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Comorbidity

Definition:

Comorbidity - Comorbidity is a psychological term used to describe the occurrence of more than one diagnosis in a single patient. Comorbidity is common in the diagnosis of psychological disorders.

Description:

The American Psychiatric Association (APA) publishes a book containing comprehensive definitions of mental disorders known as the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The DSM-IV-TR contains criteria for Personality Disorders which are broad with some overlap between different diagnoses. This overlap is known as "Comorbidity". A patient has to exhibit some, but not all of the traits of a particular disorder in order to be given that diagnosis. Many patients exhibit collections of criteria which allow them to be diagnosed with more than one disorder.

So, for example, it is possible for a person who suffers from Narcissistic Personality Disorder to exhibit some of the traits listed in the criteria for Borderline Personality Disorder. Likewise, it is possible for a person with Dependent Personality Disorder to behave a lot like a person with Obsessive Compulsive Personality Disorder. This overlapping nature of personality disorders is known as Comorbidity.


Comorbidity Between Personality Disorders

The following table shows statistically how likely it is that a person who is diagnosed with one personality disorder will also be diagnosed with another personality disorder, as defined by the American Psychiatric Association's Diagnostic & Statistical Manual of Mental Disorders (DSM-IV).

The numbers displayed in the table below are a statistical measures of co-occurrence known as "tetrachoric correlations". The more positive the number, the more likely it is that a person will be diagnosed with the second personality disorder listed. The more negative the number, the less likely it is that a person will be diagnosed with the second personality disorder in the table.

Note: This data was compiled from an initial survey of 5692 people in the US. None of the people in the survey sample were identified as meeting the criteria for Histrionic Personality Disorder or Narcissistic Personality Disorder. Therefore, no comorbidity information is shown for HPD or NPD.

  PPD SPD STPD ASPD BPD AVPD DPD OCPD
PPD 0.77 0.48 0.73 0.76 0.70 0.20 0.59
SPD 0.77 0.96 -0.84 0.56 0.55 -0.84 0.40
STPD 0.48 0.96 0.13 0.34 0.53 -0.86 0.49
ASPD 0.73 -0.84 0.13 0.64 0.05 -0.83 0.45
BPD 0.76 0.56 0.34 0.64 0.54 0.82 0.67
AvPD 0.70 0.55 0.53 0.05 0.54 0.70 0.63
DPD 0.20 -0.84 -0.86 -0.83 0.82 0.70 0.80
OCPD 0.59 0.40 0.49 0.45 0.67 0.63 0.80

Source: Lenzenweger et al, 2007 - DSM-IV personality disorders in the National Comorbidity Survey Replication


Comorbidity Between Personality Disorders and DSM-IV Axis I Disorders

67% of people who meet the DSM-IV criteria for a Personality DIsorder have been found in a 2007 study to also meet the criteria for at least one of the DSM-IV Axis I disorder. The table below shows the probability that a person who has been diagnosed with a personality disorder will also meet the criteria for each of the following Axis I disorders, as defined by the American Psychiatric Association's Diagnostic & Statistical Manual of Mental Disorders (DSM-IV).

Comorbidity is a psychological term used to describe the occurrence of more than one diagnosis in a single patient.

Axis I Disorder Comorbidity
Anxiety Disorders 52.4%
- Generalized Anxiety Disorder (GAD) 15.2%
- Specific phobia 23.4%
- Social phobia 26.3%
- Panic disorder 10.0%
- Adult separation anxiety disorder (ASAD) 8.9%
- Post Traumatic Stress Disorder (PTSD) 14.1%
Mood Disorders 24.1%
- Major Depressive Disorder (MDD) 13.4%
- Dysthymia 10.8%
- Bipolar I or II 8.1%
Impulse Control Disorders 23.2%
- Intermittent Explosive Disorder (IED) 15.9%
- Attention Deficit Disorder (ADD) 11.0%
Substance Abuse 22.6%
- Alcohol abuse or dependence 10.9%
- Drug abuse or dependence 5.6%
- Tobacco dependence 11.8%
Any DSM-IV Axis I Disorder 67.0%

Source: Lenzenweger et al, 2007 - DSM-IV personality disorders in the National Comorbidity Survey Replication

Note that although 67% of the people meeting the criteria for a personality disorder also meet the criteria for an Axis I disorder, the reverse is not true. Only 24.8% of people meeting the criteria for an Axis I disorder also meet the criteria for an Axis II personality disorder.


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