A co-occurring disorder is one that sees a combination of mental health issues occurring in the same person. It has also been referred to as a dual diagnosis or a dual disorder, although ‘dual’ implies there are two co-occurring disorders, and there may sometimes be more.
Diagnosing co-occurring disorders
It can be very difficult to identify whether the two (or more) issues are occurring separately to one another, whether they have become linked along the way, or whether one condition precipitated the other(s). For example, if someone exhibits signs of addiction, it does not always mean that this is the dominant issue they face.
It could be that one way they try to manage their depression or anxiety better, for example, is to drink alcohol or take drugs. In a circumstance like this, the addictive behaviour can, in fact, cause further confusion for the sufferer when they are trying to seek out appropriate treatment and support. It can even appear to have ‘replaced’ the underlying issue, at least temporarily.
Whilst people may not always want to look at the underlying reasons for their behaviour, then, it is often a crucial step in the process of both seeking help, and understanding their own issues more accurately.
How co-occurring disorders may play out
1) Co-occurring depression and substance abuse
If someone, for instance, begins to experience depressive episodes and is misusing substances at the same time, then that person would be suffering from co-occurring disorders. It would be worth considering what triggered the depressive episodes, as the trigger could well be the substance itself. Alcohol, for example, is a well-known depressant, meaning it can interfere with our brain’s neurotransmitters, and if consumed excessively or too regularly, can impact on the quality of our mood and consequently, our mental health.
What is perhaps less acknowledged is that alcohol has been found to increase levels of norepinephrine, a hormone that increases impulsivity, hence why people often feel dissatisfied with things they have done while under the influence of alcohol which they might not have done otherwise.
Individuals may become unhappy and even depressed when they are faced with the consequences of actions taken while under the influence of alcohol.
Handling the emotions experienced in the aftermath of mistakes made whilst under the influence of a substance may be so difficult that it becomes hard for the person to see that these issues are exacerbated by the substance, as opposed to helped by it.
The other aspect to consider is the recovery from having taken any kind of substance, whether it is a type of drug or alcohol. Whether it is a “come-down” or simply exhaustion, it can take days for someone to feel rebalanced and back to themselves. These side-effects may create a cycle of dependency in themselves, where the individual feels they need the substance in order to avoid feeling the ‘come-down’ or depressive episode that can ensue when it wears off.
The individual may also become aware that social situations feel harder when they are “on their own”, so to speak, without the aid of the substance to assist them in feeling less self-conscious.
Anxiety can develop from this realisation, whereas in the past, the individual may have been able to hold their own socially. This is an example of why co-occurring disorders can be difficult to identify at times– because it is not always clear which issue existed independent of the other, or whether it did at all.
2) Co-occurring depression and eating disorders
The same issue can face sufferers of eating disorders and the professionals who treat them. Someone who is feeling extremely depressed, anxious and isolated may well experience a loss of appetite or a distinct lack of interest in nurturing themselves. This can include not seeing the point in getting out of bed, showering, brushing one’s teeth, eating, or a multitude of other seemingly small but important tasks.
If there is no motivation for the person to feed themselves, this can be mistaken for an eating disorder, as opposed to a manifestation of the severe pain they are feeling through their depression.
Having said that, it is not uncommon for someone suffering from an eating disorder to also experience other mental health issues alongside it. In the case of anorexia, long-term malnutrition can change the biochemical activity in a person’s brain, impacting on their behaviour and mood, and causing them to feel a variety of different emotions ranging from anger to acute anxiety and isolation. Some other side effects generally associated with eating disorders are insomnia, irritability, exhaustion, paranoia, and a feeling of nameless dread (whereby the sufferer experiences high anxiety that something awful is going to happen and it is not understood or contained).
Research suggests that over 50% of people who experience eating disorders also experience depression. Considering these symptoms and research, it would be difficult not to draw a parallel between the effects that anorexia can have on mood and the effects that depression can have on mood. This is why, at times, mental health issues can no longer be viewed in isolation, because they can often be enmeshed.
Challenges associated with recovery from a co-occurring disorder
Whilst treatment differs depending on the individual’s issue(s), a combination of support from professionals (such as the GP, inpatient treatment in a rehabilitation setting, or therapy) and support from loved ones (whether this is family, friends, or colleagues), is encouraged.
When someone is in treatment for a co-occurring disorder, their recovery may be more complicated in terms of them being able to see direct results. This can be for numerous reasons: one of them is that the person may hope that once they have their substance-use under control, their mental health will improve drastically.
If depression, for example, exists independently, it may require more motivation and patience on the part of the person going through treatment, as they work through their depression alongside their issue with substances. The same can be important to remember for any co-occurring disorder, as it can be tempting to feel discouraged when things do not immediately improve.
Seeking additional support during this particular stage of the recovery process is key so as to avoid feeling isolated and defeated within oneself. Working in an integrated way with a professional can ensure that a number of different issues can be addressed simultaneously, without any being discarded or thought of as insignificant. There are many factors that can contribute to co-occurring disorders and ultimately, it is important not to rule any out, but rather, to simply be mindful that they may be significant in their own right.