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 post-traumatic stress disorder (PTSD) have co-morbidity with anxiety or depressive disorders.
Co-Morbidities and Treatment
While there isn’t medication for dissociative disorders, there are medications for some co-morbidities. Therefore, patients can not only focus on coping skills and processing in therapy but also try out medicines 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
Agoraphobia is an anxiety disorder where the person fears and avoids places or situations where they might feel trapped, helpless, embarrassed, or panicked. They fear an anticipated situation, often leaving them confined to their home. This anxiety can grow over time and make it harder and harder for the person to leave their home. 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 can become frightening due to the potential of being unable to find the way home.
Anxiety Disorders (GAD, Social Anxiety Disorder, Substance-Induced)
Generalized anxiety is a disordered level of worry and uncontrollable internal stress not limited to a short period of a person’s life. There are medication options for GAD. Generalized anxiety is commonly co-morbid with dissociative disorders because when someone has gone through extensive repeated trauma (the cause of many dissociative disorders) and often has had to be “on the lookout” for their safety, it can often 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 or a flashback. They may be anxious about their condition and how it makes them different from others or of others noticing their disorder.
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 improves with treatment and age. If diagnosed, don’t be discouraged – seek treatment, as this is a disorder you can work through. Many people with dissociative disorders may have BPD as a co-morbidity because BPD is another disorder that often comes from childhood trauma.
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 many physical, emotional, and psychological problems. Depression can cause issues doing daily activities and spur feelings of inadequacy or of not wanting to live anymore. Luckily, depression is one of the co-morbids on this list for which there are medication options. I am not saying medication is the right answer or that therapy should always be tied to medication. Still, when a patient is dealing with a laundry list of disorders, some of which don’t have medications as an option, it can be a relief to have the option to try a medication. Many with dissociative disorders have depression as a co-morbid due to the history of trauma and living life with mental illness.
Insomnia is a sleep disorder. With insomnia, a patient may have trouble falling, staying, or simply getting good-quality sleep. Insomnia can profoundly affect a person. Someone may get 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. For trauma disorders as a whole, nightmares can be a massive issue to contend with. Not only can they disrupt your sleep, but they can also cause a hesitancy to allow oneself to sleep. Once you start talking about DID or dissociative amnesia, we can start to understand how amnesia, losing time, forgetting what time it is, 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 people who were threats to them in the past were asleep, and you can begin to understand why insomnia can be such an issue.
A migraine is a type of headache that is often localized to one side of the head. It can come with nausea, vomiting, and 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 understand why they happen and how to treat them. While there are medication options, many questions are still yet to be answered. Many remain unable to find effective treatment. Due to this lack of understanding, it can be hard to pinpoint why migraines are often co-morbid with dissociative disorders. In DID/OSDD migraines can sometimes accompany switches as headaches can be a symptom of switching. Additionally, migraines can follow a flashback, which can be another reason for the co-morbidity.
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 a result of trauma or extreme stress. Treatment with CBT (Cognitive Behavior Therapy) and serotonin reuptake inhibitors are effective in treatment for some cases. Still, much more research is needed to learn about PNES and find additional treatment methods.
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.
Somatization disorder is another psychiatric disorder known to be co-morbid with dissociative disorders. It is characterized by focusing on physical symptoms, such as pain, weakness, or shortness of breath, to a level that results in significant distress or problems functioning. Another common symptom is excessive thoughts about said 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 disorders and other trauma-and-stressor-related disorders.
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