Mental Health Comorbidity

What it is and What to do

 

You may have heard the term comorbidity when speaking of COVID risk in those with pre-existing conditions. Or you’ve heard a doctor refer to your grandfather’s heart disease and high blood pressure as comorbid diagnoses.

Comorbidity is defined as two or more medical conditions in a patient. While many people are familiar with the term, many also fail to realize the depth of comorbidities associated with mental health. 

A mental illness diagnosis is many-sided. It’s often accompanied by a secondary condition, which could be either mental or physical. Additionally it’s common for a physical diagnosis to manifest symptoms in the mental space. According to Mental Health America, 1 in 4 cancer patients suffer from depression, and 1 in 3 depressed people also face a form of substance abuse. 

 

“A comorbid diagnosis can feel intense and difficult to navigate. However a thorough understanding of the disorders that co-occur can shed light and provide hope for recovery.”

 

Join us as we dive deeper into mental health comorbidity, discuss coping mechanisms and disclose navigation techniques.

Depression and Anxiety (mental health’s two peas in a pod)

Many of us are familiar with feelings of anxiety and depression. It is natural to “feel the blues” or grow anxious over a stressful situation. However, when these symptoms become persistent and begin to negatively impact daily life, it’s possible a bigger issue is at hand. In a study by the Anxiety and Depression Association of America, almost 7% of American adults were found to suffer from major depressive disorder (MDD) and over 18% were shown to experience an anxiety disorder.

However, these two diagnoses don’t stray far from one another. 

In a study published by the National Library of Medicine, 57% of all patients diagnosed with depression also had at least one anxiety disorder. In this sample, 33% suffered from social anxiety disorder, 15% were diagnosed with generalized anxiety, and 13.4% experienced Post Traumatic Stress Disorder (PTSD). They also found a high correlation between depressed patients and insomnia or hypersomnia.

Psychology Today refers to depression and anxiety as “two sides to the same coin”.   Meaning the separate labels actually share one common disorder. If we take a closer look into this, it begins to make sense.

Think back to when you experienced depression (or perhaps are facing it now). You may remember your daily tasks grew more difficult to complete, your relationships took a hit, and your confidence levels plummeted. You probably lacked the motivation to schedule a doctor appointment, clean your house, or engage in social activities. 

In response, you most likely felt anxious for letting things slip through the cracks, or for failing to achieve desired outcomes. 

Now, think back to a time when you experienced anxiety. You may bring to mind feelings of overwhelm that severely hindered your ability to function in everyday activities.

As a result, depression may have crept in as feelings of defeat and hopelessness in overcoming anxious tendencies. 

To take this a step further, anxiety and depression share a specific coping style: avoidance. Depressed and anxious people often avoid what they fear, instead of working to develop techniques to overcome it. 

What about other mental disorders?

 

Studies show that multiple mental health conditions can appear in one patient. A study completed in Australia reports that, 83% of those diagnosed with Borderline Personality Disorder (BPD) also experienced MDD in the course of their lifetime. Additionally, MDD has also been shown in those suffering an eating disorder. In one sample, MDD prevalence ranged from 50%-65% in those with bulimia nervosa, and 50%-65% in those with anorexia nervosa. 

 

It can be difficult to determine what came first. Mental illness and substance abuse often also go hand in hand. Numbers from the National Institute of Drug Abuse show that of the 7.7 million Americans that face both a mental disorder and substance abuse, 37.9% of those with a substance use disorder also suffered a mental illness, and 18.2% with a mental illness also suffered from drug abuse. 

“In simple terms, mental illness can negatively affect the gastrointestinal tract, and vice versa.”

 

Zooming in on the mind/ body connection…

 

Have you ever experienced “butterflies” in the stomach before a date? How about feeling your face flush after doing something embarrassing? These simple physiological responses show us just how strong the connection between mind and body is. 

A closer look at this correlation can provide insight into comorbid mental and physical illnesses. It has been shown that the more severe a physical condition is, the higher the chances of the patient becoming depressed are. Depression occurs in 40%-65% of those who have had a heart attack, 25% of those with adult onset diabetes, and 10%-25% of stroke survivors.

Can a mental illness really cause a physical disorder? The short answer is, yes.  

Over 90% of serotonin (aka your “happy hormone”) is produced in the gut.  The gut-brain axis (GBA) has been widely researched in recent years. It gives us a clearer picture of how connected our bodily symptoms are. The National Library of Medicine  states that the GBA “consists of bidirectional communication between the central and the enteric nervous system, linking emotional and cognitive centers of the brain with peripheral intestinal functions.”

Let’s look at IBS as an example. One study found that of those who sought treatment for IBS, an alarming 50%-90% also suffered from a psychological disorder. These disorders included MDD, generalized anxiety disorder, social phobia, panic disorder, and PTSD.

Yet these elevated numbers make sense as the colon directly responds to stress by being partially controlled by the nervous system.

“The silver lining of comorbidity is that you have multiple cues and clues to work with that can help you uncover the root causes of your conditions.”

So, what can you do?

 

The first thing to note when dealing with comorbid diagnoses is that you are not alone. The appearance of multiple conditions has (unfortunately) increased dramatically over the past two decades for a number of reasons.  Here are a few tips to help with coping and recovery:

 

• ALWAYS disclose all of your symptoms and medications to your doctor AND therapist.

  Doctors are professionals, but they typically specialize in one area. Your therapist may not fully understand the digestive system just like your doctor many not be educated on panic attacks.

  It is your responsibility as the patient to disclose all of your health information to both your doctor and your therapist – even if your symptoms “belong” to a different field.

  Being transparent about everything you are facing will help lead to correct diagnoses and proper treatment. Also make sure you are telling your doctor and therapist each medication you are taking. Mixing certain medications can have adverse and potentially threatening side effects.

• Focus on a healthy lifestyle.

  A good amount of sleep each night, regular exercise, and maintaining a nutrient-rich diet can help improve symptoms of both physical and mental conditions. The mind and body are better able to restore equilibrium when nourished properly. Certain foods containing tryptophan (a building block of serotonin) can directly help to improve your mood. Try adding tryptophan-rich foods to your diet such as salmon, turkey, eggs, spinach, seeds and nuts.

• Don’t go through it alone!

  Remember you can always seek help from a professional. Our therapists at MyCocun are trained to spot comorbid conditions in their patients and provide effective treatment plans based on the unique needs of each individual. Your story becomes our story as we tackle each diagnosis together. Get started with a tele-counselor today, from the comfort of your home (at a fraction of the cost of in-person therapy)!