Assigning multiple diagnoses allows for the communication of clinical complexity that a more general, all-encompassing diagnosis (such as "severe neurotic disorder") lacks. According to DSM-IV, a patient who meets criteria for dysthymia, abuses alcohol, has obsessions and compulsions, and binges and purges would be assigned 4 separate Axis I disorders. Recognizing the limits of our understanding, DSM-IV guides clinicians to convey the maximum amount of descriptive information possible, even if a diagnosis of numerous simultaneous disorders results. Thus, the term "comorbidity" is misleading in psychiatry, because it implies that we have identified multiple distinct disease states. Feinstein 2 first coined the term "comorbidity" in the general medical literature, defining it as "any distinct additional clinical entity that has existed or that may occur during the clinical course of a patient who has the index disease under study" (eg, a patient with asthma and diabetes mellitus).īut in psychiatry, can we distinguish clinical entities in this way? Is the person who binges and purges and also drinks to excess suffering from 2 distinct disorders (bulimia nervosa and alcohol abuse) or a single disorder of impulse control? Similarly, when symptoms of generalized anxiety and depression co-occur, whether they indicate the presence of 2 distinct clinical entities or are 2 components of a single disorder is mostly a matter of speculation. Using clinical examples, we explore strategies that can be implemented in revisions of the DSM for reducing psychiatric comorbidity, and we consider the strengths and weaknesses of each.Ĭomorbidity is often used to describe the presence of more than one identified psychiatric disorder in a patient. In this article, we examine the evolution of our current diagnostic system to better understand this emergence of comorbid psychiatric diagnoses. 1 The reason lies in the design of the diagnostic system itself: DSM-IV is a descriptive, categorical system that splits psychiatric behaviors and symptoms into numerous distinct disorders, and uses few exclusionary hierarchies to eliminate multiple diagnoses. Treatment strategies for the comorbid condition as well as future areas of research and clinical need are discussed.ĪDHD ASD adolescent autism spectrum disorder children comorbidity developmental delay neurodevelopmental disorder.Since the revision of DSM-III, high rates of co-occurring psychiatric disorders have been observed, particularly in cases of moderate and severe psychiatric illness. Here, we provide an update on the biological, cognitive and behavioral overlap/distinctiveness between the two neurodevelopmental disorders with a focus on data published in the last four years. As a function of both the increased prevalence of both disorders as well as the ability to make an ASD diagnosis in ADHD, there has been a significant amount of research focusing on the comorbidity between ADHD and ASD in the past few years. Both ASD and ADHD are reported to have had substantial increases in prevalence within the past 10 years. In earlier versions of the DSM, this was not acceptable. With the DSM-5, clinicians are permitted to make an ASD diagnosis in the context of ADHD. Attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) commonly co-occur.
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