What is a Co-morbid Psychiatric Disorder?

ImageA co-morbid psychiatric disorder is any disorder that co-occurs with another psychiatric disorder. Often times we see people as having one issue, when often the truth is they have more than one problem which complicates treatment and recovery.

Recently I started seeing a young man who has both attention deficit/hyperactivity disorder and oppositional defiant disorder. This complicates treatment slightly because both issues have to be taken into consideration at all times sincetotally ignoring one while focusing on the other is seldom successful.

When I worked in the adult unit of a psychiatric hospital, it wasn’t uncommon to see people with depression and alcoholism, or schizophrenia and chronic marijuana use. Often these people use drugs to try to self-medicate and lessen the symptoms of their psychiatric disorders and other times the substances help create or amplify the psychiatric disorder. As a matter of fact, substance abuse and mental health disorders often co-occur in individuals and it’s often hard to tell what came first. Did the alcoholic become depressed the more the disease took over him, or did the depression drive him to drink?People with anxiety disorders for example often turn to illegal substances or prescription pills in attempts to relieve their anxiety. One of my clients who became depressed after losing her baby quickly became addicted to the Xanax given to her by her doctor to help cope with her depression and anxiety.

Definitely some disorders are more likely to co-occur with other disorders. As an example, people with bi-polar disorder are highly susceptible to substance abuse, ADHD, obesity and anxiety disorders.

In the high school setting I generally see teenagers who have depression and an eating disorder, so I work with them to solve both, usually paying more attention to what problem seems to be the most present and severe. With the 15 year old I recently started seeing, he is already receiving medication for his ADHD and while I definitely believe that his ADHD plays a role in his oppositional defiant behavior, I’ll focus on that later since the main reason he was referred for counseling is because of his bad attitude, refusing to follow simple rules, and anger towards his parents and teachers.

Often times teachers and parents are only aware of what condition is rearing it’s ugly head the most and aren’t aware that their are other factors contributing to the behavior. Teenagers rarely drink and smoke just because. Sure there are many who do, but usually once I sit down with them there is more to their substance abuse than peer pressure, usually if it’s not problems at home or self-esteem issues there are signs of a psychiatric disorder such as depression, anxiety or bipolar disorder.

That’s what makes treating and dealing with co-morbidity so difficult. If a patient goes to his family doctor complaining of not being able to sleep at night, he may be prescribed a sleep aid. If he doesn’t tell his doctor that the reason he can’t sleep at night is because he’s worried about his job, the economy, his elderly mother, his doctor in college, etc., then his anxiety will not go away and worse yet, he may become dependent on sleep aids.

It’s isn’t to ignore co-morbidity by focusing on just the problem that we see, but it’s important that we ask, what else may be going on. This will not only help us understand the people we care about, people that we deal with on a regular basis, but also ourselves.

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