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Alex Vines

Professor Connie Douglas

Round Table Essay Draft I

23 March 2017

Comorbidity

Mental illness impacts 1 in every 5 Americans. When using the term mental illness,

people refer to common disorders such as anxiety and depression while also describing severe

conditions such as schizophrenia and bipolar disorder. What people often do not realize is that

sometimes psychiatric conditions occur together. Comorbidity is defined as the simultaneous

presence of two or more conditions in the same individual. In the past, this term has been used to

describe the presence of a common medical condition in addition to a psychiatric condition. An

example of this would be anxiety disorders and high blood pressure. However, the term has

expanded to define the presence of two or more psychiatric conditions, such as depression and

anxiety. One theme that is common in research of comorbidity is that it is important to

understand the phenomenon in order to properly diagnose and treat patients. In my research, I

learned about comorbidity in terms of psychiatric disorders, substance abuse, and sleep

disorders.

The example of comorbidity that sparked my interest is the presence of two or more

psychiatric disorders in one individual at the same time. Arguably, the most common incidence

of this is simultaneous anxiety disorders and depression. Around half of people struggling with

depression also qualify for an anxiety disorder and vice versa (Fainman). An anxiety disorder is

defined as a persistent and irrational feeling of intense anxiety for extended periods of time.
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There are many anxiety disorders, including generalized anxiety disorder, panic disorder,

phobias and PTSD. The causes of all anxiety conditions and depression as separate entities are

very similar. Environmental factors such as problems with work, school or relationships can

increase risk for both conditions. In addition, the patterns of brain chemistry for both disorders

are almost identical. Abnormal regulation of neurotransmitters such as serotonin, GABA and

dopamine is present for both anxiety disorders and depression (Fainman). Both classes of

disorders are associated with the same areas of the brain which are the amygdala and the

hypothalamus. The amygdala is responsible for emotional regulation and the hypothalamus is

responsible for many things including regulation of mood, sex drive, and sleep patterns.

Disturbances in the functioning of both of these areas in the brain are associated with both

anxiety disorders and depression. In people with simple phobia disorder, 50 to 80 percent

qualified for comorbid major depressive disorder (Fainman). While anxiety disorders and

depression is a common example of comorbidity, it is not the only one. An article by Fugen

Neziroglu describes the comorbid relationship between obsessive-compulsive disorder (OCD)

and eating disorders. Obsessive compulsive disorder is described as repetitive unwanted

thoughts (obsessions) and behaviors to relieve the anxiety caused by those thoughts

(compulsions). Similar behavior patterns are found in people with eating disorders. In patients

with anorexia nervosa and bulimia nervosa, obsessions revolve around food intake and weight

gain. Calorie restriction, excessive exercise, and excessive dieting are similar to compulsions

seen in OCD. In this case, an eating disorder could cause someone to develop obsessive

compulsive-like symptoms. However, the opposite occurs as well. Some common compulsions

seen in patients with OCD is counting. A patient may feel a certain number is lucky and the
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"right" number. When this ritual interferes with food, that is when an eating disorder can

develop. Perhaps an OCD patient feels that they need to eat a certain amount of bites or chew a

certain amount of times. This could either limit food intake, or lead to excessive food intake. Or,

a patient with OCD may avoid certain foods due to fear of contamination. Although the resulting

eating disorder is not centered around the typical fears of weight gain, it is still present and if it

meets the criteria, it qualifies as an eating disorder. This is why comorbidity occurs. Another

common theme of people with obsessive-compulsive disorder is the need for control. Eating

disorders can develop as a way for an obsessive-compulsive patient to fixate on something or

control an aspect of their life.

Comorbidity is also very common in the instance of substance abuse. Substance abuse, or

drug addiction, is considered a disease and sometimes a mental illness. About 10% of Americans

are addicted to drugs according to the Partnership for Drug Free Kids. Drug addiction can be

comorbid with many different mental illnesses such as anxiety, depression, bipolar disorder, etc.

As with other instances of comorbidity, the drug addiction and psychiatric condition feed off of

each other. The emotional stress and trauma from a psychiatric disorder can lead a person to self

medicate with drugs. On the other hand, some drugs can actually trigger a mental illness in

people. LSD, a hallucinogen, has been known to trigger schizophrenia in those who are

predisposed to it. Other times, people can develop depression when they are unable to use the

drugs that they are addicted to. The common theme I mentioned is seen with these cases of

comorbidity, that it is important to understand comorbidity in order to treat these problems.

When the drive to use drugs is caused by the emotional stress or abnormal mood regulation of a
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mental disorder, the individual is going to have a harder time overcoming their drug addiction

unless that mental disorder is also being treated.

The most unfamiliar yet relevant case of comorbidity that I studied is comorbidity

between psychiatric disorders and sleep disorders. While researching comorbidity in children and

adolescents, I discovered an article on sleep disorders in children with autism and aspergers.

Sleep disorders are found to be more common among children/teenagers with Aspergers or

autism than among children/teenagers in general, with 40-80 percent of adolescents with high

functioning autism report having sleep problems. A sleep disorder is defined as "changes in

sleeping patterns or habits that can negatively affect health". Well known sleep disorders include

insomnia, narcolepsy, sleep walking/talking, and night terror syndrome. However, there are other

problems that affect health and sleep normality. The most common sleep problems that were

reported were troubles falling asleep and troubles staying asleep. "Periods of nocturnal

awakening lasting from 30 min up to 2-3 hours have been reported, where the child may vocalize

or get up and play with toys or objects in the room" (Thenhausen). The considered causes of

sleep problems in children with autism are mental disturbances and the severity of the autism.

The typical behaviors of internalizing tendencies in children with autism could be a reason for

low quality sleep. Sleep patterns can also be a tell-tale sign of the severity of the child's autism.

Currently, the prevalence of sleep disorders in children with autism is 80 percent. Sleep

disorders are not only seen in people with autism and aspergers, they are also commonly seen in

people with anxiety disorders. Anxiety disorders are characterized by persistent and irrational

anxiety on a day to day basis. Commonly seen sleeping disorders in anxiety patients are

insomnia and hyper-insomnia. Insomnia is the inability to fall asleep and stay asleep, even when
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one is presented with the opportunity. Hyper-insomnia is extreme sleepiness during the daytime

followed by inability to sleep at night. These sleep disorders can be caused by many different

things. In fact, these disorders used to be described as merely symptoms rather than a disorder in

and of themselves. "These findings were replicated for chronic insomnia in a recent study,

which further showed that, insomnia appeared before the anxiety disorder in 18% of cases,

anxiety and insomnia appeared about, in the same time in 38.6% of cases, and anxiety appeared

before insomnia in 43.5% of cases. These authors concluded that, psychiatric history, including

anxiety disorder, is closely related to the severity and chronicity of current, insomnia" (Staner).

The main idea that I took away from all of the research that I did is that it is important to

understand the phenomenon of comorbidity. Of all the research I have done, I have yet to find a

voice that does not consider the concept of comorbidity important in the psychiatric community.

Rather, there are different classifications and examples of comorbidity that were explored by

different people. The phenomenon can be explained in different ways depending on how it is

occurring in an individual. That is why I explored comorbidity between typical psychiatric

conditions, comorbidity between typical psychiatric conditions and sleep disorders, and

comorbidity between typical psychiatric conditions and substance abuse. It is important that the

concept of comorbidity is understood in diagnosing and treating a patient with any of these

conditions. Sleep disorders caused by psychiatric conditions cannot be treated unless the

psychiatric condition is also being treated. Overcoming drug addiction becomes much easier for

an addict if the underlying emotional stress and psychological disturbance is not present. Finally,

psychiatric conditions that influence each other can also prevent the treatment of one another,

unless both conditions are being tended to.

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References

1. Abuse, National Institute on Drug. "Comorbidity: Addiction and Other Mental

Disorders." DrugFacts: Comorbidity: Addiction and Other Mental Disorders |

National Institute on Drug Abuse (NIDA). N.p., n.d. Web. 15 Feb. 2017.

2. Staner, Luc. "Sleep and anxiety disorders." Dialogues in Clinical Neuroscience.

Les Laboratoires Servier, Sept. 2003. Web. 07 Mar. 2017.

3. "The Relationship Between Eating Disorders and OCD Part of the Spectrum."

International OCD Foundation. N.p., 24 Aug. 2015. Web. 16 Feb. 2017.

4. Thenhausen, Nora, Martin Kuss, Alfred Wiater, and Angelika A. Schlarb. "Sleep

problems in adolescents with Asperger syndrome or high-functioning

autismSchlafstrungen bei Jugendlichen mit Asperger-Syndrom oder

hochfunktionellem Autismus." SpringerLink. Springer Medizin, 26 Aug. 2016.

Web. 07 Mar. 2017.