Wednesday, December 22, 2010

Comorbidity in Psych


Comorbity-diseases or conditions that coexist with a primary disease but they also stand on their own as specific diseases (Debra Ranzella, R.N., 2008).

Co-occuring-formerly known as dual diagnosis or dual disorder, co-occurring disorders describe the presence of two or more disorders at the same time. For example, a person may suffer substance abuse as well as bipolar disorder. (Psychology Today, 2010).

Dual diagnosis-often used interchangeably with the terms co-morbidity, co-occurring illnesses, concurrent disorders, comorbid disorders, co-occurring disorder, dual disorder, and, double trouble. Professional literature has used a confusing array of terms and acronyms to describe co-occurring disorders or a dual diagnosis (Dual Recovery Anonymous, 2010).

Understanding that every single person on this earth has a different experience takes a lot of accounting into consideration in the lens of psychology.To better understand psychology, it may be helpful to think first in medical terms and situations. When we think of comorbidity in a medical framing we can attribute a lot of cause and effect and multiple diseases within a person's lifestyle habits. For instance a person with heart disease will have had a pattern with artereoscleurosis, with what their diet is, with weight factors, with what exercise they can and cannot do, and with what genes where their genetic lottery. We see that there is a proliferation of consequence within diagnosis and very educated, logical, and rational pathways of thinking will expand on a person's condition (Cloninger, 2002). Within the primary disgnosis of heart disease we see various comorbidity not only in disease but in overall conditions that contribute greatly to the primary disease. All add up to the big picture. One cannot be looked out without contributing or overlapping into the other. Thus, the dual diagnosis issue is at hand not just in medical orientations but relevant in psychology as well.
In psychology recently it was stated that virtually 60% of personality disorders have something co-morbid lurking in the diagnosis and those critical of these figures claim that there's inprocise diagnosing occuring with having such a high rate of co-morbidity (Kessler et al., 1994). This author argues that when we think in a medical orientation about accounting for overall, holistic well-being in a person's behavior and thinking, it's actually more likely that we would diagnose more as we see that “a” causes “b” and may cause “c” but may also vary from person to person. Not everything is a straight line. Rather human nature is unique and each person's chemistry may present an interesting sub-set of symptoms when thinking about an over-arching disorder or many disorders.Thus the web is woven, quite complexly in terms of comorbidity.
In treating clients, there's a need to identify the illness or substance abuse that is more threatening to the safety and security of the client. This is where an immediate intervention starts. An extreme psychotic episode can be just as threatening as addiction in an extreme situation. It's important to take stock of habits of extremes in both substance abuse and psychosis in initial assessments.
While proper diagnosis is needed, it appears that accuracy in dual-diagnosis is elusive in the field. This author wishes to circle back to the idea of improcise language can lead to misdiagnosis. Culturally there is an issue that everyone wants quickly diagnosed and treated. Insurance companies want clients in and out like the McDonalds drive-through line.
Being able to be given time to critically synthesize the DSM-IV-TR classifications and it's rules of diagnosis within a disease but also within the nuance of the individual with unique symptoms is no easy task. Dual diagnosis doesn't have to be the villian it's portrayed to be. For instance, with generalized anxiety disorder a client may not only have GAD but may medically complain of muscle tension (Levyberg, 2009). This medical framing speaks to the parallels of psychology in that we are what we think and do. If we think anxiously, then of course our body is anxious as manifested in muscle tension. If one drinks alcohol they depress themselves not only with their drink but with their thoughts as the alcohol paints the picture in their mind's eye. Thus we have dual diagnosis alcoholism and depression situated within bad coping skills.
Cloninger, C. R. (2002). Implications of comorbidity for the classification of mental disorders: the need for a psychobiology of coherence. In Psychiatric Diagnosis and Classification Chichester: John Wiley & Sons.
Kessler, R. C., McGonagle, K. A., Zhao, S.,(1994) .Lifetime and 12-month prevalence of DSM- III-R psychiatric disorders in the United States: results from the National Comorbidity Survey.Archives of General Psychiatry
Levyberg, A., Sandell, R., & Sandahl, C. (2009). Affect-focused body psychotherapy in patients with generalized anxiety disorder: Evaluation of an integrative method. Journal of Psychotherapy Integration
Definitions References:
Dual-Diagnosis Recovery (2010). retrieved 12/16/2010 at
Manzella, D. (2008). retrieved 12/16/2010 at :
Psychology Today. (2008). retrieved 12/16.2010 at occurring-disorders

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