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Multiple disorders are the rule, not exception

Serious mental illnesses, in and of themselves, create significant challenges, not only for individuals suffering from these conditions, but for clinicians attempting to treat the conditions.

Psychiatric disorders such as chronic or recurrent major depression, bipolar disorder, schizophrenia, obsessive-compulsive disorder, and borderline personality disorder are difficult problems even if they present only by themselves.

The harsh reality, however, is that this is rarely the case.

In a perfect world, an individual suffering from just one specific psychiatric condition would present to a clinician and receive appropriate, successful treatment for that condition.

But in this far-from-perfect world, it is the rule, rather than the exception, for people seeking help to present with two or more psychiatric conditions.

When two or more psychiatric conditions are presented simultaneously by the same individual, that individual is said to be suffering from co-existing, or co-morbid, disorders.

Depression and various types of anxiety problems often co-exist, but that is only the beginning of the spectrum of co-morbidity.

Depression and/or anxiety are often factors in several other types of primary diagnoses, like schizophrenia and obsessive-compulsive disorder, creating a situation that compounds treatment challenges.

“Having one diagnosable psychiatric disorder doesn’t by any means immunize you from all others,” Dr. Joseph Silverman – an Altoona psychiatrist who has retired from regular practice but who still performs clinical evaluations – wrote in an email to the Mirror. “Multiple diagnoses are more common than not. It is not rare to have more than five! (And) it is generally believed that two or more concurring diagnoses are a greater therapeutic challenge.”

Among the most common combinations of co-morbid disorders include various types of anxiety-related problems that include obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), social anxiety disorder, panic attacks, and phobias.

“Anxiety disorders, in particular, cluster,” Silverman said.

According to a 2009 article by Dr. Alexandra Bottas, M.D., that was published in the Psychiatric Times, there is a substantial correlation between schizophrenia and OCD in the clinical population.

People with eating disorders like anorexia nervosa and bulimia are also often suffering from significant levels of depression and anxiety, according to 2012 studies produced by the Renfrew Center Foundation, a nationally-renowned organization that specializes in the treatment of eating disorders.

In a specific psychiatric condition known as schizoaffective disorder, people manifest some symptoms of schizophrenia, along with some symptoms of major depression.

There is also a strong correlation between substance-abuse disorders and psychiatric problems like depression and anxiety, as any professional clinician who has treated one or both sets of problems will readily acknowledge.

“Drug and alcohol problems, including nicotine addiction, are all too common among psychiatric patients,” Silverman said. “Some problems like substance abuse interfere so much with treatment (of psychiatric issues like depression or anxiety disorders) that the (substance-abuse issues) must be controlled before the (psychiatric issues) can be addressed.”

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