Comorbidity, or the co-occurrence of two distinct medical conditions, is a common phrase in both physical and mental health. Whilst the term was originally conceived to describe medical phenomena, the term was adopted by psychiatry in the description of more than one clinical presentation occurring simultaneously. However, its use in psychiatry is not without controversy. 

What we know already

Large-scale prevalence data can seemingly tell us much about the high rate of comorbidity in mental health. Data from US National Comorbidity Survey, for example, suggested that, of those reporting mental health difficulties (across a 12-month prevalence), only 55% carried a single psychiatric diagnosis.

One important area of recent research concerns the rates of comorbidity of physical and mental health difficulties, particularly in the area of chronic health conditions. Mental Elf blogs have reported that people with schizophrenia are significantly more likely to die from heart disease and cancer; while the National Schizophrenia Audit calls for improved monitoring of physical health in people with schizophrenia. We know that depression and anxiety are more common when a person has a chronic health problem, and this comorbidity leads to poorer clinical and quality of life outcomes. This has led to an increase in interventions targeting the psychological consequences of chronic ill health.

Areas of uncertainty

The controversy in psychiatric comorbidity is the issues of mutual exclusivity. We are not able to conclude as to whether ‘comorbid’ psychiatric diagnoses are separate clinical entities, or multiple features of the same underlying cause. This has led to much criticism of the term ‘psychiatric comorbidity’.

Furthermore, certain diagnostic labels, such as personality disorders, attract particular scrutiny, due to their high levels of comorbidity with other mental health diagnoses. Similarly, people often meet the criteria for more than one personality disorder. This again creates uncertainty as to the precise nature of the condition, or conditions, being diagnosed.

What’s in the pipeline?

The recent publication of the Diagnostic and Statistic Manual (DSM)-5 seemingly retains the notion that multiple distinct clinical diagnoses exist, thus maintaining the argument for psychiatric comorbidity. Alternative conceptualisations have been suggested, along dimensional models, such as ‘anxious-misery’, ‘externalising’ and ‘fear-based’ dimensions. However, these were not adopted in the DSM-5.

As our understanding of mental health conditions continues to improve, so too hopefully will our understanding of comorbidity, and its relevance to psychological and psychiatric phenomena.


First, M. B. (2005). Mutually exclusive versus co-occurring diagnostic categories: the challenge of diagnostic comorbidity. Psychopathology, 38, 206-210. [Abstract]

Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62, 617-627. [Abstract]

Naylor, C., Parsonage, M., McDaid, D., Knapp, M., Fossey, M. and Galea, A. (2012) Long-term conditions and mental health: the cost of co-morbidities. The King’s Fund, London, UK. [Full text]


Written by: Patrick Kennedy-Williams
Reviewed by:
Last updated: Sep 2015
Review due: Sep 2016

Our comorbidity Blogs

What impact are psychotropic drugs having on our physical health?


John Baker summarises the findings of a recent review of people with schizophrenia, bipolar disorder and depression. The study looks at the adverse effects on physical health of psychotropic drugs (antipsychotics, antidepressants and mood stabilisers).

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Depression in patients with alcohol use disorders


Sally Adams summarises a recent meta-analysis of outcomes for independent and substance-induced disorders in people with depression and alcohol use disorders.

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Antidepressants for depression in cancer: Cochrane review highlights lack of evidence

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Kirsten Lawson reports on a recent Cochrane systematic review, which highlights a lack of high quality trials about the efficacy and safety of antidepressants for depression in cancer.

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Joining the dots: mental and physical health

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Lia Ali and colleagues from the IMPARTS project present the findings of their group discussions about a recent review of mortality in mental disorders. Along the way she discusses the staff training they carried out and the tweet chat they ran to consider the implications of this research, both to individuals and on the global burden of disease.

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Pharmacotherapy for anxiety and comorbid alcohol use disorders


Natasha Clarke summarises a recent Cochrane review of pharmacotherapy for anxiety and comorbid alcohol use disorders, which found only very low quality evidence about the effectiveness of medication (buspirone, paroxetine, sertraline) for treating patients with both conditions.

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Psychotherapies for anxiety in bipolar disorder


Elena Marcus finds inconclusive results in this recent systematic review of psychological therapy for anxiety in bipolar spectrum disorders, which includes trials of CBT, mindfulness based cognitive therapy and stress management therapy.

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CBT for insomnia in psychiatric populations: an effective alternative to hypnotics?

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Amy Green appraises a systematic review of CBT for insomnia (CBTi) in people with comorbid mental illness, which concludes that cognitive behaviour therapy could be an effective alternative to hypnotics. However, concerns about the review methodology cast some doubt on the findings.

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Alcohol misuse and PTSD comorbidity: a significant problem lacking solutions


Current NICE guidelines state that PTSD should not be dealt with unless alcohol dependence is first treated. Paul Christiansen summarises a systematic review of the comorbidity between PTSD and alcohol misuse and wonders where the guidance leaves patients and professionals.

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Schizophrenia and osteoporosis: sticks and stones may break my bones…


Chris Pell summarises a recent meta-analysis of prevalence estimates and moderators of low bone mass in people with schizophrenia. The study finds a significantly increased risk of osteoporosis in people with schizophrenia.

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