Vines 1

Alex Vines

Professor Douglas

UWRT 1102

2 May 2017

The Nature of Psychiatric Comorbidity

Comorbidity is defined as the simultaneous presence of two or more psychiatric

conditions in one individual. By describing a relationship as comorbid, one is implying that the

two conditions influence and interact with each other. Originally, the term was used to describe a

relationship between a common medical diagnosis and a psychiatric condition (The British

Journal of Psychiatry). However, due to increasing cases of comorbidity in mental health, the

term has grown to describe relationships between multiple psychiatric conditions.

A basic example of comorbidity is the simultaneous presence of obsessive-compulsive

disorder (OCD) and an eating disorder in one individual. There are three eating disorders

recognized by the DSM-V. Anorexia nervosa is actually a mental illness that involves an

excessive desire to lose weight, often leading to restriction of food intake and low body weight.

Bulimia nervosa is also a mental illness that revolves around losing weight, yet the individual

will carry out binge-purge cycles. A person with bulimia will often consume large amounts of

food in one sitting and proceed to purge in the form of vomiting, excessive exercise or laxative

abuse. Finally, there is binge eating disorder which involves periods of excessive food intake

with no following purging. In a study carried out in 2004, it was found that forty one percent of

individuals with an eating disorder also have OCD (Neziroglu). Obsessive-compulsive disorder

is characterized by unwanted thoughts that cause anxiety (obsessions) and repetitive behaviors to

relieve that anxiety (compulsions). Common compulsions are hand washing, counting and
 Vines 2

checking. It has been suggested that eating disorders could be a part of the OCD spectrum, which

offers an explanation as to why they occur together so often. However, eating disorders are still a

separate category of mental illness. While the two conditions share behavior patterns, OCD does

not have to be present for individuals to develop an eating disorder and vice versa. It is, however,

easier to develop an eating disorder for an individual with OCD. The excessive fear of gaining

weight is highly comparable to obsessions seen with obsessive compulsive disorder (Neziroglu).

Additionally, food restriction and purging could be seen as compulsions. Since people with OCD

possess that pattern of thinking, the chance that those patterns will apply to eating is higher than

in individuals without OCD. In this case of comorbidity, it is highly likely that one disorder is

caused by another. Even if one does not cause the other, the two definitely interact and influence

each other.

A similar instance of comorbidity is seen with psychiatric disorders and sleep disorders.

While sleep disorders are not technically a psychiatric condition, the effects can be equally as

harmful as the effects of a psychiatric illness. Common sleep disorders are insomnia, hyper-

insomnia, and narcolepsy. Insomnia is the persistent inability to sleep even when presented with

appropriate conditions to do so. Hyper-insomnia is similar insomnia, with additional extreme

daytime sleepiness. Lastly, narcolepsy is excessive daytime sleepiness and extreme urge to sleep

at inappropriate times. Commonly, sleep disorders are comorbid with anxiety disorders. A recent

survey indicated that twenty four to thirty six percent of patients with insomnia also possess an

anxiety disorder (Staner). In patients with hyper-insomnia, an anxiety disorder is seen in up to

forty two percent (Staner). This comorbidity could be due to similar environmental factors or

chemical patterns in the brain. When studying patients with both insomnia and anxiety disorders,

thirty eight percent of patients reported that insomnia and the anxiety disorder developed at about
 Vines 3

the same time (Staner). However, the phenomenon of one condition causing the other is common

when studying sleep disorders and psychiatric conditions. In all anxiety disorders, the presence

of anxiety as a symptom is necessary. Everybody experiences the feeling of anxiety from time to

time, however, people with anxiety disorders experience it more than usual. It is difficult to sleep

when one is feeling anxious, and anxiety is known to keep people awake at night. The persistent

feeling of anxiety in a person with an anxiety disorder can lead them to have persistent difficulty

sleeping which meets the criteria for insomnia. This seems to be the case more often than not,

with forty three percent of patients reporting that their anxiety disorder was present before

insomnia developed (Staner). While a sleep disorder may not cause an anxiety disorder, lack of

sleep has numerous negative effects on a human being including the worsening of a psychiatric

condition. Due to the nature of comorbidity, the treatment for an anxiety disorder can also treat

the sleep disorder.

Other cases of comorbidity can be explained biologically. A common example of this

instance is comorbidity between anxiety disorders and depression. According to an article by

David Fainman, approximately 50 percent of people struggling with depression also struggle

with some sort of anxiety disorder. Similar inconsistencies in brain chemistry are seen in people

with both conditions. The amygdala is a structure in the brain that controls emotional response.

The amygdala plays a significant role in both depression and anxiety disorders (Fainman). In

addition, abnormal regulation of the neurotransmitters serotonin, dopamine and GABA is seen in

patients with either disorder (Fainman). Additionally, anxiety disorders are often comorbid with

one another. A study in the United States found that seventy four percent of patients with

agoraphobia, sixty eight percent of those with simple phobia, and fifty six percent of those with

social phobia also possess a second anxiety disorder (Goodwin). This instance is also explained
 Vines 4

by similar patterns in brain chemistry. The class of drugs known as antidepressants were created

to treat depression. However, recently doctors have begun to prescribe them to patients with

anxiety disorders. Many antidepressants are SSRIs, or selective serotonin reuptake inhibitors.

Due to the fact that abnormal regulation of serotonin is involved in both depression and anxiety

disorders, the medicine can be effective in treating either condition. In cases of comorbidity, an

antidepressant could treat a persons anxiety disorder and depression simultaneously. Unlike the

case with eating disorders and OCD, biologically based comorbidity does not indicate that one

condition causes the other. Rather, one factor (such as a chemical imbalance) can contribute to

the development of both disorders separately.

The phenomenon known as comorbidity is still being researched by professionals.

Initially, the term was not used to describe relationships between multiple psychiatric conditions.

However, the occurrence rate of comorbid psychiatric conditions is increasing, leading to

extensive research on the topic. Whether comorbidity occurs due to biological factors or

interactions between disorders, the reality of it is the same. The phenomenon must be recognized

and understood in order to effectively treat a patient with comorbid disorders. Either both

disorders stem from a similar cause, or one must be treated before the other can be treated. The

recognition of comorbidity is still relatively new, and continued research could provide a

significant breakthrough in the diagnosis and treatment of mental illness.

References

Fainman, David. "Examining the Relationship Between Anxiety Disorders and Depression."

N.p., n.d. Web.

 Vines 5

Goodwin, Guy M. "The Overlap between Anxiety, Depression, and Obsessive-compulsive

Disorder." Dialogues in Clinical Neuroscience. Les Laboratoires Servier, Sept. 2015.

Web. 07 Mar. 2017.

'Psychiatric comorbidity': an artefact of current diagnostic systems? | The British Journal of

Psychiatry." 'Psychiatric comorbidity': an artefact of current diagnostic systems? | The

British Journal of Psychiatry. N.p., n.d. Web. 14 Feb. 2017.

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

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

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

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