Comorbidity

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Comorbidity is a term introduced by Feinstein in 1970 to describe cases in which a Distinct Additional Clinical Entity. Occurred during the clinical course of a patient's initial condition, be that physical, psychological, or otherwise. This means that along side an original condition, for example, a heart palpatation (flutter), a patient would develop a panic disorder linked to that, but not caused by it.

Not only does the term refer to cases of overlapping psychological and general medical conditions, but cases of two or more psychiatric diagnoses, e.g. depression, coupled with a panic disorder. This is known as ‘Psychiatric Comorbidity.

This use of the term ‘comorbidity’ to indicate the concomitance of two or more psychiatric diagnoses appears 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; because “the use of imprecise language may lead to correspondingly imprecise thinking (Lilienfeld et al, 1994), this usage of the term comorbidity should probably be avoided.

However, the fact remains that the co-occurrence of multiple psychiatric diagnoses is now more frequent than in the past. This is certainly in part a consequence of the use of standardized diagnostic interviews, which helps to identify several clinical aspects that in the past remained unnoticed after the principal diagnosis had been made a development that is obviously welcome because it is likely to lead to more comprehensive clinical management or treatment of the patient.

Comorbidity and GID

Gender identity disorder can be a traumatic experience for a trans person, and the occurrence of comorbid conditions is not uncommon. The most common, being personality disorders, and severe depression.

Mental health disorders that may interfere with a GID diagnosis

  • Personality disorders
    • Cluster A (odd or eccentric disorders)
      • Paranoid personality disorder
      • Schizoid personality disorder
      • Schizotypal personality disorder
    • Cluster B (dramatic, emotional, or erratic disorders)
    • Cluster C (anxious or fearful disorders)
      • Avoidant personality disorder
      • Dependent personality disorder
      • Obsessive-compulsive personality disorder
  • Mood disorders
  • Dissociative identity disorder
  • Psychotic disorders

Mental health disorders that may not interfere with a GID diagnosis

Diagnosis

The presence of a mental health disorder does not immediately preclude a diagnosis of gender identity disorder, but caution must be observed, particularly in the case of psychotic disorders. This means that while genuine cases of gender identity disorder can either lead to, or be accompanied by a comorbid condition, some conditions can develop identity disorders.

An example being as follows: A person suffers from Gender Identity Disorder. The condition untreated leads to them becoming comorbidly suffering from clinical depression.

One school of thought followed by some psychiatrists, is that the comorbid condition be treated before the GID itself, considering the conditions being purely overlapping, not necessarily related. This is a point of much debate within psychiatric circles. Most psychiatrists believe many comorbid or concomitant conditions to be the direct result of the original condition (GID) and that both or all may be treated by focusing on the root disorder.


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