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Breaking Down the Model: Part III – Secondary Symptoms

September 5, 2022

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By: Joyce Willis, MC, LPC

Up to this point, we have discussed the history of Pia Mellody’s Model of Developmental Immaturity and how it is incorporated into treatment at Meadows Behavioral Healthcare. We learned the definition of codependency and its five primary symptoms. We have identified the Five Core Issues: self-esteem, boundaries, reality, dependency, and moderation. We also discussed how living in extremes in the Core Issues leads to immaturity issues. We will now explore the Secondary Symptoms resulting from living in the extremes in the Core Issues.

This is where The Model of Developmental Immaturity gets interesting. Columns I (The Nature of the Child) and II (The Core Issues) are tracked straight across the chart. Once we enter Column III (Secondary Symptoms), the chart can spiderweb and does not necessarily continue tracking straight across. For instance, with self-esteem issues, we can travel down to addiction issues and mood disorders or we can experience spirituality issues or any of the other Secondary Symptoms. This is the case with all five Core Issues. Being in the extreme in any Core Issue can lead to any or all of the Secondary Symptoms, which all result in unmanageability in our life due to trauma and immaturity.

Pia Mellody’s Developmental Immaturity Issues Model

Negative Control Issues

Negative control issues have to do with being controlling of other people. This comes from a lack of respect for the right of other people to be who they are. These issues can lead us to use manipulation and sarcasm to control other people. Negative control happens when we believe we have the right to determine what another person looks like, thinks, feels, and does or does not do. On the other hand, negative control can be allowing someone else to control us. Allowing someone else to control how we look, think, feel, and act is a part of the negative control. How does negative control affect the five Core Issues? Negative control can lead to problems in the following areas:

  • Self-esteem

If we are struggling with esteeming ourselves and someone has an opinion about us that we do not like, we will try to control what they think in order to feel good about ourselves. This may take the form of arguing, sarcasm, or rationalizing.

  • Boundaries

If we are struggling with functional boundaries, we have difficulty separating our own reality from someone else’s reality about us. If our external boundary is dysfunctional, we often give ourselves permission to do what we want do, when we want to. We give ourselves permission to touch or keep our distance without considering the comfort level of others. Our boundaries can also be impaired by not setting boundaries with how close people get to us and not stopping people from touching us. Negative control occurs in boundaries when we either determine what we can do with someone physically without permission or we give too much permission, when it is not in our best interest.

  • Reality

If we struggle with knowing who we are, we try to control what others think to fulfill someone else’s expectations. We often do this without being aware we are doing this. We try to convince others of who we are, so that they believe in this “made-up” person we present ourselves as.

  • Dependency (needs and wants)

If we have trouble taking care of our needs and wants, we try to control others’ behavior so that they take care of our needs or wants. We then can become angry when someone cannot read our minds and take care of these needs and wants.

Resentment Issues

Resentment issues have to do with being unable to let go of resentments after being victimized by another person. The “victim” stays in resentment by trying to get the offender to admit the violation, to express regret and/or to right the wrong. It is a possibility that the offender might never do any of these things. So instead of focusing on protection and good self-care to overcome past violations, the victim remains a victim and continues to build resentment. Resentment can take the form of running old tapes in our heads and replaying these tapes to try to get revenge. Resentment, in the most extreme form, is like taking poison and waiting for someone else to die. Trying to get revenge leads to the opposite of what we want. Continuing to hold onto resentment can lead to further isolation, increased shame, pain, and anger.

Continuing to hold onto resentment can lead to further isolation, increased shame, pain, and anger.

How does resentment affect the five Core Issues? Much like negative control, resentment can lead to issues with:

  • Self-esteem

If we think that someone has offended us, our self-esteem lowers and we feel shame. We may feel a need to punish the person in order to redeem our value. We resort to getting even in order to restore our own self-esteem. Self-esteem is affected by the “better than” position also. If we believe we are better than, we give ourselves the right to react in anger and offend the other person.

  • Boundaries

Often, with resentment, we have no boundaries, so we offend and can be powerless to stop offending. The resentment we hold onto brings a need to get even.

  • Reality

By holding onto resentment, we are likely to misinterpret situations that happen and think we have been wronged when we haven’t. This can lead to hostility and offensive behavior toward the perceived offender.

woman showing resentment

Spirituality Issues

Spirituality issues have to do with having no connection to a higher power, which can result from having problems facing who we are or being unwilling to see others as they are. Spirituality issues include making others or our addictions our higher power or trying to be the higher power ourselves. Neither of these is about living in truth, which is the basis of spirituality.

How do spirituality issues affect the five Core Issues? They surface in two areas:

  • Self-esteem

If we believe we are worthless, this may lead to not believing we are worthy to relate to a higher power. This can lead to us alienating ourselves from others and from our higher power. If we are trying to be our own higher power due to thinking we are better than, we do not need an external higher power. Either way, we harm our spiritual recovery.

  • Reality

Becoming truly spiritual requires that we admit and share our imperfections and mistakes and that we listen when others share their imperfections and mistakes. Not being able to do this robs us of a nurturing spiritual relationship with our higher power.

Addiction and Mood Disorders

Addiction problems usually manifest to medicate reality or to create intensity. Addictions stem from codependence. Any substance or process that relieves our distress can become an addiction. This includes addictions to substances such as alcohol and drugs, and also behavioral or process addictions like eating disorders, gambling, and sex addiction. All these substance and behavioral addictions stem from a common desire to medicate unwanted reality or a way to relieve pain.

When we are so afraid of the painful reality of our childhood, this can lead to mood disorders, such as depression or anxiety. We can use depression and anxiety to avoid the pain of dealing with the past or with our present situations. Depression or anxiety can let us continue to keep what happened in the past as non-existent, leading to denial and not moving into recovery.

We can use depression and anxiety to avoid the pain of dealing with the past or with our present situations. Depression or anxiety can let us continue to keep what happened in the past as non-existent, leading to denial and not moving into recovery.

In this area, it is important to discuss physical illness as well. The stress of avoiding pain or owning our own reality can lead us to physical illnesses for which there are no true medical reasons. We can often suffer chronic symptoms that persist in our lives. Many of these symptoms may result from not expressing our feelings. Examples of physical symptoms are headaches, high blood pressure, and asthma.

How do addiction, mood disorders, and physical issues affect the five Core Issues? When we avoid reality through addictions, mood disorders, and/or physical illnesses, we can develop problems with:

  • Self-esteem

Addictions, mood disorders and physical illnesses can lead to us feeling less than other people. We can also use our substance abuse to be arrogant and better than, continuing in addiction to avoid loneliness and shame. Whether we believe we are less than or better than, we cannot be in an honest, trustworthy relationship with others.

  • Reality

When we are stuck in addictions, mood disorders and physical illnesses, we often want to avoid feeling emotions so we medicate our feelings and become removed from the reality of what is.

Intimacy Issues

Intimacy issues have to do with the difficulty in being relational. Intimacy does not just refer to physical or sexual intimacy. Intimacy has to do with being vulnerable enough to let someone know us emotionally, spiritually, and intellectually. Intimacy is also about having respectful curiosity to know someone else on an emotional, spiritual, and intellectual level. Trauma can lead to difficulty being intimate and being relational.

How do intimacy issues affect the five Core Issues? An impaired ability to sustain functional intimacy can lead to problems in all five areas:

  • Self-esteem

If we are in the “less than” position, we compare ourselves to others and come up short. As a result, we cannot truthfully share in an intimate way, because we fear others will find out how defective we are. If we are in the “better than” position, we often judge others. This makes it uncomfortable for someone to be around us.

  • Boundaries

Intimacy is blocked when we are in the victim or the offender role. We cannot get to know others or share who we are if we do not have a functional internal boundary.

  • Reality

If we struggle with knowing who we are, we cannot share ourselves with others. If we are looking for someone else to define who we are, then we may try to change how we think, feel, and act. This can lead to dishonest and manipulative behavior that does not allow for intimacy.

  • Dependency (needs and wants)

If we are too dependent on others to meet our needs and wants, we risk becoming the child in a relationship rather than an equal partner. If we are stubborn about our independence and do not ask for help, intimacy is blocked because we stop sharing our needs and wants. If we deny our needs and wants completely, then we are out of touch with our own humanity and are, in essence, not operating as a real person in a way to be intimate with others.

  • Moderation/Containment

If we behave in a way that shows no containment (angry outbursts, threatening behaviors, extreme intensity), there is no intimacy. If we share who we are in an intense and frightening manner, we are blocking true intimacy. The other side of this is shutting down our emotions and shutting others out. This leads to intimacy dying. True adult-to-adult intimacy is about being able to be spontaneous and fun while being responsible and respectful.

We have now explored the first three columns of the Model of Developmental Immaturity. Childhood trauma causes immaturity in the Core Issues. Trauma and immaturity drive the Secondary Symptoms, leading to unmanageability in our lives. Trauma, immaturity, and unmanageability create Relational Problems.

We will explore Relational Problems in Part IV of Breaking Down the Model.

Source: Pia Mellody’s book Facing Codependence.

Joyce Willis is a Licensed Professional Counselor and is currently a therapist at The Meadows Outpatient Center-Scottsdale. She earned her bachelor’s degree in education from the University of Akron. After teaching for several years, Joyce earned a master’s in counseling from the University of Phoenix. She has been in the counseling profession since 1996 and in that time has worked extensively in the addictions field. Her specialties include treatment for addictions, bereavement, trauma, depression, and anxiety. Joyce has a special interest in mindfulness and helping people connect their emotional, spiritual, mindful, and physiological selves with compassion and respect.