not independence. A-FT.** |
| 10 | Cross, S. E., Bacon, P. L., & Morris, M. L. (2000). The relational-interdependent self-construal and relationships. *Journal of Personality and Social Psychology, 78*(4), 791–808. [doi:10.1037/0022-3514.78.4.791](https://doi.org/10.1037/0022-3514.78.4.791); PMID 10794381. | Three programs: Study 1 eight student samples, total N=4,283; Study 2 N=266; Study 3 68 usable female dyads. | Higher RISC predicted close/committed ties, considering others, and observer-perceived openness/responsiveness. | Mostly North American students; Study 3 female strangers, selective usable dyads. **Retained as the decisive healthy-relational-identity counterexample. A-FT.** |
| 11 | Kluwer, E. S., Karremans, J. C., Riedijk, L., & Knee, C. R. (2020). Autonomy in relatedness: How need fulfillment interacts in close relationships. *Personality and Social Psychology Bulletin, 46*(4), 603–616. [doi:10.1177/0146167219867964](https://doi.org/10.1177/0146167219867964); PMID 31390934; PMCID PMC7057354. | Three studies, N=388, 241, and 220. | Relatedness predicted constructive relationship accommodation especially/only when autonomy need fulfillment was high. | Predominantly self-report and observational; accommodation scenarios/intentions do not prove long-term behavior. **Retained as a direct flexible-interdependence test. OA-FT.** |

### B. Contingent worth, self-excluding care, self-silencing, and sacrifice

| # | Full citation / identifier | Design, population, N | Finding retained | Main limitation / why retained / access |
|---:|---|---|---|---|
| 12 | Knee, C. R., Canevello, A., Bush, A. L., & Cook, A. (2008). Relationship-contingent self-esteem and the ups and downs of romantic relationships. *Journal of Personality and Social Psychology, 95*(3), 608–627. [doi:10.1037/0022-3514.95.3.608](https://doi.org/10.1037/0022-3514.95.3.608); PMID 18729698. | Four studies: S1 five samples N=1,661; S2 14-day diary N=198; S3 twice-daily N=94; S4 66 couples (65 analyzed). | RCSE amplified relationship-event valence → momentary self-esteem beyond attachment anxiety and other self/relationship constructs; mutual high RCSE predicted commitment, not satisfaction/closeness. | Nonexperimental, predominantly young US heterosexual and 80%+ women in diary samples. **Retained as strongest direct evidence for relationally contingent worth. A-FT.** |
| 13 | Aubé, J. (2008). Balancing concern for other with concern for self: Links between unmitigated communion, communion, and psychological well-being. *Journal of Personality, 76*(1), 101–134. [doi:10.1111/j.1467-6494.2007.00481.x](https://doi.org/10.1111/j.1467-6494.2007.00481.x); PMID 18186712. | S1 self/peer report N=102 students; S2 community N=94, 10-year follow-up; S3 diary N=78 college women. | Across methods, UC—not communion—was associated with poorer adjustment. | Small samples; attrition/measurement detail require full-text recheck before quoting effects. **Retained for rare longitudinal/multimethod design; only abstract-level conclusions used. ABS.** |
| 14 | Helgeson, V. S., Swanson, J., Ra, O., Randall, H., & Zhao, Y. (2015). Links between unmitigated communion, interpersonal behaviors and well-being: A daily diary approach. *Journal of Research in Personality, 57*, 53–60. [doi:10.1016/j.jrp.2014.12.007](https://doi.org/10.1016/j.jrp.2014.12.007). | Ten-day daily diary, N=79 college students. | UC related to more support provision and interpersonal difficulties; support/over-nurturance related positively to well-being mainly at low UC. | Very small student sample, brief diary, self-report; no causal manipulation. **Retained for within-person nuance; only abstract-level conclusions used. ABS.** |
| 15 | Jack, D. C., & Dill, D. (1992). The Silencing the Self Scale: Schemas of intimacy associated with depression in women. *Psychology of Women Quarterly, 16*(1), 97–106. [doi:10.1111/j.1471-6402.1992.tb00242.x](https://doi.org/10.1111/j.1471-6402.1992.tb00242.x). | Initial scale study: 63 women students, 140 women in battered-women’s shelters, 270 mothers of 4-month-old infants who had used cocaine during pregnancy. | Established STSS/retest/internal consistency and concurrent association with depressive symptoms. | Women-only, highly heterogeneous/clinical-context samples; cross-sectional shared self-report and depression-item overlap. **Retained as foundational measurement, not causal evidence. P-FT/metadata.** |
| 16 | Remen, A. L., Chambless, D. L., & Rodebaugh, T. L. (2002). Gender differences in the construct validity of the Silencing the Self Scale. *Psychology of Women Quarterly, 26*(2), 151–159. [doi:10.1111/1471-6402.00053](https://doi.org/10.1111/1471-6402.00053). | EFA/CFA and validity, 187 women and 169 men undergraduates (N=356). | Limited support for four subscales even among women; among men some items appeared to measure intimacy avoidance/threatened independence. | Student sample; binary gender; cross-sectional. **Retained as essential measurement/gender contradiction. P-FT/metadata.** |
| 17 | Jack, D. C., Brody, L. R., & Sikov, A. (2026). Advancing the next generation of research on self-silencing and depression: A narrative review and synthesis of three decades of research. *Sex Roles, 92*, Article 7. [doi:10.1007/s11199-025-01637-8](https://doi.org/10.1007/s11199-025-01637-8). | Narrative review, 126 eligible STSS studies; 56 mediator/moderator studies tabulated. | Repeated associations with depression, conflict, inequity, and low mutuality; causal order and mechanisms remain unclear. | Narrative rather than systematic risk-of-bias/meta-analysis; few longitudinal studies; author-allegiance and Western/White/heterosexual/binary-gender bias. **Retained as current synthesis and limitation map. OA-FT.** |
| 18 | Righetti, F., Sakaluk, J. K., Faure, R., & Impett, E. A. (2020). The link between sacrifice and relational and personal well-being: A meta-analysis. *Psychological Bulletin, 146*(10), 900–921. [doi:10.1037/bul0000297](https://doi.org/10.1037/bul0000297); PMID 32673005. | Meta-analysis, 82 datasets, 9,547 effects, N=32,053. | Willingness/satisfaction with sacrifice usually positive; enacted sacrifice slightly negative for personal well-being; perceived cost negative. | Heterogeneous definitions; mostly observational/self-report and correlational effects. **Retained as strongest contradiction to “sacrifice is self-erasure.” A-FT.** |
| 19 | Impett, E. A., Gere, J., Kogan, A., Gordon, A. M., & Keltner, D. (2014). How sacrifice impacts the giver and the recipient: Insights from approach–avoidance motivational theory. *Journal of Personality, 82*(5), 390–401. [doi:10.1111/jopy.12070](https://doi.org/10.1111/jopy.12070); PMID 24007506. | 80 dating couples; observed sacrifice discussion, 14-day diary, 3-month follow-up. | Approach motives predicted better giver/recipient emotion and relationship outcomes; avoidance motives predicted worse outcomes. | Motives not randomized; young Bay Area couples (75 heterosexual, 4 lesbian, 1 gay). **Retained for dyadic, prospective motive specificity. A-FT.** |

### C. Dependency, reassurance, attachment, and caregiving

| # | Full citation / identifier | Design, population, N | Finding retained | Main limitation / why retained / access |
|---:|---|---|---|---|
| 20 | Pincus, A. L., & Wilson, K. R. (2001). Interpersonal variability in dependent personality. *Journal of Personality, 69*(2), 223–251. [doi:10.1111/1467-6494.00143](https://doi.org/10.1111/1467-6494.00143); PMID 11339797. | S1 validation samples N=921 and 472; S2 subtype comparison samples N=103 and 122. | Submissive dependency linked fearful/pathological attachment and loneliness; love dependency linked more secure/affiliative patterns. | Cross-sectional self-report and selected subtype groups; taxonomy requires replication across cultures/clinical groups. **Retained because it decomposes “dependency.” P-FT/metadata.** |
| 21 | Bornstein, R. F., Geiselman, K. J., Eisenhart, E. A., & Languirand, M. A. (2002). Construct validity of the Relationship Profile Test: Links with attachment, identity, relatedness, and affect. *Assessment, 9*(4), 373–381. [doi:10.1177/1073191102238195](https://doi.org/10.1177/1073191102238195); PMID 12462757. | Psychometric/construct-validation study, 90 college students (50 women, 40 men). | Destructive overdependence, dysfunctional detachment, and healthy dependency showed distinguishable expected correlates. | Small, author-developed, student self-report validation. **Retained as direct evidence that dependence is multidimensional. A-FT.** |
| 22 | Starr, L. R., & Davila, J. (2008). Excessive reassurance seeking, depression, and interpersonal rejection: A meta-analytic review. *Journal of Abnormal Psychology, 117*(4), 762–775. [doi:10.1037/a0013866](https://doi.org/10.1037/a0013866); PMID 19025224. | Meta-analysis: 38 studies, aggregate N=6,973 for depression; 16-study rejection analysis. | ERS–depression mean r≈.32; ERS–rejection mean r≈.14, stronger for target self-report than informant report; prospective evidence mixed. | Mostly college/cross-sectional, heterogeneous “rejection,” one dominant brief ERS measure/research tradition. **Retained as best quantitative test and major contradiction to a deterministic loop. A-FT.** |
| 23 | Shaver, P. R., Schachner, D. A., & Mikulincer, M. (2005). Attachment style, excessive reassurance seeking, relationship processes, and depression. *Personality and Social Psychology Bulletin, 31*(3), 343–359. [doi:10.1177/0146167204271709](https://doi.org/10.1177/0146167204271709); PMID 15657450. | S1 72 couples; S2 61 couples plus 14-day diary. | Attachment anxiety largely accounted for ERS–depression overlap; ERS was partner-observable, but daily relationship effects varied by anxiety/gender and were not uniformly harmful. | Young unmarried couples, modest N, much mediation cross-sectional, multiple moderation tests. **Retained for dyadic process and contradiction. A-FT.** |
| 24 | Feeney, J. A. (1996). Attachment, caregiving, and marital satisfaction. *Personal Relationships, 3*(4), 401–416. [doi:10.1111/j.1475-6811.1996.tb00124.x](https://doi.org/10.1111/j.1475-6811.1996.tb00124.x). | Couple survey, 229 married couples. | Secure attachment associated with responsive rather than compulsive caregiving; caregiving related to satisfaction, with gender/marriage-length moderation. | Cross-sectional self-report; established marriages; dated binary-gender design. **Retained as foundational adult compulsive-caregiving operationalization; broad claims limited to abstract/metadata. ABS.** |
| 25 | Feeney, B. C., & Collins, N. L. (2003). Motivations for caregiving in adult intimate relationships: Influences on caregiving behavior and relationship functioning. *Personality and Social Psychology Bulletin, 29*(8), 950–968. [doi:10.1177/0146167203252807](https://doi.org/10.1177/0146167203252807); PMID 15189615. | 202 young couples enrolled, 194 analyzed; Time 1 motive/style measures, Time 2 at 2–3 months. | Distinct motives predicted distinct care patterns; responsive care predicted recipient trust/satisfaction and later functioning; compulsive/controlling care was separable. | Mostly heterosexual, mean age about 19; new self-report scales; short follow-up; no randomized caregiving. **Retained as the most direct motive→care-style evidence. A-FT.** |

---

## Domain C. Dyadic regulation, temporal coupling, recurrence, rigidity, and dynamical methods (24)

For compactness, the evidence table is followed by its matching full-citation list. Row order and reference-list order are identical; together they constitute the complete record. “Attractor” evidence here means an operational recurrent region or return tendency in an explicitly modeled interaction space, not a literal neural basin or an inevitable relationship fate.

## Compact verified source register (24 core sources)

**Access codes:** **FT** = full text directly consulted; **OA-FT** = open full text; **A+** = abstract/metadata plus result cross-checked against a full review or author manuscript. Abstract-only sources are used only for claims contained in the abstract, not for unreported fine-grained interpretation.

| Source | Design; population; N | Principal result relevant here | Major limitation / why it matters | Access |
|---|---|---|---|---|
| Butler (2011) | Major theoretical/method review; no N | Defines emotions in relationships as temporal interpersonal systems and organizes within- and cross-person dynamics. | Framework, not proof of any particular loop. Supplies the legitimate conceptual bridge to temporal dyadic analysis. | A+ |
| Butler & Randall (2013) | Focused theoretical synthesis; no N | Distinguishes stabilizing coregulation from broader covariation and dysregulation; emphasizes bidirectionality and dynamics. | Terminology is not standardized across fields. Essential for preventing “coregulation = good synchrony.” | A+ |
| Timmons et al. (2015) | Literature review of 24 couple studies | Physiological linkage varies by signal/task and can accompany positive or negative functioning; longitudinal evidence was sparse. | Heterogeneous, mostly small studies; predates recent work. Best couple-specific caution. | OA-FT |
| Palumbo et al. (2017) | Systematic review of interpersonal autonomic physiology | Documents widespread but methodologically fragmented linkage findings and major statistical/confounding problems. | Broad dyad types, not exclusively couples. Grounds warnings about common input, modality, and analytic choice. | A+ (repository manuscript/appendices and metadata checked) |
| Mayo et al. (2021) | Systematic review and two meta-analyses | Relationship association small/nonsignificant overall (*r* ≈ .09) with high heterogeneity (*I*² = 76%); modality mattered. | Diverse contexts/outcomes and methods. Strongest direct rebuttal to “synchrony = health.” | A+ (publisher full results/abstract) |
| Hollenstein (2007) | Methods review; no N | Explains SSG construction and metrics for synchronized event sequences, including operational attractor/rigidity measures. | SSG summaries depend on coding, duration, and state definitions; not classical attractor proof. Methodological anchor. | FT |
| Bringmann et al. (2018) | Simulation plus idiographic daily affect series from one heterosexual couple | Time-varying VAR can recover changing cross-partner effects that stationary models conceal; stable systems are estimated better by simpler VAR. | One empirical dyad; long series needed. Demonstrates model-dependence and nonstationarity risk. | FT |
| Grumi et al. (2022) | Systematic/narrative review of 16 parent-child SSG studies | Adaptive interaction appears to combine organization with context-appropriate flexibility; findings vary by development and context. | Small, heterogeneous developmental literature; little adult generalization. Current synthesis of SSG family evidence. | A+ |
| Reed et al. (2015) | Laboratory coupled-oscillator study; 39 heterosexual couples | Valence dynamics during health discussions differed by couple body-weight configuration; some patterns damped, others amplified. | Small, exploratory, culturally/gender specific; BMI configuration is not codependency. Directly shows why linkage valence must be estimated. | OA-FT |
| Randall et al. (2021) | Laboratory CLO model; 42 different-gender couples (84 people) | Recalled stress damped in both partners; men's stress was coupled to women's. Negative, not positive, perceived dyadic coping moderated dynamics; hypotheses were not explicitly supported. | Small/underpowered, self-reported global coping, recalled dial ratings, oscillatory-model assumption. Direct test of stress/support dynamics and an important null. | FT |
| Zee & Bolger (2023) | Dyadic laboratory experiment with Bayesian dynamical modeling; 101 romantic couples | Stabilizing cardiovascular oscillator dynamics were stronger in support than control discussions, especially when men received support; large between-dyad heterogeneity. | One laboratory session, young/heterosexual sampling limits, model-specific equilibrium language. Best direct support for context-sensitive short-term stabilization. | A+ (OA methods paper and published abstract checked) |
| DiGiovanni et al. (2024) | Two dyadic experiments; 147 friend dyads and 113 romantic dyads | Significant PEP covariation, but co-rumination manipulation did not increase it; friends showed more than romantic partners; some dyads had negative covariation. | Homogeneous samples; sympathetic covariation only. Large direct contradiction to a simple synchrony/harm story. | A+ (publisher report and open methods/materials checked) |
| Reed et al. (2013) | Laboratory physiology/observation; 44 heterosexual couples (88 people) | Partner influence and demand-withdraw shifted blood-pressure linkage from anti-phase toward in-phase; effects were not uniform across IBI/skin conductance. | Cross-sectional, small, lab task; no health or agency outcome. Connects attempted influence to phase-specific linkage without proving control. | A+ (author manuscript and abstract checked) |
| Helm et al. (2014) | Cross-lagged panel study; 32 romantic couples | Each partner's RSA was associated with the other's prior RSA; linkage was stronger with higher relationship satisfaction. | Very small sample, repeated observations do not replace dyad N, causal direction unresolved. Evidence that lagged physiological interdependence can be salutary in context. | A+ |
| Levenson & Gottman (1983) | Laboratory conflict/neutral discussion; 30 married couples | Physiological linkage was greater during conflict and in less satisfied couples than during neutral interaction. | Small, dated/homogeneous sample, composite physiology and shared task effects. Foundational counterexample to “more linkage = better.” | A+ (full result checked via review) |
| Liu et al. (2013) | Naturalistic cortisol diary; 19 heterosexual married couples, 4 samples/day for 4 days | Same-day diurnal slope synchrony; CAR synchrony under greater strain/disagreement; no significant next-day cross-lag partner effects. | Tiny sample and shared daily environment; short observation. Explicitly shows synchrony without demonstrated partner influence. | OA-FT |
| Butler et al. (2014) | SSG laboratory study; 26 couples where one or both smoked | During health disagreements, emotion and protect-versus-engage intentions formed different successful/worsening sequences across single- and dual-smoker couples and smoking conditions. | Tiny exploratory sample, subjective continuous ratings, smoking condition not long-term maintenance. Direct bridge from coping sequences to symptom-embedded dyadic regulation. | FT |
| Brinberg et al. (2025) | SSG illustration/empirical support conversations; 81 friend dyads | Dyads spent 59% of turns in a predefined problem-description attractor; entropy, attractor proportion, and exit timing generally did not predict emotional improvement/support quality. | Illustrative, cross-sectional, friend rather than romantic dyads; attractor set a priori. Crucial demonstration that operational attractors need not be maladaptive or outcome-relevant. | FT |
| Hollenstein et al. (2004) | Prospective observational family study; initial N=270, up to 240 observed parent-child dyads | Rigidity modestly predicted high/increasing externalizing trajectories across four assessments; content did not fully account for structure. | Small correlations, rigidity indicators weakly interrelated, at-risk child sample. Strongest prospective repertoire-rigidity evidence, but indirect for adult couples. | FT |
| Lunkenheimer et al. (2011) | Longitudinal observation; 163 mother-child and 94 father-child dyads at age 3, outcomes age 5.5 | Flexibility × positive affect predicted lower teacher-rated externalizing; mother/father flexibility main effects diverged. | Oversampled child risk, largely White/married/educated families, short task. Shows flexibility is content- and role-dependent. | OA-FT |
| Granic & Lamey (2002) | Perturbation study; 33 clinically referred mother-child dyads, children 8–12 | After a wrap-up signal, comorbid dyads shifted from permissiveness to mutual hostility; externalizing-only dyads remained permissive. | Tiny all-clinical sample, no normative group or causal mechanism. Direct evidence that perturbations can reveal distinct state reorganization. | FT |
| Granic et al. (2007) | Pre/post “real-world” PMT+CBT study; 38 parent-child dyads (34 boys), ages 7–11 | 20 clinician-defined improvers increased all three flexibility metrics; 18 non-improvers decreased. | No randomized/control group, small, improver grouping, clinician outcome; parent CBCL did not show the same association. Promising change evidence, not proof. | FT |
| Lichtwarck-Aschoff et al. (2012) | Six-wave treatment-process study using categorical RQA; 41 mother-child dyads (40 boys) | An entropy-peak class (20 dyads) contained more clinician-rated improvers than the no-peak class; affect content did not distinguish groups. | Uncontrolled, tiny latent-class analysis, clinician-only focal outcome, limited treatment-fidelity data. Ceiling is “phase-transition-like profile.” | FT |
| Dishion et al. (2012) | Prospective community family observation; 998 adolescents/families, age 16–17 interaction to 18–19 outcome | Conflict-bout duration discriminated outcome groups; peaceful-resolution content combined with low transition entropy predicted low later antisocial behavior. | Observational and content-specific; “attractor” operationalized from observed interaction. Key contradiction to “low entropy/rigidity always bad.” | OA-FT |

---

## 10. Curated references

1. Brinberg, M., Solomon, D. H., Bodie, G. D., Jones, S. M., & Ram, N. (2025). Using state space grids to quantify and examine dynamics of dyadic conversation. *Communication Methods and Measures, 19*(1), 1–23. https://doi.org/10.1080/19312458.2024.2413973
2. Bringmann, L. F., Ferrer, E., Hamaker, E. L., Borsboom, D., & Tuerlinckx, F. (2018). Modeling nonstationary emotion dynamics in dyads using a time-varying vector-autoregressive model. *Multivariate Behavioral Research, 53*(3), 293–314. https://doi.org/10.1080/00273171.2018.1439722
3. Butler, E. A. (2011). Temporal interpersonal emotion systems: The “TIES” that form relationships. *Personality and Social Psychology Review, 15*(4), 367–393. https://doi.org/10.1177/1088868311411164
4. Butler, E. A., Hollenstein, T., Shoham, V., & Rohrbaugh, M. J. (2014). A dynamic state-space analysis of interpersonal emotion regulation in couples who smoke. *Journal of Social and Personal Relationships, 31*(7), 907–927. https://doi.org/10.1177/0265407513508732
5. Butler, E. A., & Randall, A. K. (2013). Emotional coregulation in close relationships. *Emotion Review, 5*(2), 202–210. https://doi.org/10.1177/1754073912451630
6. DiGiovanni, A. M., Peters, B. J., Tudder, A., Gresham, A. M., & Bolger, N. (2024). Physiological synchrony in supportive discussions: An examination of co-rumination, relationship type, and heterogeneity. *Psychophysiology, 61*(7), e14554. https://doi.org/10.1111/psyp.14554
7. Dishion, T. J., Forgatch, M., Van Ryzin, M. J., & Winter, C. (2012). The nonlinear dynamics of family problem solving in adolescence: The predictive validity of a peaceful resolution attractor. *Nonlinear Dynamics, Psychology, and Life Sciences, 16*(3), 331–352. PMID: https://pubmed.ncbi.nlm.nih.gov/22695152/ ; full text: https://pmc.ncbi.nlm.nih.gov/articles/PMC3547648/
8. Granic, I., & Lamey, A. V. (2002). Combining dynamic systems and multivariate analyses to compare the mother-child interactions of externalizing subtypes. *Journal of Abnormal Child Psychology, 30*(3), 265–283. https://doi.org/10.1023/A:1015106913866
9. Granic, I., O'Hara, A., Pepler, D., & Lewis, M. D. (2007). A dynamic systems analysis of parent-child changes associated with successful “real-world” interventions for aggressive children. *Journal of Abnormal Child Psychology, 35*, 845–857. https://doi.org/10.1007/s10802-007-9133-4
10. Grumi, S., Pettenati, G., Manfredini, V., & Provenzi, L. (2022). Flexibility and organization in parent-child interaction through the lens of the dynamic system approach: A systematic review of State Space Grid studies. *Infant Behavior and Development, 67*, 101722. https://doi.org/10.1016/j.infbeh.2022.101722
11. Helm, J. L., Sbarra, D. A., & Ferrer, E. (2014). Coregulation of respiratory sinus arrhythmia in adult romantic partners. *Emotion, 14*(3), 522–531. https://doi.org/10.1037/a0035960
12. Hollenstein, T. (2007). State space grids: Analyzing dynamics across development. *International Journal of Behavioral Development, 31*(4), 384–396. https://doi.org/10.1177/0165025407077765
13. Hollenstein, T., Granic, I., Stoolmiller, M., & Snyder, J. (2004). Rigidity in parent-child interactions and the development of externalizing and internalizing behavior in early childhood. *Journal of Abnormal Child Psychology, 32*(6), 595–607. https://doi.org/10.1023/B:JACP.0000047209.37650.41
14. Levenson, R. W., & Gottman, J. M. (1983). Marital interaction: Physiological linkage and affective exchange. *Journal of Personality and Social Psychology, 45*(3), 587–597. https://doi.org/10.1037/0022-3514.45.3.587
15. Lichtwarck-Aschoff, A., Hasselman, F., Cox, R., Pepler, D., & Granic, I. (2012). A characteristic destabilization profile in parent-child interactions associated with treatment efficacy for aggressive children. *Nonlinear Dynamics, Psychology, and Life Sciences, 16*(3), 353–379. PMID: https://pubmed.ncbi.nlm.nih.gov/22695153/
16. Liu, S., Rovine, M. J., Cousino Klein, L., & Almeida, D. M. (2013). Synchrony of diurnal cortisol pattern in couples. *Journal of Family Psychology, 27*(4), 579–588. https://doi.org/10.1037/a0033735
17. Lunkenheimer, E. S., Olson, S. L., Hollenstein, T., Sameroff, A. J., & Winter, C. (2011). Dyadic flexibility and positive affect in parent-child coregulation and the development of child behavior problems. *Development and Psychopathology, 23*(2), 577–591. https://doi.org/10.1017/S095457941100006X
18. Mayo, O., Lavidor, M., & Gordon, I. (2021). Interpersonal autonomic nervous system synchrony and its association to relationship and performance—A systematic review and meta-analysis. *Physiology & Behavior, 235*, 113391. https://doi.org/10.1016/j.physbeh.2021.113391
19. Palumbo, R. V., Marraccini, M. E., Weyandt, L. L., Wilder-Smith, O., McGee, H. A., Liu, S., & Goodwin, M. S. (2017). Interpersonal autonomic physiology: A systematic review of the literature. *Personality and Social Psychology Review, 21*(2), 99–141. https://doi.org/10.1177/1088868316628405
20. Randall, A. K., Tao, C., Leon, G., & Duran, N. D. (2021). Couples' co-regulation dynamics as a function of perceived partner dyadic coping. *Anxiety, Stress, & Coping, 34*(6), 597–611. https://doi.org/10.1080/10615806.2021.1912740
21. Reed, R. G., Barnard, K., & Butler, E. A. (2015). Distinguishing emotional coregulation from codysregulation: An investigation of emotional dynamics and body weight in romantic couples. *Emotion, 15*(1), 45–60. https://doi.org/10.1037/a0038561
22. Reed, R. G., Randall, A. K., Post, J. H., & Butler, E. A. (2013). Partner influence and in-phase versus anti-phase physiological linkage in romantic couples. *International Journal of Psychophysiology, 88*(3), 309–316. https://doi.org/10.1016/j.ijpsycho.2012.08.009
23. Timmons, A. C., Margolin, G., & Saxbe, D. E. (2015). Physiological linkage in couples and its implications for individual and interpersonal functioning: A literature review. *Journal of Family Psychology, 29*(5), 720–731. https://doi.org/10.1037/fam0000115
24. Zee, K. S., & Bolger, N. (2023). Physiological coregulation during social support discussions. *Emotion, 23*(3), 825–843. https://doi.org/10.1037/emo0001107

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## Domain D. When Care Becomes Control: accommodation, reassurance, substitution, and calibrated support (19 additional sources)

This domain adds only records not already retained in Domain B. Starr and Davila (2008), Shaver et al. (2005), and Feeney and Collins (2003) are cross-domain anchors recorded once in Domain B. The 19 records below retain the experimental, prospective, treatment, measurement, and contradiction evidence needed for the care-to-control analysis.
## Accommodation and its direction of effect

### D1. Calvocoressi et al. (1999)

**Full citation:** Calvocoressi, L., Mazure, C. M., Kasl, S. V., Skolnick, J., Fisk, D., Vegso, S. J., Van Noppen, B. L., & Price, L. H. (1999). Family accommodation of obsessive-compulsive symptoms: Instrument development and assessment of family behavior. *The Journal of Nervous and Mental Disease, 187*(10), 636–642. https://doi.org/10.1097/00005053-199910000-00008 (PMID: 10535658).

- **Study type / population / N:** Psychometric and cross-sectional study of 36 adults with OCD and their primary family caregivers.
- **Principal finding:** The interviewer-rated Family Accommodation Scale showed strong interrater agreement, good internal consistency, and clinically coherent convergent/discriminant associations; accommodation related to symptom severity and impairment.
- **Major limitation:** Very small clinical sample, cross-sectional design, and reports vulnerable to patient/relative distress and shared context; it validates measurement more securely than causal theory.
- **Why it matters:** It provides the foundational operational shift from a global “codependent family” label to specific, measurable behaviors such as ritual participation, routine modification, avoidance facilitation, and reassurance.

### D2. Wu et al. (2016)

**Full citation:** Wu, M. S., McGuire, J. F., Martino, C., Phares, V., Selles, R. R., & Storch, E. A. (2016). A meta-analysis of family accommodation and OCD symptom severity. *Clinical Psychology Review, 45*, 34–44. https://doi.org/10.1016/j.cpr.2016.03.003 (PMID: 27019367).

- **Study type / population / N:** Meta-analysis of 41 studies spanning child, adolescent, and adult OCD samples.
- **Principal finding:** Accommodation had a moderate association with OCD severity (approximately *r* = .42). Number of accommodation-scale items moderated effect size; most demographic and clinical moderators did not.
- **Major limitation:** Primary studies were predominantly cross-sectional and self-report/relative-report; measurement and sample heterogeneity were substantial, so direction and mechanism could not be established.
- **Why it matters:** It establishes the robustness of the accommodation–severity association while making clear that an association is not proof that family behavior causes or maintains OCD.

### D3. Hermida-Barros et al. (2024)

**Full citation:** Hermida-Barros, L., Primé-Tous, M., García-Delgar, B., Forcadell, E., Lera-Miguel, S., Fernández de la Cruz, L., Vieta, E., Radua, J., Lázaro, L., & Fullana, M. A. (2024). Family accommodation in obsessive-compulsive disorder: An updated systematic review and meta-analysis. *Neuroscience & Biobehavioral Reviews, 161*, 105678. https://doi.org/10.1016/j.neubiorev.2024.105678 (PMID: 38621516).

- **Study type / population / N:** Preregistered systematic review and meta-analysis of 108 studies and 8,928 children, adolescents, and adults with OCD.
- **Principal finding:** Accommodation levels were moderate and correlated with severity (*r* = .42). Baseline accommodation did not predict pre–post OCD improvement (*g* = −.03). Accommodation decreased during individual CBT (*g* = 2.00) and family-focused CBT (*g* = 1.17).
- **Major limitation:** The corpus remains dominated by observational designs with heterogeneous measures and interventions. Declining accommodation may cause, follow, or co-occur with symptom improvement.
- **Why it matters:** This is the principal contemporary adjudication and the most important contradiction to a simple maintenance claim: robust covariation coexists with weak evidence that baseline accommodation determines treatment change.

### D4. Boeding et al. (2013)

**Full citation:** Boeding, S. E., Paprocki, C. M., Baucom, D. H., Abramowitz, J. S., Wheaton, M. G., Fabricant, L. E., & Fischer, M. S. (2013). Let me check that for you: Symptom accommodation in romantic partners of adults with obsessive-compulsive disorder. *Behaviour Research and Therapy, 51*(6), 316–322. https://doi.org/10.1016/j.brat.2013.03.002 (PMID: 23567474).

- **Study type / population / N:** Observational pre–post study embedded in a 16-session couple-based CBT trial; 20 adult OCD patients and romantic partners.
- **Principal finding:** Greater accommodation covaried with greater symptoms and lower partner (not patient) relationship satisfaction at baseline; higher post-treatment accommodation was associated with poorer treatment response.
- **Major limitation:** Tiny, uncontrolled treatment sample; 19 of 20 identified patients were women; post-treatment association does not determine whether accommodation impeded recovery or persisted because symptoms did.
- **Why it matters:** It is one of the few direct studies of romantic-partner accommodation in adult OCD, the closest clinical population to the lecture's partner-level claims.

### D5. Thompson-Hollands et al. (2015)

**Full citation:** Thompson-Hollands, J., Abramovitch, A., Tompson, M. C., & Barlow, D. H. (2015). A randomized clinical trial of a brief family intervention to reduce accommodation in obsessive-compulsive disorder: A preliminary study. *Behavior Therapy, 46*(2), 218–229. https://doi.org/10.1016/j.beth.2014.11.001 (PMID: 25645170; PMCID: PMC4748371).

- **Study type / population / N:** Preliminary randomized adjunctive trial of 18 adults with OCD and 18 involved relatives. All patients received exposure and response prevention; relatives received a two-session accommodation-focused intervention or no family intervention.
- **Principal finding:** At week eight, the family intervention produced large between-condition differences in accommodation (*d* = 1.05) and OCD symptoms (*d* = 1.27); earlier accommodation change predicted later symptom change (standardized β = .45).
- **Major limitation:** Extremely underpowered, 94% White, and a multi-component adjunct whose active ingredient could not be isolated. Effect estimates are unstable and require replication.
- **Why it matters:** It is rare experimental evidence that changing a relative's response can improve outcomes beyond individual treatment, while its scale prevents declaring the mechanism settled.

### D6. Kelley et al. (2024)

**Full citation:** Kelley, K. N., Caporino, N. E., & Falkenstein, M. J. (2024). Family accommodation in intensive/residential treatment for adults with OCD: A cross-lagged panel analysis. *Behavior Therapy, 55*(2), 391–400. https://doi.org/10.1016/j.beth.2023.07.012 (PMID: 38418048).

- **Study type / population / N:** Longitudinal cross-lagged study of adults in intensive/residential OCD treatment; 315 at admission and 111 with discharge, one-month, and six-month follow-up data.
- **Principal finding:** Symptom improvement from admission to discharge predicted lower accommodation from discharge to one month; increasing accommodation from discharge to one month predicted increasing symptoms from one to six months.
- **Major limitation:** Selected high-severity treatment population, large follow-up attrition, patient-reported accommodation, active treatment confounding, and limitations of traditional cross-lagged models for within-person causal inference.
- **Why it matters:** It supports bidirectionality in adults: symptoms can organize family behavior, while later accommodation may also precede worsening.

### D7. Bertelsen et al. (2023)

**Full citation:** Bertelsen, T. B., Himle, J. A., & Håland, Å. T. (2023). Bidirectional relationship between family accommodation and youth anxiety during cognitive-behavioral treatment. *Child Psychiatry & Human Development, 54*(3), 905–912. https://doi.org/10.1007/s10578-021-01304-5 (PMID: 34997892; PMCID: PMC10140011).

- **Study type / population / N:** Ten-session cross-lagged panel study of 73 youths receiving CBT for anxiety disorders, including 17 with OCD.
- **Principal finding:** Prior-session accommodation predicted slightly greater next-session anxiety (β = .11, 95% CI [.06, .17]), while prior anxiety more strongly predicted subsequent accommodation (β = .23, 95% CI [.08, .38]).
- **Major limitation:** Youth rather than adult sample, mixed diagnoses, active-treatment context, no untreated comparison, and informant/method constraints.
- **Why it matters:** It is one of the strongest temporal tests and directly prevents family-blaming: distress appears to recruit accommodation at least as much as accommodation precedes distress.

### D8. Stewart et al. (2020)

**Full citation:** Stewart, K. E., Sumantry, D., & Malivoire, B. L. (2020). Family and couple integrated cognitive-behavioural therapy for adults with OCD: A meta-analysis. *Journal of Affective Disorders, 277*, 159–168. https://doi.org/10.1016/j.jad.2020.07.140 (PMID: 32828003).

- **Study type / population / N:** Meta-analysis of 15 publications representing 16 independent adult OCD samples; only ten samples included follow-up.
- **Principal finding:** Integrated treatments were associated with improvement in OCD symptoms, depression, anxiety, functioning, relationship outcomes, and accommodation, with preliminary evidence of benefit beyond individual exposure and response prevention.
- **Major limitation:** Small evidence base, lenient inclusion criteria, subjective moderator coding, heterogeneous and frequently uncontrolled designs; pooled pre–post change can overstate treatment-specific effects.
- **Why it matters:** It is the key counterexample to the idea that family involvement itself maintains illness. Deliberately structured involvement can be part of effective treatment.

## Reassurance and interpersonal relief

### D9. Kobori and Salkovskis (2013)

**Full citation:** Kobori, O., & Salkovskis, P. M. (2013). Patterns of reassurance seeking and reassurance-related behaviours in obsessive-compulsive disorder and anxiety disorders. *Behavioural and Cognitive Psychotherapy, 41*(1), 1–23. https://doi.org/10.1017/S1352465812000665 (PMID: 22948342).

- **Study type / population / N:** Questionnaire-development and cross-sectional comparison of 153 adults with OCD, 50 with panic disorder, and 52 healthy controls (total *N* = 255).
- **Principal finding:** The Reassurance Seeking Questionnaire showed acceptable reliability/validity; both clinical groups sought more reassurance, while OCD showed greater intensity, carefulness, and self-reassurance.
- **Major limitation:** Self-report and cross-sectional design using a newly developed measure; elevated reassurance may be a consequence, correlate, or maintaining response.
- **Why it matters:** It distinguishes clinically repetitive reassurance from ordinary information and comfort and gives the lecture an operational rather than moral vocabulary.

### D10. Salkovskis and Kobori (2015)

**Full citation:** Salkovskis, P. M., & Kobori, O. (2015). Reassuringly calm? Self-reported patterns of responses to reassurance seeking in obsessive compulsive disorder. *Journal of Behavior Therapy and Experimental Psychiatry, 49*(Part B), 203–208. https://doi.org/10.1016/j.jbtep.2015.09.002 (PMID: 26433701).

- **Study type / population / N:** Retrospective episode study of 153 adults with OCD, 50 with panic disorder, and 52 healthy controls.
- **Principal finding:** Clinical participants reported immediate relief after reassurance followed by renewed discomfort and urges to seek reassurance; the healthy group did not report the same rebound pattern.
- **Major limitation:** Episodes were recalled, not observed or experimentally induced; no measure showed that relief increased subsequent response probability.
- **Why it matters:** It supplies the most direct evidence for “relief now, return later,” but also defines the evidential boundary between a compatible pattern and a demonstrated reinforcement mechanism.

### D11. Halldorsson et al. (2016)

**Full citation:** Halldorsson, B., Salkovskis, P. M., Kobori, O., & Pagdin, R. (2016). “I do not know what else to do”: Caregivers' perspective on reassurance seeking in obsessive-compulsive disorder. *Journal of Obsessive-Compulsive and Related Disorders, 8*, 21–30. https://doi.org/10.1016/j.jocrd.2015.11.003.

- **Study type / population / N:** Qualitative thematic analysis of semi-structured interviews with ten UK caregivers of adults with OCD: seven partners, two mothers, and one daughter; nine were women and caregiving duration ranged from 8 to 30 years.
- **Principal finding:** Caregivers described immediate shared relief after reassurance, feeling unable to respond differently, fear of distress or anger, frustration, and relationship costs.
- **Major limitation:** Very small purposive specialist/charity sample, retrospective one-sided narratives, no direct observation, and no prevalence or causal inference.
- **Why it matters:** It is the clearest provider-side evidence for the hypothesized dual-relief mechanism and simultaneously shows why that mechanism must remain a hypothesis rather than a settled loop.

### D12. Causier and Salkovskis (2025)

**Full citation:** Causier, C., & Salkovskis, P. M. (2025). Fighting OCD together: An experimental study of the effectiveness and acceptability of seeking and receiving emotional support for OCD. *Journal of Behavior Therapy and Experimental Psychiatry, 86*, 101987. https://doi.org/10.1016/j.jbtep.2024.101987 (PMID: 39232282).

- **Study type / population / N:** Counterbalanced within-person scenario experiment with 36 adults with OCD who imagined personalized reassurance and emotional-support episodes.
- **Principal finding:** Emotional support reduced anticipated future reassurance urges relative to reassurance and was rated more helpful for emotion management, calming, closeness, and a sense of jointly opposing OCD.
- **Major limitation:** Imagined scenarios, small sample, immediate self-report outcomes, no actual support provider, behavior, symptoms, or follow-up.
- **Why it matters:** It supplies preliminary evidence for a humane alternative: declining certainty need not mean declining emotional connection.

## Capacity substitution, autonomy support, and healthy counterevidence

### D13. Vowels and Carnelley (2022)

**Full citation:** Vowels, L. M., & Carnelley, K. B. (2022). Partner support and goal outcomes: A multilevel meta-analysis and a methodological critique. *European Journal of Social Psychology, 52*(4), 679–694. https://doi.org/10.1002/ejsp.2846.

- **Study type / population / N:** Preregistered multilevel meta-analysis of 195 effect sizes from 36 samples and 10,130 participants in romantic relationships.
- **Principal finding:** Partner support was positively associated with goal outcomes overall (*r* = .25); responsive (*r* ≈ .27) and practical (*r* ≈ .22) support were positive, while negative/controlling/coercive/interfering support was negative (*r* ≈ −.14). Practical support was less strongly related to self-efficacy.
- **Major limitation:** Only about 20% of effects were longitudinal; support and goal measures were often unvalidated or single-item, and recipient progress may elicit support.
- **Why it matters:** This is the strongest quantitative counterweight to a rescue narrative. Most partner support is associated with expansion, not narrowing; the negative signal is concentrated in control and interference.

### D14. Zniva et al. (2017)

**Full citation:** Zniva, R., Pauli, P., & Schulz, S. M. (2017). Overprotective social support leads to increased cardiovascular and subjective stress reactivity. *Biological Psychology, 123*, 226–234. https://doi.org/10.1016/j.biopsycho.2016.12.009 (PMID: 28017786).

- **Study type / population / N:** Randomized laboratory experiment with 44 undergraduates and close friends; recipients received procedural autonomy support, complete solutions (“overprotection”), or no help on arithmetic tasks, followed by a solo stress challenge.
- **Principal finding:** Receiving solutions was followed by greater heart rate, diastolic blood pressure, subjective stress, and lower perceived control during later unaided performance. Procedural support did not produce the same adverse pattern.
- **Major limitation:** Tiny student sample, artificial arithmetic task, brief follow-up, possible evaluative/demand effects, and no evidence about chronic relationships or dependence.
- **Why it matters:** It is the cleanest causal demonstration of capacity substitution: solving a manageable task for someone can impair the immediately subsequent solo attempt relative to scaffolding.

### D15. Koestner et al. (2012)

**Full citation:** Koestner, R., Powers, T. A., Carbonneau, N., Milyavskaya, M., & Chua, S. N. (2012). Distinguishing autonomous and directive forms of goal support: Their effects on goal progress, relationship quality, and subjective well-being. *Personality and Social Psychology Bulletin, 38*(12), 1609–1620. https://doi.org/10.1177/0146167212457075 (PMID: 22930370).

- **Study type / population / N:** Three prospective studies over approximately three months: 62 romantic couples (124 people; 116 completers), 105 female friendship dyads (210; 196 completers), and a broader sample of 426 at baseline with 220 follow-ups.
- **Principal finding:** Autonomy support predicted goal progress, partly through more autonomous goal motivation, and was associated with relationship quality and wellbeing. Directive positive support showed weaker and less consistent benefits.
- **Major limitation:** Predominantly young/student samples, self-reported support and outcomes, substantial attrition in Study 3, and no randomized manipulation of ongoing partner behavior.
- **Why it matters:** It makes “agency-preserving help” concrete: perspective taking and choice support outperform mere instruction even when both are benevolent.

### D16. Feeney (2007)

**Full citation:** Feeney, B. C. (2007). The dependency paradox in close relationships: Accepting dependence promotes independence. *Journal of Personality and Social Psychology, 92*(2), 268–285. https://doi.org/10.1037/0022-3514.92.2.268 (PMID: 17279849).

- **Study type / population / N:** Multi-method studies of adult romantic couples: 115 couples in Study 1 and 165 married couples in Study 2, with 129 at six-month follow-up; methods included partner reports, observation, longitudinal outcomes, and an assistance-response paradigm.
- **Principal finding:** A partner's responsive acceptance of legitimate dependence predicted greater self-efficacy, independent exploration, and goal completion rather than greater helplessness.
- **Major limitation:** Mostly different-gender Pittsburgh-area couples; some longitudinal effects were small; the experimental component manipulated responses to a help request rather than chronic dependency; extreme or needless dependency was not tested.
- **Why it matters:** It is the decisive contradiction to the idea that reliance itself narrows agency. Secure access to care can support exploration and independence.

### D17. Bolger et al. (2000)

**Full citation:** Bolger, N., Zuckerman, A., & Kessler, R. C. (2000). Invisible support and adjustment to stress. *Journal of Personality and Social Psychology, 79*(6), 953–961. https://doi.org/10.1037/0022-3514.79.6.953 (PMID: 11138764).

- **Study type / population / N:** Thirty-two-day daily-diary study of 68 couples in which one partner was preparing for the New York State Bar Examination (2,138 couple-days reported in the focal analyses).
- **Principal finding:** Support reported by providers but not registered by recipients predicted better adjustment, whereas explicitly received support sometimes carried affective costs.
- **Major limitation:** One acute achievement stressor, young different-gender couples, observational visibility, report discrepancies that can reflect memory or interpretation, and possible confounding by support quality.
- **Why it matters:** It shows that the meaning and delivery of help matter; aid that foregrounds incapacity can have different effects from support woven into ordinary interaction.

### D18. Bolger and Amarel (2007)

**Full citation:** Bolger, N., & Amarel, D. (2007). Effects of social support visibility on adjustment to stress: Experimental evidence. *Journal of Personality and Social Psychology, 92*(3), 458–475. https://doi.org/10.1037/0022-3514.92.3.458 (PMID: 17352603).

- **Study type / population / N:** Three randomized experiments with 257 women anticipating a stressful speech; a confederate peer delivered visible or subtle/invisible support.
- **Principal finding:** Subtle support reduced distress without the same efficacy threat or emotional cost sometimes elicited by conspicuous support.
- **Major limitation:** Female student samples, confederates rather than close partners, brief laboratory threat, and manipulations that can mix visibility with evaluation, politeness, or responsiveness.
- **Why it matters:** It supports the mechanism that help may undermine competence through its interpersonal meaning, while not licensing covert management or the claim that visible help is generally harmful.

### D19. Overall et al. (2010)

**Full citation:** Overall, N. C., Fletcher, G. J. O., & Simpson, J. A. (2010). Helping each other grow: Romantic partner support, self-improvement, and relationship quality. *Personality and Social Psychology Bulletin, 36*(11), 1496–1513. https://doi.org/10.1177/0146167210383045 (PMID: 20858888).

- **Study type / population / N:** Study 1 was a 150-person self-report study; Study 2 observed 47 couples discussing self-improvement goals and followed them every three months for one year.
- **Principal finding:** Nurturing and action-facilitating support predicted greater self-improvement and relationship quality; criticism, invalidation, and negative support predicted worse outcomes.
- **Major limitation:** Study 1 was cross-sectional; Study 2 was small, support was not randomized, and excluding dissolved/attrited couples may bias prospective estimates.
- **Why it matters:** It shows that practical involvement can expand capacity when it facilitates the recipient's own action rather than replacing it.

---

## Domain E. Healthy interdependence and capacity-building support (6 additional sources)

Vowels and Carnelley (2022), Feeney (2007), Koestner et al. (2012), Zniva et al. (2017), Causier and Salkovskis (2025), and Kluwer et al. (2020) are already recorded in Domains D or B. The six records below add the directly cited caregiving, secure-base, responsiveness, mixed-outcome, and self-determination anchors without duplicating those entries.
### E1. Feeney (2004): secure-base support as availability, encouragement, and noninterference

**Full citation.** Feeney, B. C. (2004). A secure base: Responsive support of goal strivings and exploration in adult intimate relationships. *Journal of Personality and Social Psychology, 87*(5), 631–648. [https://doi.org/10.1037/0022-3514.87.5.631](https://doi.org/10.1037/0022-3514.87.5.631). PMID: [15535776](https://pubmed.ncbi.nlm.nih.gov/15535776/)

**Study type, population, and N.** Multimethod observational and experimental study of **116 romantic couples**; 108 couples contributed usable observational data, and sample size varied by experimental analysis. Couples discussed one partner's personal goal, and support behavior and recipient outcomes were measured.

**Principal finding.** A partner's secure-base behavior—being available, encouraging exploration, and refraining from unnecessary interference—predicted greater immediate happiness, state self-esteem, and perceived goal attainability in the goal-striving partner. The experimental component provided short-term evidence that the manner of support affects recipients, not merely that satisfied couples report more support.

**Major limitation.** Outcomes were proximal and largely subjective, the interaction was laboratory-based, and the study did not demonstrate durable gains in skill, agency, or goal achievement. The participant pool limits cultural and life-course generalization.

**Why it matters.** It gives the lecture a precise alternative to both withdrawal and rescue: a secure base combines reliable availability with enough noninterference for the other person to act.

### E2. Feeney and Thrush (2010): secure-base support and observed exploration in marriage

**Full citation.** Feeney, B. C., & Thrush, R. L. (2010). Relationship influences on exploration in adulthood: The characteristics and function of a secure base. *Journal of Personality and Social Psychology, 98*(1), 57–76. [https://doi.org/10.1037/a0016961](https://doi.org/10.1037/a0016961). PMID: [20053031](https://pubmed.ncbi.nlm.nih.gov/20053031/); PMCID: [PMC2805473](https://pmc.ncbi.nlm.nih.gov/articles/PMC2805473/)

**Study type, population, and N.** Two-session multimethod study of **167 married couples**, combining self-report, partner report, a videotaped exploration task, and independent behavioral coding.

**Principal finding.** The proposed secure-base components—availability, noninterference, and encouragement—were linked to more constructive exploration and exploratory attitudes. Attachment-related characteristics helped explain who provided and benefited from secure-base behavior.

**Major limitation.** Despite temporal sequencing within the laboratory protocol, the central associations were observational. A structured exploration task is not equivalent to repeated assistance during addiction, severe anxiety, illness, or high-risk decisions.

**Why it matters.** The study moves the idea beyond global relationship satisfaction: support was connected to observable exploratory behavior. It is direct evidence for connection as a platform for action rather than an alternative to action.

### E3. Gleason et al. (2008): received support can increase closeness and distress at the same time

**Full citation.** Gleason, M. E. J., Iida, M., Shrout, P. E., & Bolger, N. (2008). Receiving support as a mixed blessing: Evidence for dual effects of support on psychological outcomes. *Journal of Personality and Social Psychology, 94*(5), 824–838. [https://doi.org/10.1037/0022-3514.94.5.824](https://doi.org/10.1037/0022-3514.94.5.824). PMCID: [PMC3898885](https://pmc.ncbi.nlm.nih.gov/articles/PMC3898885/)

**Study type, population, and N.** Intensive daily-diary study surrounding the New York State bar examination. Final analytic participation was **293 examinees and 290 partners** (472 couples initially agreed); daily observations were collected across a 31-day protocol.

**Principal finding.** On average, received emotional support was associated with greater relationship closeness **and** greater negative mood. Effects varied substantially between people, and the support–closeness and support–distress effects were inversely related. Self-esteem moderated only some effects.

**Major limitation.** Participants were highly educated couples coping with one acute, unusual stressor; support was measured with brief daily items; and the design was observational. On difficult days, distress may elicit support rather than result from it.

**Why it matters.** It blocks a one-dimensional evaluation of care. A response can strengthen connection while simultaneously signaling incapacity, increasing indebtedness, or intensifying distress. Immediate closeness is not sufficient evidence that support expanded capacity.

### E4. Maisel and Gable (2009): responsiveness as the condition under which received support helps

**Full citation.** Maisel, N. C., & Gable, S. L. (2009). The paradox of received social support: The importance of responsiveness. *Psychological Science, 20*(8), 928–932. [https://doi.org/10.1111/j.1467-9280.2009.02388.x](https://doi.org/10.1111/j.1467-9280.2009.02388.x). PMID: [19549083](https://pubmed.ncbi.nlm.nih.gov/19549083/)

**Study type, population, and N.** Daily-experience study of **67 cohabiting romantic couples**.

**Principal finding.** Both visible and invisible support were associated with lower sadness and anxiety and better relationship quality when support was experienced as responsive—that is, understanding, validating, and caring. “More support” alone was not the operative ingredient.

**Major limitation.** The diary study was correlational, used brief measures, and involved a small cohabiting sample. Perceived responsiveness may partly reflect preexisting relationship quality, recipient mood, or successful support rather than a separable causal mechanism.

**Why it matters.** It supplies a necessary calibration principle. The same formal act—advice, reassurance, practical aid—can function differently depending on whether it accurately responds to the recipient's expressed need and preserves dignity and agency.

### E5. Feeney and Collins (2001): observable caregiving and caregiver-side mechanisms

**Full citation.** Feeney, B. C., & Collins, N. L. (2001). Predictors of caregiving in adult intimate relationships: An attachment theoretical perspective. *Journal of Personality and Social Psychology, 80*(6), 972–994. [https://doi.org/10.1037/0022-3514.80.6.972](https://doi.org/10.1037/0022-3514.80.6.972). PMID: [11414378](https://pubmed.ncbi.nlm.nih.gov/11414378/)

**Study type, population, and N.** Multimethod dyadic study of **194 romantic couples**. Questionnaire analyses examined attachment-linked caregiving mechanisms; a laboratory phase experimentally varied one partner's need for support and coded the other's observable support behavior.

**Principal finding.** Attachment style predicted caregiving through social-support knowledge, prosocial orientation, interdependence, trust, and egoistic motivation; the same mechanisms predicted observable support during a specific episode of clear partner need. The paper shows that caregiving behavior reflects caregiver-side motives and capacities as well as recipient distress.

**Major limitation.** The broad attachment and motive pathways were largely observational, the laboratory episode was brief, and the sample was young and culturally narrow. It does not show that caregiving relieves the provider's uncertainty or that provider relief reinforces future intervention.

**Why it matters.** It directly supports the review's carefully qualified claim that intervention may serve functions for the caregiver as well as the recipient, while preserving that the proposed dual-relief loop remains to be tested.

### E6. Ryan and Deci (2017): autonomy as volition, not separateness

**Full citation.** Ryan, R. M., & Deci, E. L. (2017). *Self-determination theory: Basic psychological needs in motivation, development, and wellness*. Guilford Press. ISBN 978-1-4625-2876-9. Stable publisher record: [https://www.guilford.com/books/Self-Determination-Theory/Ryan-Deci/9781462538966](https://www.guilford.com/books/Self-Determination-Theory/Ryan-Deci/9781462538966)

**Study type, population, and N.** Major integrative theoretical monograph synthesizing the self-determination research program; no new participant sample or single pooled N.

**Principal finding.** The framework defines autonomy as volitional, self-endorsed action rather than independence from other people, and treats autonomy, competence, and relatedness as jointly important psychological needs. It distinguishes autonomy support from control while allowing reliance, guidance, and close attachment.

**Major limitation.** A broad theory book is not a direct test of the present relational mechanism. Its component literatures vary in design and setting, and the monograph cannot show that autonomy-supportive caregiving causes long-term expansion of agency in codependent-like dyads.

**Why it matters.** It supplies the conceptual guardrail required by the review: the healthy comparator is not self-sufficiency but supported authorship within connection. The empirical burden for particular support effects remains with the narrower studies in this register.

---

## Domain F. Addiction and the family/partner system (15)

This section retains the sources actually carrying the review's addiction-family claims: construct critique, affected-family experience and wellbeing, significant-other treatment, CRAFT efficacy and heterogeneity, Al-Anon referral, reciprocal partner influence, and the “tough love” safety boundary. Three useful but redundant implementation studies from the working register—Copello et al. (2009), Bischof et al. (2016), and Hellum et al. (2022)—were not retained in the 110-source core.
### F1. Rotunda and Doman (2001): the enabling construct under scrutiny

**Full citation:** Rotunda, R. J., & Doman, K. (2001). Partner enabling of substance use disorders: Critical review and future directions. *The American Journal of Family Therapy, 29*(4), 257–270. https://doi.org/10.1080/01926180126496  
**Identifier note:** Some bibliographic databases retain the legacy alias `10.1080/01926180152588680`; the publisher currently resolves the shorter DOI above.  
**Study type:** Critical narrative review and conceptual analysis.  
**Population / N:** Prior research on partners—especially female partners of men with alcohol problems; no new sample and no pooled N.  
**Principal finding:** The paper separates “enabling” from broad codependency language and argues that partner responses should be operationalized behaviorally. The extant empirical work did not justify treating enabling as a stable spouse type or global pathology.  
**Major limitation:** The reviewed evidence was already small, heterogeneous, gender-skewed, and largely observational; the review predates contemporary intervention and harm-reduction research.  
**Why it matters here:** This is the best direct source for demoting *enabling* from a moral/personality label to a testable question about a particular partner behavior and its contingencies. It prevents the lecture from inferring reinforcement merely because help and continued use co-occur.

### F2. Orford, Copello, Velleman, and Templeton (2010a): SSCS model

**Full citation:** Orford, J., Copello, A., Velleman, R., & Templeton, L. (2010a). Family members affected by a close relative’s addiction: The stress–strain–coping–support model. *Drugs: Education, Prevention and Policy, 17*(sup1), 36–43. https://doi.org/10.3109/09687637.2010.514801  
**Study type:** Seminal theoretical synthesis grounding a multi-study research program.  
**Population / N:** Adult family members affected by relatives’ alcohol or drug misuse across the authors’ program; no new sample or single pooled N in this article.  
**Principal finding:** Addiction in a close relative is framed as a chronic stressor. Strain is shaped by coping and available social support; family members are not assumed to be intrinsically disordered. The model informed the 5-Step Method.  
**Major limitation:** It is a programmatic model rather than a prospective causal test. “Coping” categories can combine behaviors with different functions, and the direction among stress, coping, and strain can be reciprocal.  
**Why it matters here:** It supplies a humane alternative to codependency: attention, behavior, and identity may reorganize under chronic relational stress without constituting a personality defect. It also makes support for the affected family member an outcome in its own right.

### F3. Orford, Velleman, Copello, Templeton, and Ibanga (2010b): lived family experience

**Full citation:** Orford, J., Velleman, R., Copello, A., Templeton, L., & Ibanga, A. (2010b). The experiences of affected family members: A summary of two decades of qualitative research. *Drugs: Education, Prevention and Policy, 17*(sup1), 44–62. https://doi.org/10.3109/09687637.2010.514192  
**Study type:** Qualitative synthesis of a 20-year, multi-country program of interview studies.  
**Population / N:** Partners, parents, siblings, and adult children affected by excessive drinking or drug use; women partners and mothers were most represented. The article does not report a single pooled N.  
**Principal finding:** Recurrent experiences included uncertainty, worry, conflict over money/property, deteriorating relationships, and threats to family life. Coping included putting up with behavior, standing up to it, seeking support, and withdrawing/gaining independence; high-quality support was often lacking.  
**Major limitation:** This is an interpretive synthesis rather than a formal systematic review or longitudinal test. Sampling was help-seeking and gender-imbalanced, and the authors’ claim of a universal core experience exceeds what qualitative recurrence alone can establish.  
**Why it matters here:** It gives empirical texture to “When Care Becomes Control” without pathologizing care. It shows why monitoring, accommodation, withdrawal, and protection may all be understandable adaptations to uncertainty rather than fixed identities.

### F4. Horváth and Urbán (2019): tolerant/inactive coping, burden, and hopelessness

**Full citation:** Horváth, Z., & Urbán, R. (2019). Testing the stress–strain–coping–support (SSCS) model among family members of an alcohol misusing relative: The mediating effect of burden and tolerant-inactive coping. *Addictive Behaviors, 89*, 200–205. https://doi.org/10.1016/j.addbeh.2018.10.010  
**Study type:** Cross-sectional questionnaire study with path/mediation analysis.  
**Population / N:** 168 help-seeking family members of relatives misusing alcohol; mean age 44.61; 87.5% women.  
**Principal finding:** Greater perceived severity of the relative’s alcohol problem was associated with greater burden and tolerant/inactive coping, which in turn were associated with hopelessness; engaged coping showed a moderating effect.  
**Major limitation:** Cross-sectional mediation cannot establish temporal mediation or causality; all central variables were family-member self-report; the help-seeking, overwhelmingly female sample limits generalization. Severity could drive both coping and hopelessness.  
**Why it matters here:** This is direct but noncausal evidence that patterns resembling accommodation/self-sacrifice cluster with burden and reduced perceived possibility. It supports *association*, not the claim that accommodation progressively causes hopelessness.

### F5. Rushton et al. (2023): contemporary family-wellbeing interventions

**Full citation:** Rushton, C., Kelly, P. J., Raftery, D., Beck, A., & Larance, B. (2023). The effectiveness of psychosocial interventions for family members impacted by another’s substance use: A systematic review and meta-analysis. *Drug and Alcohol Review, 42*(4), 960–977. https://doi.org/10.1111/dar.13607  
**Study type:** PRISMA systematic review and meta-analysis of RCTs, non-RCTs, and pre–post studies; preregistered in PROSPERO.  
**Population / N:** 19 studies; 10 contributed to meta-analyses. Family members/concerned others of people using alcohol or other drugs; individual studies ranged from very small pilots to samples over 300.  
**Principal finding:** In three RCTs, individually delivered interventions reduced depression (SMD = 0.50, 95% CI 0.21–0.79) and distress (SMD = 0.28, 95% CI 0.03–0.54). Some pre–post/group analyses suggested improvements in coping and family functioning, but effects varied by outcome and design.  
**Major limitation:** Small samples, substantial risk of bias, heterogeneous interventions/outcomes, sparse long-term follow-up, and reliance on self-report constrain certainty. Several pooled estimates combine only two or three studies; pre–post effects are vulnerable to regression to the mean and history.  
**Why it matters here:** It shows that support can benefit the affected family member directly, not merely turn them into an instrument for changing the person with addiction. It also prevents overclaiming durability or a single active mechanism.

### F6. Merkouris, Rodda, and Dowling (2022): affected-other interventions across addictions

**Full citation:** Merkouris, S. S., Rodda, S. N., & Dowling, N. A. (2022). Affected other interventions: A systematic review and meta-analysis across addictions. *Addiction, 117*(9), 2393–2414. https://doi.org/10.1111/add.15825  
**Study type:** PRISMA systematic review and random-effects meta-analysis of controlled trials; preregistered in PROSPERO.  
**Population / N:** 20 studies in 22 reports; 15 studies contributed to meta-analysis. Mostly partners/spouses affected by alcohol problems, followed by gambling and illicit drugs; no gaming intervention studies.  
**Principal finding:** Against passive controls, interventions improved selected post-treatment outcomes—depression (SMD = −0.48), life satisfaction, coping, marital discord (SMD = −0.40), and treatment entry—but not every affected-other or substance-use outcome. No pooled benefit was detected at 4–11-month follow-up.  
**Major limitation:** No included study was rated low risk of bias; active-comparator trials and mutual-help programs were excluded; outcomes and intervention aims varied; longer-term meta-analyses often contained only two to four studies. Cross-addiction pooling does not guarantee transfer to substance-use contexts.  
**Why it matters here:** It supports the claim that family-directed interventions can change some outcomes while showing that benefits may decay and are not global. It argues for outcome-specific language rather than “the relationship got healthy.”

### F7. Ariss and Fairbairn (2020): involving significant others in SUD treatment

**Full citation:** Ariss, T., & Fairbairn, C. E. (2020). The effect of significant-other involvement in treatment for substance use disorders: A meta-analysis. *Journal of Consulting and Clinical Psychology, 88*(6), 526–540. https://doi.org/10.1037/ccp0000495  
**Study type:** Meta-analysis of RCTs comparing significant-other-involved SUD treatment with active individually based treatment.  
**Population / N:** 16 independent trials; 2,115 adolescents and adults; 77 effect sizes. Significant others included romantic partners, family, and close others.  
**Principal finding:** Significant-other-involved treatment produced a small incremental reduction in substance use/problems over active individual treatment (d = 0.242, 95% CI 0.148–0.336; low heterogeneity), approximately a 5.7% reduction in use frequency, with effects evident 12–18 months after treatment.  
**Major limitation:** Treatment models, substances, ages, and significant-other roles were heterogeneous; aggregate effects cannot identify which relational component worked. Trial efficacy does not validate an “enabling” mechanism, and the literature includes limited demographic/relationship diversity.  
**Why it matters here:** It directly contradicts the idea that dependence on relational support is inherently harmful. Structured involvement can increase capacity and improve outcomes; the issue is the function and design of support, not closeness itself.

### F8. Miller, Meyers, and Tonigan (1999): landmark CRAFT alcohol trial

**Full citation:** Miller, W. R., Meyers, R. J., & Tonigan, J. S. (1999). Engaging the unmotivated in treatment for alcohol problems: A comparison of three strategies for intervention through family members. *Journal of Consulting and Clinical Psychology, 67*(5), 688–697. https://doi.org/10.1037/0022-006X.67.5.688  
**Study type:** Three-arm randomized clinical trial.  
**Population / N:** 130 concerned significant others living with a treatment-refusing problem drinker; mean age about 47; 91% women.  
**Principal finding:** Treatment entry was reported for 64% of identified drinkers in CRAFT, versus 30% after Johnson-style intervention and 13% after Al-Anon facilitation. Entry usually occurred after four to six sessions. Concerned others improved across conditions, not uniquely in CRAFT.  
**Major limitation:** A single specialist research setting, gender-skewed sample, no blinding, and reliance in part on concerned-other reports limit generalization. The primary outcome was treatment entry, not sustained recovery; the Al-Anon arm was therapist-delivered facilitation, not naturalistic Al-Anon participation.  
**Why it matters here:** It is the clearest experimental demonstration that changing a family member’s interpersonal behavior can alter another person’s treatment-seeking probability. It does not show that the family caused drinking or that CRAFT controls later recovery.

### F9. Roozen, de Waart, and van der Kroft (2010): early CRAFT meta-analysis

**Full citation:** Roozen, H. G., de Waart, R., & van der Kroft, P. (2010). Community reinforcement and family training: An effective option to engage treatment-resistant substance-abusing individuals in treatment. *Addiction, 105*(10), 1729–1738. https://doi.org/10.1111/j.1360-0443.2010.03016.x  
**Study type:** Systematic review and random-effects meta-analysis.  
**Population / N:** Four RCTs; 264 concerned significant others of treatment-refusing people with alcohol or drug problems.  
**Principal finding:** CRAFT produced more treatment engagement than Al-Anon/Nar-Anon facilitation (RR = 3.25, 95% CI 2.11–5.02; NNT = 2) and Johnson intervention (RR = 2.15, 95% CI 1.28–3.62; NNT = 3). All three approaches were associated with improvement in concerned-other functioning over six months.  
**Major limitation:** Only four small trials, strong overlap in intervention lineage/research groups, English-language publication restriction, and a treatment-entry rather than recovery endpoint. The precision of pooled ratios should not be mistaken for broad real-world transportability.  
**Why it matters here:** It supports contingency alteration as a practical lever while preserving a crucial contradiction: family wellbeing can improve under several approaches, and treatment entry is not evidence that “rescue” was the disorder’s maintaining cause.

### F10. Archer et al. (2020): heterogeneity in CRAFT effectiveness

**Full citation:** Archer, M., Harwood, H., Stevelink, S., Rafferty, L., & Greenberg, N. (2020). Community reinforcement and family training and rates of treatment entry: A systematic review. *Addiction, 115*(6), 1024–1037. https://doi.org/10.1111/add.14901  
**Study type:** Systematic review with meta-analysis and narrative moderator analysis; controlled and uncontrolled evaluations included.  
**Population / N:** 14 studies, 20 treatment conditions, 691 concerned significant others; predominantly women spouses/parents in North America and Europe.  
**Principal finding:** CRAFT was about twice as effective as controls/comparators for treatment entry overall, but rates varied widely. Combined individual-plus-group delivery had the highest reported rates (77–86%); individual, group, workbook, and gambling adaptations were more variable or lower.  
**Major limitation:** The review combines designs of unequal causal strength, outcome ascertainment was often by concerned-other report, and moderator patterns are study-level and confounded. High rates in intensive formats may partly reflect selection, fidelity, or service integration rather than modality alone.  
**Why it matters here:** It replaces “CRAFT works” with the more accurate “effects depend on implementation, target behavior, relationship, and context.” That conditionality should structure any lecture claim about altering interpersonal contingencies.

### F11. Kirby et al. (2017): what part of CRAFT may be active?

**Full citation:** Kirby, K. C., Benishek, L. A., Kerwin, M. E., Dugosh, K. L., Carpenedo, C. M., Bresani, E., Haugh, J. A., Washio, Y., & Meyers, R. J. (2017). Analyzing components of Community Reinforcement and Family Training (CRAFT): Is treatment entry training sufficient? *Psychology of Addictive Behaviors, 31*(7), 818–827. https://doi.org/10.1037/adb0000306  
**Study type:** Three-arm randomized clinical trial with 4-, 6-, and 9-month follow-up.  
**Population / N:** 115 concerned significant others of treatment-resistant drug users.  
**Principal finding:** Treatment entry was higher after full CRAFT (62%; OR = 2.7) and a shorter Treatment Entry Training package (63%; OR = 2.9) than Al-Anon/Nar-Anon facilitation (37%); full CRAFT and the shorter package did not differ. Identified-person drug use and concerned-other mood/functioning improved over time without between-group differences.  
**Major limitation:** Treatment entry was the clearest differential outcome; substance use and wellbeing were not uniquely improved. The study was not powered to prove formal equivalence between the two active packages, and reports came primarily from concerned significant others.  
**Why it matters here:** It suggests that targeted communication and treatment-invitation skills may account for much of CRAFT’s engagement effect; a larger “care-management” role is not necessarily better. This fits capacity-building rather than indefinite behavioral substitution.

### F12. Siljeholm et al. (2024): CRAFT versus credible counselling

**Full citation:** Siljeholm, O., Edvardsson, K., Bergström, M., & Hammarberg, A. (2024). Community Reinforcement and Family Training versus counselling for parents of treatment-refusing young adults with hazardous substance use: A randomized controlled trial. *Addiction, 119*(5), 915–927. https://doi.org/10.1111/add.16429  
**Study type:** Preregistered randomized superiority trial with an active manualized comparator and 24-week primary endpoint.  
**Population / N:** 113 Swedish parents (92% women) of treatment-refusing young adults aged 18–24; CRAFT n = 58, counselling n = 55.  
**Principal finding:** Treatment entry did not differ: 33% after CRAFT versus 31% after counselling (OR = 0.84, 95% CI 0.35–1.99). Both conditions reported clinically relevant reductions in young-adult substance use; neither changed parental depression, anxiety, or stress.  
**Major limitation:** Recruitment stopped at 70% of the planned sample after an interim futility analysis; delivery moved partly online during COVID-19; outcomes relied on parent reports; this was a parent/young-adult context rather than adult partners.  
**Why it matters here:** It is the strongest recent contradiction to a simple CRAFT-superiority narrative. Structured empathic counselling may reproduce much of the benefit, and a branded contingency intervention is not invariably superior.

### F13. Timko et al. (2022): Al-Anon referral trial

**Full citation:** Timko, C., Grant, K. M., Han, X., Young, L. B., & Cucciare, M. A. (2022). Al-Anon Intensive Referral to facilitate concerned others’ participation in Al-Anon Family Groups: A randomized controlled trial. *Addiction, 117*(3), 590–599. https://doi.org/10.1111/add.15670  
**Study type:** Multisite randomized controlled trial of Al-Anon Intensive Referral (AIR) versus usual care, with 3-, 6-, and 12-month follow-ups.  
**Population / N:** 279 concerned others of patients entering residential AUD treatment in three US sites; 77% women, 33% spouses, 25% parents; 74% retained at 12 months.  
**Principal finding:** AIR did not significantly increase Al-Anon participation over usual care. It was associated with more resources in the concerned-other–patient relationship, but the primary referral/attendance target was null.  
**Major limitation:** The patient was already in residential treatment, usual care could include family education, participation was impossible to blind, and the trial tests an intensive *referral* to Al-Anon—not Al-Anon’s efficacy or naturalistic self-selection into it.  
**Why it matters here:** Recovery-community reach and clinical influence should not be confused with experimental validation. It also illustrates that a relational resource outcome can improve even when the nominal participation mechanism does not.

### F14. Muyingo et al. (2020): longitudinal romantic-partner influence on alcohol use

**Full citation:** Muyingo, L., Smith, M. M., Sherry, S. B., McEachern, E., Leonard, K. E., & Stewart, S. H. (2020). Relationships on the rocks: A meta-analysis of romantic partner effects on alcohol use. *Psychology of Addictive Behaviors, 34*(6), 629–640. https://doi.org/10.1037/adb0000578  
**Study type:** Traditional meta-analysis plus two-stage meta-analytic structural equation modeling of longitudinal dyadic studies.  
**Population / N:** 17 studies; 10,553 romantic couples assessed at least twice. The underlying literature was largely different-sex couples.  
**Principal finding:** Each partner’s earlier alcohol use predicted the other’s later use after accounting for prior use. Average effects were small: women-to-men β = .19 and men-to-women β = .12, with the former statistically larger. Time lag, alcohol measure, marital status, and publication year moderated estimates.  
**Major limitation:** Observational cross-lagged associations do not eliminate assortative mating, shared environments, time-varying confounding, or measurement error; small average effects do not identify whether influence involved support, modeling, access, conflict, or accommodation.  
**Why it matters here:** It is direct evidence for reciprocal influence and against a purely individual model, but it sets the appropriate scale: coupling exists and is modest, not literal control by one nervous system over another.

### F15. Hawkins et al. (2026; online 2025): “tough love” in a toxic drug supply

**Full citation:** Hawkins, J., Salmon, A., Fernando, S., Battle, C., Esau, S., Snyder, D., & Sikora, M. (2026). “I don’t know what we should have done differently”: A qualitative study on the dilemmas of “tough love” and toxic drugs in British Columbia, Canada. *Drugs: Education, Prevention and Policy, 33*(2), 156–165. Advance online publication 2 May 2025. https://doi.org/10.1080/09687637.2025.2493140  
**Study type:** Community-based participatory qualitative study using semi-structured interviews.  
**Population / N:** 22 concerned significant others in British Columbia during the unregulated toxic-drug emergency.  
**Principal finding:** “Tough love” was not a uniform practice. Decisions about engagement or withdrawal were shaped by expected harms, beliefs about love/agency/drug use, and available resources. Participants described uncertainty and regret; boundary language was often more workable than the binary of “enabling” versus disconnection.  
**Major limitation:** Small purposive regional sample, retrospective accounts, no behavioral or clinical outcome test, and a specific overdose-policy context. Qualitative findings identify dilemmas and meanings, not comparative efficacy.  
**Why it matters here:** This is the clearest contemporary safeguard against presenting “natural consequences” as an evidence-based universal. In high-lethality contexts, withdrawing support can narrow futures by increasing irreversible harm rather than increasing agency.

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## Final count and non-core authorities

- Domain A — codependency history and measurement: 21
- Domain B — Borrowed Self mechanisms: 25
- Domain C — dyadic regulation and dynamical methods: 24
- Domain D — care, accommodation, reassurance, and control: 19 additional sources
- Domain E — healthy interdependence: 6 additional sources
- Domain F — addiction family/partner systems: 15
- **Final deduplicated core total: 110**

The following are used only as non-core historical or classification authorities and are not included in the 110: the American Psychiatric Association's DSM-5-TR and cumulative-update pages; the World Health Organization's ICD-11 browser; Al-Anon's official history; and Beattie's 1986 popular book. They establish diagnostic status or cultural history, not empirical mechanisms.

### Resolved bibliographic issues

- Rotunda and Doman (2001) uses the publisher-resolving DOI [10.1080/01926180126496](https://doi.org/10.1080/01926180126496); the legacy alias is recorded in its evidence entry.
- Dear, Roberts, and Lange's definition audit is dated 2004, following the authors' institutional repository.
- Feeney and Collins (2001) is retained as a distinct multimethod study from their 2003 caregiving-motives paper; both are included because the main report cites each for a different claim.
- The current main report no longer contains the earlier Hollenstein (2013), Granic et al. (2003), Stafford (2001), Harkness et al. (2001), Fritz and Helgeson (1998), Helgeson and Fritz (1998), or Rodríguez-González et al. (2022) orphan citations.
- Molina et al. (2026) contains internally inconsistent study-type counts between abstract and body; the review reports that discrepancy rather than silently selecting a tally.