Comorbidity
Comorbidity invokes scary images for me. Maybe it is because I taught high school English and broke complex words by their root, prefix, and suffix. Morbid (Oxford English Dictionary) is from classical Latin morbidus; diseased, sick, causing disease, unhealthy < morbus disease + -idus -id suffix. Or maybe it is scary for me because my PTSD is marked by comorbidity.
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Morbidity
a. The condition or state of being diseased, or being caused by disease; physical or mental illness.
The general sense of ‘co” is ‘together’, ‘in company’, ‘in common’, ‘joint, -ly’, ‘equal, -ly’, ‘reciprocally’, ‘mutually’.
One of the findings of a September 2019 study in “Psychiatric Research” ” is that most emotional disorder is not due to a single emotional system or a single chemical imbalance. Most people reflect the concept of comorbidity with several emotional and chemical unbalances. That is essentially what comorbidity means, that more than one psychiatric syndrome occurs at the same time. The paper concludes:
A pragmatic approach to psychiatric assessment, allowing for recognition of individual experience, may therefore be a more effective way of understanding distress than maintaining commitment to a disingenuous categorical system.
So much more effective way of understanding emotional distress, but sadly, a long, late cry in the dark. DSM dictates commitment to this disingenuous categorical system as long as the drug companies and insurance companies keep profiting from such commitment. Sort of like trying to stop climate change. Economics dictates over plaintiff cries of reality..
An example of comorbidity is Post-Traumatic Stress Disorder (PTSD). PTSD is a complex condition involving several different emotion systems. In addition to chronically overactive manifestations of the FEAR and PANIC/GRIEF systems, PTSD is a state of terror that is often accompanied by RAGE.
Another example of comorbidity is depression. Depression is a comorbid mix of psychological pain, anxiety, angry irritability, as well as diminished urges to seek and pursue life interests. A diagnostic description would need to address the many emotional systems involved.
Generalized categories such as depression are ambiguous, implying both generalized malaise and sickness. A more accurate comorbid description would need to address the emotional systems involved and the ways that their over or under-arousal contribute to the clinical symptoms.
Surrogate Me
In my long history with therapists, none inquired about my history of childhood trauma. With the DSM as his bible, my first psychoanalyst labeled me as OCD and it stuck throughout my history of therapists. When first diagnosed with that DSM tag I was seventeen. The symptoms seemed to fit. Then no therapist after that questioned the OCD tag.
That tag morphed into a surrogate me. It made it relatively easy for therapists to deal with me and easy to get reimbursed by insurance companies. And though now I realize I have PTSD, it was not until DSM-III in 1980 that the controversial category was added. But for years after that, it applied mainly to war veterans. Bit by bit and really not until 2013 and DSM-5 that PTSD was inclusive of childhood trauma. And though PTSD now recognizes comorbidity, it is limited to a few categories. So I still don’t feel like I quite fit in even in this world of mental illness.
Comorbidity R Us
Jaak Panksepp recognized early on that people with attachment disorders have problems with several basic emotional systems. And he realized that PTSD as well is a complex condition that involves several emotion systems. He understood that PTSD is a way that the brain can be traumatized with emotional systems that include Fear, Panic/Grief as well as Rage.
Not only PTSD. he said most people will reflect several emotional imbalances. This means that more than one psychiatric syndrome occurs at the same time – comorbidity. He said that “depression” is very ambiguous, implying both generalized malaise and sickness. A more accurate description would need to address the emotional systems involved and the ways that their over or under-arousal contribute to the clinical symptoms.
“We suspect that scientific psychiatrists, at some time in the future will begin to understand emotional problems in terms of better descriptions of imbalanced brain emotional systems and an understanding of the many neurochemical changes that can lead to effective distress.”
The categories of the DSM-5 do not sufficiently address comorbidity. Even DSM-5 is still a catalog of categories of illness, whereas a more pragmatic approach allowing for recognition of the individual may be a more effective way of understanding mental struggles.
Most emotional disorder is not due to a single emotional system or a single chemical imbalance. Most people reflect the concept of comorbidity with several emotional and chemical unbalances. That is essentially what comorbidity means, that more than one psychiatric syndrome occurs at the same time. Generalized categories such as depression are ambiguous, implying both generalized malaise and sickness. A more accurate comorbid description would need to address the emotional systems involved and the ways that their over or under-arousal contribute to the clinical symptoms.
Self-help books that help:
Total Self-Renewal through Attention Therapies and Open Focus
The Open-Focus Brain: Harnessing the Power of Attention to Heal Mind and Body
