Co-Morbids

What is a Co-Morbid Disorder?

A co-morbid disorder or co-morbidity refers to two or more conditions that occur simultaneously in a person. These can be of varying symptoms and presentations and are not limited to psychiatric illnesses. For example, many people with posttraumatic stress disorder (PTSD) have co-morbidity with anxiety or depressive disorders.

Co-Morbidities and Treatment

While there isn’t medication for dissociative disorders directly, there are medications for some co-morbidities. Therefore, patients can not only focus on coping skills and processing in therapy but also try out medications for their co-morbid conditions with the guidance of their clinicians to attempt to ease some of their symptoms.

Common Co-Morbidities with Dissociative Disorders

PTSD (Post Traumatic Stress Disorder) and C-PTSD (Complex PTSD)

To start, let’s clarify the difference between PTSD and C-PTSD. PTSD comes from a localized event – a plane crash someone survived, a bombing, a shooting. C-PTSD comes from a history of trauma that was repeated and inescapable. Those dealing with DID developed it from repeated trauma and therefore are coping with C-PTSD rather than PTSD. Many with other dissociative disorders are also dealing with C-PTSD. Dissociative disorders are often responses to long-term abusive and dangerous relationships or environments. In the case of DID or OSDD, every patient with those disorders will also have C-PTSD.

Depressive Disorders (MDD, PDD, DMDD, Substance-Induced)

Depression is a mood disorder that affects nearly every aspect of a patient’s life. It causes a general lack of interest, feelings of sadness, and can lead to a huge variety of physical, emotional, and psychological problems. Depression can cause problems doing day to day activities and can spur feelings of inadequacy or of not wanting to live anymore. Luckily, depression is one of the co-morbids on this list that there are medication options for. Now I am not saying medication is the right answer and therapy should always be tied to medication, but when a patient is dealing with a laundry list of disorders all of which don’t have medications as an option, it can be a relief to have that as an option to try for one of them. The reason many with dissociative disorders have depression as a co-morbid is both due to the history of trauma as well as due to living life with mental illness and being ‘different’ which can cause one to feel ‘wrong’ in society and become depressed.

Anxiety Disorders (GAD, Social Anxiety Disorder, Substance-Induced)

Generalized anxiety is a disordered level of worry and uncontrollable internal stress that is not localized to a short period of a person’s life. GAD is a disorder that there are medication options for. The reason GAD is commonly co-morbid with dissociative disorders is because when someone has gone through extensive repeated trauma (the cause of many dissociative disorders), they often have had to be ‘on the lookout’ for their own safety, which often can cause anxiety, since they are always on edge. Additionally even once the person is out of the abusive/dangerous situation, they are always at risk of an episode, a flashback, and may be generally anxious about their condition and how it makes them different than others and/or others noticing their disorder.

Agoraphobia

Agoraphobia is a type of anxiety disorder where the person fears and avoids places or situations where they might feel trapped, helpless, embarrassed, or might panic. They fear an anticipated situation and often this leaves them confined to their home. This can grow over time and make it harder and harder for the person to leave their home the longer the fear grows and the longer it’s been since they have left. There are medication options for anxiety and panic disorders but nothing specific to agoraphobia. The reason dissociative disorders are often co-morbid with agoraphobia is due to the fear of having an episode in public or being ‘discovered’. Especially when dealing with amnesia, the thought of being somewhere unfamiliar becomes frightening and the potential when dealing with dissociative amnesia or something like DID to possibly have someone not be able to find their way home and spend the night on the street or something of that nature can get overwhelming very quickly.

Insomnia

Insomnia is a sleep disorder. With insomnia a patient may have trouble falling asleep, staying asleep, or simply getting good quality sleep. Insomnia can deeply affect a person, as when insomnia is bad someone can be getting only a few hours of sleep each night if any, which will massively affect their entire life – mood, health, productivity, mental health, memory, and more. There are medication options to help with insomnia. The reason many with dissociative disorders commonly experience insomnia as a co-morbid is likely due to a combination of factors and it will differ based on the disorder. For trauma disorders as a whole, nightmares can be a massive issue to contend with so not only can those disrupt your sleep but there can also be anxiety and fear and a hesitancy to allow ones self to go to sleep. Additionally once you start talking about DID and OSDD or dissociative amnesia in general we can start to understand how amnesia and losing time and forgetting what time it is and not knowing it is bedtime and “missing the night” can happen, when suddenly it’s the morning and you didn’t sleep. Add in potential flashbacks that can keep you up at night, as well as the fact that many with trauma disorders view the dead of night as a safe time because that was the time people who were threats to them in the past were asleep and they could actually relax so they didn’t want to be asleep for that… there’s a lot of reasons many people with dissociative disorders experience insomnia as well.

PNES (Psychological Non Epileptic Seizures/Dissociative Seizures)

PNES are attacks that look like epileptic seizures but are not epileptic and are actually caused by psychological factors. They are muscle spasms but do not affect the brain and are not a form of epilepsy, they are psychological and often a result of trauma or extreme stress. Treatment with CBT (Cognative Behavior Therapy) and seratonin re-uptake inhibitors (medication options) have been shown to be effective in treatment for some, but much more research is needed to learn more about PNES and find additional ways to treat this condition. There’s not much I can tell you about why many with dissociative disorders commonly have these as co-morbids except that dissociative disorders are trauma disorders and cause high stress which is what causes PNES, but there’s so little research around PNES there really needs to be more before much can be said concretely about connections.

Migraines

A migraine is a type of headache that is usually localized to one side of the head. It often comes along with nausea, vomiting, and/or extreme sensitivity to light and sound. Migraine attacks can last for hours to days and the pain levels can be severe enough to interfere with productivity and daily life. Unfortunately much more research is needed into migraines to fully understand why they happen and how to treat them – while there are medication options, there still are many questions still yet to be answered that leave many unable to find effective treatment. Due to the lack of understanding it can be hard to pinpoint exactly why migraines are often co-morbid with the dissociative disorders. When it comes to DID/OSDD we can understand how migraines can sometimes accompany switches as headaches and migraines can be a symptom of switching. Additionally migraines can follow a flashback so that can be another reason for the comorbidity with these trauma disorders. That being said, more research certainly needs to be done to make definitive statements.

BPD (Borderline Personality Disorder)

BPD is a disorder that significantly impacts someone’s ability to regulate their emotions. It includes issues with self-image, difficulty managing emotions and behavior, and a pattern of unstable relationships. BPD generally begins by early adulthood but gets better over time with treatment and age. If diagnosed don’t be discouraged – seek treatment as this is a disorder you can work through. The reason many people with dissociative disorders may have BPD as a co-morbidity is because BPD is another disorder that often comes from childhood trauma.

Somatization Disorder

Somatization disorder is another psychiatric disorder that is known to be comorbid with dissociative disorders, and is characterized by a person having a significant focus on physical symptoms, such as pain, weakness or shortness of breath, to a level that results in major distress and/or problems functioning. Another symptom that is common is excessive thoughts about said physical symptoms. This disorder the reason that this disorder co-occurs with dissociative disorders is mostly unknown, but there are studies that link somatozation disorder to trauma when it is caused by a dissociative disorder. Other risk factors include anxiety disorders, and trauma-and-stressor related disorders.