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Comorbidity
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== Mental health == In [[psychiatry]], psychology, and mental health counseling, comorbidity refers to the presence of more than one diagnosis occurring in an individual at the same time. However, in psychiatric classification, comorbidity does not necessarily imply the presence of multiple diseases, but instead can reflect current inability to supply a single diagnosis accounting for all symptoms.<ref>{{cite journal |doi=10.1159/000086093 |title=Mutually Exclusive versus Co-Occurring Diagnostic Categories: The Challenge of Diagnostic Comorbidity |year=2005 |last1=First |first1=Michael B. |journal=Psychopathology |volume=38 |issue=4 |pages=206–10 |pmid=16145276|s2cid=24215247 }}</ref> On the [[Diagnostic and Statistical Manual of Mental Disorders|DSM]] Axis I, [[major depressive disorder]] is a very common comorbid disorder. The Axis II [[personality disorder]]s are often criticized because their comorbidity rates are excessively high, approaching 60% in some cases. Critics{{who|date=March 2023}} assert this indicates these categories of mental illness are too imprecisely distinguished to be usefully valid for diagnostic purposes, impacting treatment and resource allocation.{{citation needed|date=March 2023}} Symptom overlap is a key component against DSM classification and serves as a note towards redefining criteria in disorders that the root cause may not be understood thoroughly. Regardless of criticisms, it stands that, annually{{where|date=March 2023}}, up to 45% of mental health patients fit the criteria for a comorbid [[diagnosis]]. A comorbid diagnosis is associated with more severe symptomatic expression and greater chance of dismal [[prognosis]].<ref>{{Cite journal|last1=van Loo|first1=Hanna M.|last2=Romeijn|first2=Jan-Willem|date=February 2015|title=Psychiatric comorbidity: fact or artifact?|journal=Theoretical Medicine and Bioethics|language=en|volume=36|issue=1|pages=41–60|doi=10.1007/s11017-015-9321-0|issn=1386-7415|pmc=4320768|pmid=25636962}}</ref> Certain diagnoses such as [[Attention deficit hyperactivity disorder|ADHD]], [[autism]], [[Obsessive–compulsive disorder|OCD]], and [[mood disorder]]s have higher rates of co-occurring or being prevalent in separate diagnoses. "Comorbidity in OCD is the rule rather than the exception" with OCD diagnoses facing a lifetime rate of 90%.<ref>{{Cite journal|last1=Klein Hofmeijer-Sevink|first1=Mieke|last2=van Oppen|first2=Patricia|last3=van Megen|first3=Harold J.|last4=Batelaan|first4=Neeltje M.|last5=Cath|first5=Danielle C.|last6=van der Wee|first6=Nic J. A.|last7=van den Hout|first7=Marcel A.|last8=van Balkom|first8=Anton J.|date=2013-09-25|title=Clinical relevance of comorbidity in obsessive compulsive disorder: The Netherlands OCD Association study|url=https://www.sciencedirect.com/science/article/pii/S0165032713002395|journal=Journal of Affective Disorders|language=en|volume=150|issue=3|pages=847–854|doi=10.1016/j.jad.2013.03.014|pmid=23597943 |issn=0165-0327}}</ref> With overlapping symptoms comes overlap in treatment as well, [[Cognitive behavioral therapy|CBT]] for example is common for both ADHD and OCD with pediatric onset and can be effective for both in a comorbid diagnosis.<ref>{{Cite journal|last1=Reale|first1=Laura|last2=Bartoli|first2=Beatrice|last3=Cartabia|first3=Massimo|last4=Zanetti|first4=Michele|last5=Costantino|first5=Maria Antonella|last6=Canevini|first6=Maria Paola|last7=Termine|first7=Cristiano|last8=Bonati|first8=Maurizio|last9=Conte|first9=Stefano|last10=Renzetti|first10=Valeria|last11=Salvoni|first11=Laura|date=2017-12-01|title=Comorbidity prevalence and treatment outcome in children and adolescents with ADHD|url=https://doi.org/10.1007/s00787-017-1005-z|journal=European Child & Adolescent Psychiatry|language=en|volume=26|issue=12|pages=1443–1457|doi=10.1007/s00787-017-1005-z|pmid=28527021 |s2cid=3076193 |issn=1435-165X}}</ref> OCD and eating disorders have a high rate of occurrence, it is estimated that 20-60% of patients with an eating disorder have OCD.<ref>{{Cite journal |last1=Bang |first1=Lasse |last2=Kristensen |first2=Unn Beate |last3=Wisting |first3=Line |last4=Stedal |first4=Kristin |last5=Garte |first5=Marianne |last6=Minde |first6=Åse |last7=Rø |first7=Øyvind |date=2020-01-30 |title=Presence of eating disorder symptoms in patients with obsessive-compulsive disorder |journal=BMC Psychiatry |volume=20 |issue=1 |pages=36 |doi=10.1186/s12888-020-2457-0 |issn=1471-244X |pmc=6993325 |pmid=32000754 |doi-access=free }}</ref> More often, comorbidity complicates and can prevent treatment efficacy on a varying scale depending on the circumstances. The term 'comorbidity' was introduced in medicine by Feinstein (1970) to describe cases in which a 'distinct additional clinical entity' occurred before or during treatment for the 'index disease', the original or primary diagnosis. Since the terms were coined, meta studies have shown that criteria used to determine the index disease were flawed and subjective, and moreover, trying to identify an index disease as the cause of the others can be counterproductive to understanding and treating interdependent conditions. In response, 'multimorbidity' was introduced to describe concurrent conditions without relativity to or implied dependency on another disease, so that the complex interactions to emerge naturally under analysis of the system as a whole.<ref>{{cite journal |last1=Rhee |first1=Soo Hyun |last2=Hewitt |first2=John K. |last3=Lessem |first3=Jeffrey M. |last4=Stallings |first4=Michael C. |last5=Corley |first5=Robin P. |last6=Neale |first6=Michael C. |title=The Validity of the Neale and Kendler Model-Fitting Approach in Examining the Etiology of Comorbidity |journal=Behavior Genetics |date=May 2004 |volume=34 |issue=3 |pages=251–65 |doi=10.1023/B:BEGE.0000017871.87431.2a |pmid=14990866 |s2cid=23065315 }}</ref> Although the term 'comorbidity' has recently become very fashionable in psychiatry, its use to indicate the concomitance of two or more psychiatric diagnoses is said to be incorrect because in most cases it is unclear whether the concomitant diagnoses actually reflect the presence of distinct clinical entities or refer to multiple manifestations of a single clinical entity. It has been argued that because "'the use of imprecise language may lead to correspondingly imprecise thinking', this usage of the term 'comorbidity' should probably be avoided".<ref>{{cite journal |doi=10.1192/bjp.186.3.182 |title='Psychiatric comorbidity': An artifact of current diagnostic systems? |year=2005 |last1=Maj |first1=Mario |journal=The British Journal of Psychiatry |volume=186 |issue=3 |pages=182–84 |pmid=15738496|doi-access=free }}</ref> Due to its artifactual nature, psychiatric comorbidity has been considered as a Kuhnian anomaly leading the DSM to a scientific crisis<ref>{{cite journal |doi=10.1353/ppp.0.0211 |title=The Role of Comorbidity in the Crisis of the Current Psychiatric Classification System |year=2009 |last1=Massimiliano Aragona |journal=Philosophy, Psychiatry, & Psychology |volume=16 |pages=1–11|s2cid=143888431 }}</ref> and a comprehensive review on the matter considers comorbidity as an epistemological challenge to modern psychiatry.<ref>{{cite journal |last1=Jakovljević |first1=Miro |last2=Crnčević |first2=Željka |title=Comorbidity as an epistemological challenge to modern psychiatry |url=http://www.crossingdialogues.com/Ms-A12-07.htm |journal=Dialogues in Philosophy, Mental and Neuro Sciences |date=June 2012 |volume=5 |issue=1 |pages=1–13}}</ref> The [[Hierarchical Taxonomy of Psychopathology]] is a leading alternative classification system that addresses these concerns about comorbidity.
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