Comorbids – An Overview

What is a Comorbid Disorder?

A comorbid disorder or comorbidity refers to two or more conditions that occur simultaneously in a person. These can have different symptoms and presentations and are not limited to psychiatric conditions. For example, many people with post-traumatic stress disorder (PTSD) have comorbidity with anxiety or depressive disorders.

Comorbidities and Treatment

While there are no medications for dissociative disorders, there are medications for some comorbidities. Therefore, in addition to focusing on coping skills and processing in therapy, patients can also try medications for their comorbid conditions under the guidance of their clinicians to try to alleviate some of their symptoms.

Common Comorbidities with Dissociative Disorders

Agoraphobia

Agoraphobia is an anxiety disorder in which the person fears and avoids places or situations where they may feel trapped, helpless, embarrassed, or panicked. They fear an anticipated situation, often confining themselves to their home. This fear can grow over time, making it harder and harder for the person to leave their home. There are medications for anxiety and panic disorders, but nothing specific for agoraphobia. The reason dissociative disorders are often co-morbid with agoraphobia is the fear of having an episode in public or being “discovered”. Especially in the case of amnesia, the thought of being in an unfamiliar place can be frightening because of the possibility of not being able to find one’s way home.

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

Generalized anxiety is a disordered level of worry and uncontrollable internal stress that is not limited to a short period of a person’s life. Medications are available for GAD. Generalized anxiety is often co-morbid with dissociative disorders. If someone has experienced extensive, repeated trauma (the cause of many dissociative disorders) and has often had to be “on guard” for their safety, this can often cause anxiety because they are always on edge. In addition, even when the person is out of the abusive or dangerous situation, they are always at risk of having an episode or flashback. They may be worried about their condition and how it makes them different from others, or that others will notice their disorder.

BPD (Borderline Personality Disorder)

BPD is a disorder that significantly affects a person’s ability to regulate their emotions. It includes problems with self-image, difficulty managing emotions and behavior, and a pattern of unstable relationships. BPD usually begins in early adulthood, but improves with treatment and age. If you are diagnosed, don’t be discouraged – get treatment, because this is a disorder you can work through. Many people with dissociative disorders may have BPD as a comorbidity because BPD is another disorder that often results from childhood trauma.

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

Depression is a mood disorder that affects almost every aspect of a patient’s life. It causes a general lack of interest, feelings of sadness, and can lead to many physical, emotional, and psychological problems. Depression can cause problems with daily activities and lead to feelings of inadequacy or of not wanting to live. It is one of the comorbidities on this list for which there are medication options. Many people with dissociative disorders have comorbid depression due to a history of trauma and living with mental illness.

Insomnia

Insomnia is a sleep disorder. With insomnia, a patient may have difficulty falling asleep, staying asleep, or simply getting good quality sleep. Insomnia can affect a person deeply. Someone may only get 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 medications available to help with insomnia.

The reason that many people with dissociative disorders have insomnia as a comorbidity is likely due to a combination of factors. For trauma disorders as a whole, nightmares can be a massive problem to deal with. Not only can they disrupt sleep, but they can also cause a reluctance to allow oneself to sleep. With dissociative amnesia, you may lose track of time, forget what time it is, not know it’s bedtime, and “miss the night”-suddenly it’s morning and you haven’t slept. Flashbacks can also keep you awake, as can the fact that many people with trauma disorders see the middle of the night as a safe time because the people who abused them were usually asleep.

Migraines

A migraine is a type of headache that is often localized to one side of the head. It can be accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last from hours to days, and the pain can be severe enough to interfere with productivity and daily life. Unfortunately, much more research is needed to understand why migraines occur and how to treat them. While medications are available, many questions remain unanswered. Many people are still unable to find an effective treatment. Because of this lack of understanding, it can be difficult to determine why migraines are often co-morbid with dissociative disorders. In DID and OSDD, migraines can sometimes accompany dissociation, as headaches can be a symptom of dissociation. In addition, migraine may follow a flashback, which may be another reason for comorbidity.

PNES (Psychogenic Non-Epileptic Seizures) 

PNES are muscle spasms that do not affect the brain and are not a form of epilepsy. They are psychological and often result from trauma or extreme stress. Treatment with CBT (cognitive behavioral therapy) and serotonin reuptake inhibitors are effective in treating some cases. However, much more research is needed to learn more about PNES and to find additional treatments. 

PTSD (Post Traumatic Stress Disorder) and cPTSD (complex PTSD)

PTSD comes from a localized event – a plane crash someone survived, a bombing, a shooting. CPTSD comes from a history of trauma that was repeated and inescapable. People with DID have repeated traumas and, therefore, cope with cPTSD rather than PTSD. Many people with other dissociative disorders also deal with cPTSD. Dissociative disorders are often reactions to long-term abusive and dangerous relationships or environments. In the case of DID or OSDD, any patient with these disorders will also have cPTSD.

Somatization Disorder

Somatization disorder is another psychiatric disorder known to be comorbid with dissociative disorders. It is characterized by a focus on physical symptoms, such as pain, weakness, or shortness of breath, to a level that causes significant distress or problems functioning. Another common symptom is excessive thinking about these physical symptoms. The reason this disorder co-occurs with dissociative disorders is primarily unknown, but some studies link somatization disorder to trauma. Other risk factors include anxiety and other disorders related to trauma and stress.

Sources

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