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Comorbidity of psychiatric disorders and posttraumatic stress disorder.
J Clin Psychiatry. 2000; 61 Suppl 7:22-32.JC

Abstract

Posttraumatic stress disorder (PTSD) commonly co-occurs with other psychiatric disorders. Data from epidemiologic surveys indicate that the vast majority of individuals with PTSD meet criteria for at least one other psychiatric disorder, and a substantial percentage have 3 or more other psychiatric diagnoses. A number of different hypothetical constructs have been posited to explain this high comorbidity; for example, the self-medication hypothesis has often been applied to understand the relationship between PTSD and substance use disorders. There is a substantial amount of symptom overlap between PTSD and a number of other psychiatric diagnoses, particularly major depressive disorder. It has been suggested that high rates of comorbidity may be simply an epiphenomenon of the diagnostic criteria used. In any case, this high degree of symptom overlap can contribute to diagnostic confusion and, in particular, to the underdiagnosis of PTSD when trauma histories are not specifically obtained. The most common comorbid diagnoses are depressive disorders, substance use disorders, and other anxiety disorders. The comorbidity of PTSD and depressive disorders is of particular interest. Across a number of studies, these are the disorders most likely to co-occur with PTSD. It is also clear that depressive disorder can be a common and independent sequela of exposure to trauma and having a previous depressive disorder is a risk factor for the development of PTSD once exposure to a trauma occurs. The comorbidity of PTSD with substance use disorders is complex because while a substance use disorder may often develop as an attempt to self-medicate the painful symptoms of PTSD, withdrawal states exaggerate these symptoms. Appropriate treatment of PTSD in substance abusers is a controversial issue because of the belief that addressing issues related to the trauma in early recovery can precipitate relapse. In conclusion, comorbidity in PTSD is the rule rather than the exception. This area warrants much further study since comorbid conditions may provide a rationale for the subtyping of individuals with PTSD to optimize treatment outcomes.

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Authors+Show Affiliations

Brady KT
Institute of Psychiatry, Medical University of South Carolina, Charleston 29425, USA.
Killeen TK
No affiliation info available
Brewerton T
No affiliation info available
Lucerini S
No affiliation info available

MeSH

Anxiety DisordersCombined Modality TherapyComorbidityDepressive DisorderDiagnosis, DifferentialDissociative DisordersFeeding and Eating DisordersFemaleHumansMaleMental DisordersPrevalenceStress Disorders, Post-TraumaticSubstance-Related DisordersSuicide

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

10795606

Citation

Brady, K T., et al. "Comorbidity of Psychiatric Disorders and Posttraumatic Stress Disorder." The Journal of Clinical Psychiatry, vol. 61 Suppl 7, 2000, pp. 22-32.
Brady KT, Killeen TK, Brewerton T, et al. Comorbidity of psychiatric disorders and posttraumatic stress disorder. J Clin Psychiatry. 2000;61 Suppl 7:22-32.
Brady, K. T., Killeen, T. K., Brewerton, T., & Lucerini, S. (2000). Comorbidity of psychiatric disorders and posttraumatic stress disorder. The Journal of Clinical Psychiatry, 61 Suppl 7, 22-32.
Brady KT, et al. Comorbidity of Psychiatric Disorders and Posttraumatic Stress Disorder. J Clin Psychiatry. 2000;61 Suppl 7:22-32. PubMed PMID: 10795606.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comorbidity of psychiatric disorders and posttraumatic stress disorder. AU - Brady,K T, AU - Killeen,T K, AU - Brewerton,T, AU - Lucerini,S, PY - 2000/5/5/pubmed PY - 2000/5/16/medline PY - 2000/5/5/entrez SP - 22 EP - 32 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 61 Suppl 7 N2 - Posttraumatic stress disorder (PTSD) commonly co-occurs with other psychiatric disorders. Data from epidemiologic surveys indicate that the vast majority of individuals with PTSD meet criteria for at least one other psychiatric disorder, and a substantial percentage have 3 or more other psychiatric diagnoses. A number of different hypothetical constructs have been posited to explain this high comorbidity; for example, the self-medication hypothesis has often been applied to understand the relationship between PTSD and substance use disorders. There is a substantial amount of symptom overlap between PTSD and a number of other psychiatric diagnoses, particularly major depressive disorder. It has been suggested that high rates of comorbidity may be simply an epiphenomenon of the diagnostic criteria used. In any case, this high degree of symptom overlap can contribute to diagnostic confusion and, in particular, to the underdiagnosis of PTSD when trauma histories are not specifically obtained. The most common comorbid diagnoses are depressive disorders, substance use disorders, and other anxiety disorders. The comorbidity of PTSD and depressive disorders is of particular interest. Across a number of studies, these are the disorders most likely to co-occur with PTSD. It is also clear that depressive disorder can be a common and independent sequela of exposure to trauma and having a previous depressive disorder is a risk factor for the development of PTSD once exposure to a trauma occurs. The comorbidity of PTSD with substance use disorders is complex because while a substance use disorder may often develop as an attempt to self-medicate the painful symptoms of PTSD, withdrawal states exaggerate these symptoms. Appropriate treatment of PTSD in substance abusers is a controversial issue because of the belief that addressing issues related to the trauma in early recovery can precipitate relapse. In conclusion, comorbidity in PTSD is the rule rather than the exception. This area warrants much further study since comorbid conditions may provide a rationale for the subtyping of individuals with PTSD to optimize treatment outcomes. SN - 0160-6689 UR - https://www.unboundmedicine.com/medline/citation/10795606/Comorbidity_of_psychiatric_disorders_and_posttraumatic_stress_disorder_ L2 - http://www.psychiatrist.com/jcp/article/pages/2000/v61s07/v61s0704.aspx DB - PRIME DP - Unbound Medicine ER -