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What is a Comorbidity in Mental Health?
Comorbidity is the simultaneous presence of two or more disorders in one person, implying a relationship between the diseases that can impact their course and prognosis. Psychiatric comorbidity often refers to the combination of diagnosable mental disorders.1 You may hear the terms “coexisting,” “co-occurring conditions,” “multimorbidity,” or “multiple chronic conditions” to describe comorbidities.2
American physician and epidemiologist A.R. Feinstein is credited with coining the term “comorbidity” in the 1970s. Feinstein used the example of how persons with rheumatic fever frequently also had several other conditions to illustrate the concept of comorbidity. Since then, comorbidity has evolved to refer to a person having multiple mental or physical health issues.3
According to the CDC, in 2018, 27.2% of Americans had more than one chronic health condition, and 51.8% had at least one. Women, non-Hispanic white adults, adults 65 and older, and residents of rural regions had the highest prevalence rates of comorbid conditions.4
A study published in 2020 revealed that Tennessee’s prevalence of multiple chronic conditions was highest among females 65 and older with an annual household income below $25,000.5
Four mental disorders—anxiety, depression, bipolar disorder, and schizophrenia—have been linked to up to two out of every three chronic physical conditions, according to a significant meta-analysis.6 Mental illness also raises the possibility of developing chronic physical conditions like diabetes or obesity.7
Examples of Comorbid Mental Health Conditions
Comorbidity in mental illness can occur when a person obtains a medical diagnosis followed by a mental disorder diagnosis (or vice versa). Comorbid diagnosis can also occur when a mental disorder diagnosis is made, followed by the diagnosis of another mental disorder. Below are some examples of common comorbidities:8,9
- Depression and chronic illness
- Substance use disorders and anxiety
- Substance use disorders and depression
- Substance use disorders and mood disorders
- Depression and one or more anxiety disorders
- Major depressive disorder (MDD) and anxiety
- Eating disorders and mood disorders, such as anxiety or depression
- Major depressive episode (MDE) and generalized anxiety disorder (GAD)
- Anxiety disorders and eating disorders
- Anxiety-depression and suicidal ideation
- Specific phobia and alcohol dependence
- Insomnia and obsessive-compulsive disorder (OCD)
- Narcissistic personality disorder and other personality disorders
- Post-traumatic stress disorder (PTSD) and other anxiety disorders
Causes & Risk Factors for Comorbid Mental Health Disorders
The causes and risk factors for comorbid mental disorders are complex and can vary from person to person. While some comorbidities occur randomly, others are linked by similar genetic, behavioral, or environmental variables, including the below:
- Genetic factors: Some may have a genetic predisposition to developing certain mental health disorders, and this genetic vulnerability may increase the risk of developing comorbid disorders.
- Environmental factors: Environmental factors, such as exposure to trauma, abuse, or neglect, can increase the risk of developing comorbid conditions. Additionally, environmental stressors, such as poverty, discrimination, or social isolation, can contribute to the development of comorbid mental health disorders.
- Substance use: Substance use, including alcohol and drug use, can contribute to developing comorbid disorders. Substance use may also exacerbate the symptoms of existing mental health disorders and increase the risk of developing comorbid disorders.
- Medical conditions: Certain conditions, such as chronic pain or neurological disorders, may increase the risk of comorbid mental illness.
- Treatment factors: Inadequate or ineffective treatment for an existing mental health disorder can increase the risk for the development of comorbid disorders. Additionally, using certain medications or treatments for one mental health disorder may increase the risk of developing other mental health disorders.
Signs of Comorbid Mental Health Conditions
The signs and symptoms of comorbid mental health conditions can vary depending on the specific disorders present and from person to person. However, some general signs to look out for include:
- Changes in mood: sudden and severe changes in mood, such as feelings of sadness, anxiety, or irritability, that are not easily explained by external circumstances
- Changes in behavior: changes in behavior, such as increased aggression, impulsivity, or risk-taking behaviors
- Changes in cognition: changes in thinking, such as difficulty concentrating, making decisions, or having distorted or negative thoughts about themselves or the world
- Changes in physical health: changes in physical health, such as unexplained aches and pains, changes in appetite or sleep patterns, or an increase in physical symptoms related to anxiety or depression
- Substance abuse: An individual may turn to alcohol or drugs to cope with their mental health symptoms, which can exacerbate the symptoms of existing mental health disorders or lead to the development of comorbid conditions.
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Diagnosis & Treatment for Comorbid Mental Health Disorders
Diagnosing and treating comorbid disorders can be complex, often involving addressing multiple disorders simultaneously to be effective. Therefore, treatment for comorbid conditions may require a multidisciplinary approach involving different types of mental health professionals. Here are some common approaches to comorbid diagnosis and treatment for mental health disorders:
- Thorough clinical interview: A mental healthcare provider will conduct a comprehensive clinical interview to assess your symptoms, history, and any contributing factors before making a comorbid diagnosis.
- Diagnostic evaluation: A mental health professional may use standardized diagnostic tools to evaluate your symptoms and identify comorbid conditions.
- Collaboration: Mental health professionals may collaborate with other healthcare providers, such as primary care physicians or psychiatrists, to ensure a comprehensive evaluation.
- Psychotherapy: Evidence-based therapy, such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), or eye movement desensitization and reprocessing (EMDR), can be effective in treating comorbid disorders.
- Medication: Psychiatric medication may treat specific mental health disorders, such as antidepressants for depression or anxiety, antipsychotics for schizophrenia, or mood stabilizers for bipolar disorder.
- Intensive outpatient programs (IOPs): IOPs provide structured treatment and support when you need more intensive care than traditional outpatient therapy.
- Support groups: Support groups can provide a sense of community and connection with others going through similar experiences.
- Lifestyle changes: Lifestyle changes, such as exercise, healthy eating, and stress-reducing activities, can help manage symptoms of comorbid conditions.
When medical and mental illnesses coexist, it poses a significant issue for healthcare professionals. For instance, a person diagnosed with diabetes and depression would receive therapy for both disorders. Still, close coordination between the multiple healthcare providers would be required to account for medication and symptom overlap and to reduce potential side effects.
Getting the quality treatment you need is convenient with Athena Care’s multiple therapy treatment clinics throughout Tennessee. We can even verify your insurance coverage details for you. After you submit the free, no-obligation form, an expert care coordinator will review your policy and contact you to discuss your options for treating comorbid disorders. Rest assured, all submitted or exchanged information will remain confidential.
- Klykylo, William M. “Comorbidity.” Elsevier eBooks, Elsevier BV, 2002, pp. 475–79. https://doi.org/10.1016/b0-12-343010-0/00053-2.
- Sreenivas, Shishira. “What Is Comorbidity?” WebMD, 24 Nov. 2021, www.webmd.com/a-to-z-guides/what-is-comorbidity.
- He, Vincent Y. F., et al. “Long-Term Outcomes From Acute Rheumatic Fever and Rheumatic Heart Disease.” Circulation, vol. 134, no. 3, Lippincott Williams and Wilkins, July 2016, pp. 222–32. https://doi.org/10.1161/circulationaha.115.020966.
- Boersma, Peter, et al. “Prevalence of Multiple Chronic Conditions Among US Adults, 2018.” Preventing Chronic Disease, vol. 17, Centers for Disease Control and Prevention, Sept. 2020, https://doi.org/10.5888/pcd17.200130.
- Newman, Daniel A., et al. “Correction: Prevalence of Multiple Chronic Conditions by U.S. State and Territory, 2017.” PLOS ONE, vol. 15, no. 9, Public Library of Science, Sept. 2020, p. e0239986. https://doi.org/10.1371/journal.pone.0239986.
- Daré, Labanté Outcha, et al. “Co-morbidities of Mental Disorders and Chronic Physical Diseases in Developing and Emerging Countries: A Meta-analysis.” BMC Public Health, vol. 19, no. 1, BioMed Central, Mar. 2019, https://doi.org/10.1186/s12889-019-6623-6.
- “The Relationship Between Mental Health, Mental Illness and Chronic Physical Conditions.” Canadian Mental Health Association, ontario.cmha.ca/documents/the-relationship-between-mental-health-mental-illness-and-chronic-physical-conditions. Accessed 25 Apr. 2023.
- Al-Asadi, Ali M., et al. “Multiple Comorbidities of 21 Psychological Disorders and Relationships With Psychosocial Variables: A Study of the Online Assessment and Diagnostic System Within a Web-Based Population.” Journal of Medical Internet Research, vol. 17, no. 3, JMIR Publications, Feb. 2015, p. e55. https://doi.org/10.2196/jmir.4143.
- Vaidyanathan, Uma, et al. “Patterns of Comorbidity Among Mental Disorders: A Person-centered Approach.” Comprehensive Psychiatry, vol. 52, no. 5, Elsevier BV, Sept. 2011, pp. 527–35. https://doi.org/10.1016/j.comppsych.2010.10.006.
If you suspect that you or someone you love suffers from mental health disorders, contact Athena Care today.
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