Comorbid Features

When a person is evaluated by a mental health professional, a primary diagnosis is given. This is the main area causing trouble and will be the primary focus of treatment. There are frequently other conditions of concern, however, and these also should be listed and considered in diagnosis and treatment planning. Conditions that do not fit the main diagnosis are known as comorbid features. As example would be a primary diagnosis of depression with comorbid features of alcoholism and suicidal ideation. A person can be depressed without having a drinking problem or being suicidal; however, the person in this example also struggles in these other areas.

Substance Abuse

• It is common for people who suffer from mental illness to also have a substance abuse problem.

  Ask about substance abuse. This is a comorbid feature in many diagnoses including depression, schizophrenia, obsessive-compulsive disorder and eating disorders, to name a few. The evaluator should assess if the substance problem predated the mental illness, if the person was using the substance to medicate herself or if the substance became a way of dealing with the mental illness. These questions will help ascertain which problem is primary and which is the comorbid issue.

Suicidality

• Assess for suicidality. A person who struggles with a chronic mental illness sometimes loses hope that he will get better and develops suicidal thoughts. Although having suicidal thoughts is not a primary diagnosis, a crisis state is present and the immediate focus should be on ensuring safety. Often, as the mental health issue is correctly diagnosed and treated, the suicidal thoughts abate.

Paranoid Thoughts

• To be classified as paranoia, persecutory thoughts must be excessive or illogical.

  Ask general questions about coping with life to assess for paranoia, which is a common comorbid condition in depression, bipolar disorder, personality disorder and anxiety disorder. Sometimes the person's bizarre behaviors cause other people to look at her strangely. This would be an example of reality, rather than paranoia. To be classified as paranoia, persecutory thoughts must be out of context of reality, illogical or excessive.

Pathological Personality Features

• Histrionic features may be present with depression.

  Try to assess personality patterns such as dependency, antisocial traits or histrionic features. A person with depression may have comorbid features of extreme dependency, for example, but these features may be secondary to the depression as opposed to a manifestation of dependent personality disorder, in itself. He may exhibit antisocial traits, stealing because he does not care if he is caught. This is not a manifestation of antisocial personality disorder but a sign of apathy. Finally, the depressed person may become very theatrical -- this is especially true with teenagers. A depressed teenager being theatrical does not mean she has a histrionic personality disorder.