COMORBIDITIES
co·mor·bid·i·ty
noun
noun: comorbidity; plural noun: comorbidities
1. a medical condition that is simultaneously present with another or others in a patient.
If you are not familiar with the term comorbidity, you may have heard the same concept referred to as a coexisting or co-occurring condition. In layman’s terms, and in this instance, we are discussing the presence of two or more mental health conditions existing at the same time. Understanding what OCPD is and is not is critical to the treatment of this disorder. Another crucial component is knowing whether or not you’re treating OCPD in isolation, or if there are other mental health concerns adding to the complexity of what you are facing.
Getting properly diagnosed can be fraught with challenges, and one of these challenges can be the addition of other disorders. Understanding what you are dealing with is an important first step in your mental health journey. For someone with OCPD, there are comorbid conditions that are common, there are those that are difficult to separate from obsessive compulsive personality disorder & there are other disorders that are unlikely to co-occur with your condition.
The following list is by no means exhaustive and should not be used to self-diagnose. The intent of this information is to provide you with a list of some of the more common comorbidities, along with a brief description of each. As a common questions is: “can I have condition A if condition B is present”, we want to provide a resource of known OCPD comorbidities. If any of the issues listed below feel familiar to you, we would suggest speaking with a mental health professional as the logical next step.
Mood Disorders
A person’s mood is defined as a pervasive and sustained feeling, impacting a person’s internal and external perception of themselves and the world around them. Mood disorders are a class of mental health disorders that broadly encompass the many different types of depression and bipolar disorders. Primarily, this class of disorders affect a person’s emotional state, and can also influence behaviors.
This classification of disorders is marked by a disruption in emotions. Sadness, anger and even elation can be persistent and intense in someone afflicted by a mood disorder. Although everyone on earth will experience these emotions from time to time, it is the intensity, frequency & duration of these emotional states that would assist in identifying whether or not a person’s mood is disordered.
Commonly, these prolonged emotional states can have negative implications in regard to a person’s family, friends, profession and interests. With some mood disorders, there can also be an increased risk of morbidity and mortality. If you or someone you know is experiencing thoughts of suicide, it is vital to seek out help immediately.
Examples of Mood Disorders:
Major depression
Dysthymia
Bipolar disorder
Mood disorder associated with health condition
Substance-induced mood disorder
Seasonal affective disorder (SAD)
Cyclothymic disorder
Premenstrual dysphoric disorder
Causes & Risk Factors
There are many potential causes and risk factors when it comes to mood disorders. In terms of medical explanations, there can be genetic, hormonal, biological & immunological causes. Examining your own family history may reveal new factors to consider. Oversimplified, an imbalance of brain chemicals is often considered to be at the heart of what constitutes a mood disorder.
Life itself can present us with plenty of risk factors. Stress is a built-in component of what it means to be human. Exposure to greater stresses, abuse or living through traumatic experiences can bring about the onset of a mood disorder.
Symptoms & Characteristics
As we are discussing comorbidities, it’s important to remember that the symptoms of a mood disorder may seem like other conditions or mental health concerns. As previously stated, this category can be broad, and so the following is not a comprehensive list of traits, but rather we are presenting you with some of the most common signs to look for.
Ongoing feelings of sadness and hopelessness
Feeling “empty”
Low self-esteem
Disinterest in normal day-to-day activities
Disinterest in previously enjoyed activities
Preoccupation with mortality
Irritability, aggression or hostility
Changes in weight, appetite & sleep patterns
Upset stomach and headaches
Lack of focus
Feelings of inadequacy and worthlessness
Treatment
Mood disorders are a real medical disorder. As such, it is important to consider the guidance of a mental health professional. They will undertake a psychiatric evaluation and complete a medical history examination with you. Traditionally, these disorders are treated with a combination of psychotherapy and medication.
Psychotherapy encompasses many different psychological disciplines. Cognitive-behavioral therapy (CBT) will generally focus on assisting a patient to change their distorted/negative biased thoughts and outlook as well as increasing the frequency of reinforcing behaviors that emphasize pleasure and mastery. Other forms of talk therapy will work to identify the source(s) of your emotional malaise.
Pharmacological and talk therapy treatments are not the only options available to you. There is a growing list of alternative therapies with varying levels of success in treating mood disorders. It is important that you seek out the treatment that works best for you.
Next: Anxiety disorders can also affect your mood and can frequently go hand-in-hand with mood disorders.
Anxiety Disorders
As with low mood and sadness, occasional anxiety is a part of life. And as with mood disorders, it tends to be the severity, frequency and longevity that define anxiety disorders. The components of anxiety include emotional, physiological & cognitive. A healthy amount of anxiety would not interfere with daily functioning, and may even improve your ability to problem-solve or motivate you to work harder. Anxiety is a useful evolutionary trait, whose function is to heighten our awareness of potential threats.
This, however, is not how people with anxiety disorders experience this phenomenon. This class of disorder includes intense and persistent worry and fear surrounding everyday situations. These feelings interfere with a person’s ability to perform daily activities and can be difficult to control (if not impossible without help). This can lead to avoidance and isolation.
There is a major physical component to anxiety as well. Those same bodily responses to fear and dread, that can prove so helpful in real-life dangerous situations, can be debilitating in everyday life.
Examples of Anxiety Disorders:
Generalized anxiety disorder
Panic disorder
Phobias
Social anxiety disorder
Separation anxiety disorder
Anxiety disorder associated with a health condition
Substance-induced anxiety disorder
Causes & Risk Factors
Many of the same factors contributing to mood disorders can also be applied to anxiety disorders. There can be medical, experiential & hereditary influences. Prolonged and/or severe and long lasting stress can contribute to the formation of these types of disorders. This can include trauma and new life experiences, especially negatively tinted ones. Anxiety can be aggravated by substances, medication & even caffeine.
Symptoms & Characteristics
Feeling panic, fear & uneasiness
Nightmares
Repeated thoughts or flashbacks of traumatic experiences
Uncontrollable, obsessive thoughts
Cold or sweaty hands
Dry mouth
Heart palpitations
Nausea
Numbness or tingling in hands or feet
Muscle tension
Shortness of breath
Shakiness and unsteadiness
Ritualistic behaviors, such as washing hands repeatedly
Trouble sleeping
Treatment
Psychotherapeutic and pharmacological treatments have been shown to be effective treatments for anxiety disorders. CBT for anxiety disorders emphasizes experiential learning to build tolerance for uncomfortable anxiety-related thoughts, emotions, and physiological responses by encouraging the individual to approach anxiety-triggering or avoided situations. Acceptance skills, mindfulness, and meditation are important to change one’s relationship to their anxious thoughts and worry. A healthy lifestyle can significantly improve your ability to manage stressors and thereby allow you to access the tools required to combat anxiety.
Self-care can play an important role in reducing the effects of anxiety and panic. Reducing or eliminating the consumption of alcohol and caffeine can have positive effects. Spending time outdoors, a healthy diet & getting the right amount of sleep can also be beneficial.
Eating Disorders
Eating disorders are to be taken seriously as they can have potentially life-threatening consequences. Studies show that the prevalence of eating disorders is on the rise and that they are becoming more common. Currently, the effect of eating disorders has an estimated lifetime prevalence of up to 2.2% in men and up to 8.4% in women. These statistics are eye-opening when you consider that in some instances, the mortality rate for people suffering with these disorders can be up to six times higher than the general population.
Due to the detrimental impact of these disorders, there are commonly serious medical and psychiatric consequences that can exacerbate an already dangerous condition. Eating disorders are generally characterized by disruptions in behaviors, attitudes and thinking towards food, eating, weight & appearance. There is also an excessive focus placed on these same four categories. Eating disorders, given enough time, will wreak havoc on all sorts of bodily processes and organs. These can include nutritional deficiencies, digestive issues, bone and teeth loss, hormonal imbalances & heart problems.
The strict standards and rigidity that can accompany OCPD can lead to the sorts of control issues that are the foundation of many eating disorders.
Examples of Eating Disorders:
Anorexia nervosa
Avoidant eating disorder
Bulimia
Binge eating disorder
ARFID
Causes & Risk Factors
It is possible for anyone to develop an eating disorder. There are certain factors that may increase the likelihood of developing an eating disorder. These factors include, but are not limited to trauma, depression, anxiety, additional comorbid mental health disorders & family history.
Frequent dieting can put a person at a higher risk of developing an eating disorder. Yo-yo dieting can be especially punishing and can increase the odds of developing an eating disorder. Many of the symptoms of eating disorders match the symptoms of starvation. Starvation’s impact on the brain can lead to mood changes, rigid thinking, anxiety & a reduction in appetite. Bullying can also be a risk factor when the teasing is aimed at a person’s weight. Shame is the starting point for many that suffer.
Symptoms & Characteristics
Symptoms vary, depending on the type of eating disorder. As such, this list should be considered a general reference that encompasses some of the symptoms of each of the differing disorders. People with eating disorders can have drastically different body types and sizes.
Weighing oneself repeatedly
Binge-eating
Purging
Denial of hunger
Low body weight
Withdrawal from social activities and gatherings
Fatigue and weakness
Feelings of shame and guilt when eating
Food rituals
Eating when not physically hungry
Loss of hair and dry skin
Nausea and vomiting
Excessive exercise and dieting
Yeast infection, bladder infection
Preoccupation with body weight and shape
Eating in private
Treatment
It’s encouraging to note that in many cases, the negative consequences of your eating disorder may be reduced or reversed through proper treatment. Early detection is important for a full recovery.
All eating disorders will require professional treatment. Psychotherapy and cognitive-behavioral methods have proven to be highly effective as forms of treatment. There is also research supporting specific medications as supportive adjuncts. Due to the serious nature of eating disorders, it may be necessary to seek out medical care in addition to psychological treatments.
In some instances, family members can play an important role in providing support alongside the health care provider. Family members can be helpful in encouraging the person living with an eating disorder to seek out help.
If you are someone living with an eating disorder, we would encourage you to visit Eating Disorder Hope.
OCD (Obsessive Compulsive Disorder)
And now for the moment you have all been waiting for! It is highly unlikely that this is the first time hearing those three letters in that order. OCD is in the public lexicon. It is even used as slang, or shorthand for organized or neat. But OCD is not a cute and quirky idiosyncrasy. Obsessive compulsive disorder is a diagnosable mental health condition, that for some, can be debilitating.
An average person will experience distressing thoughts and even repetitive behaviors from time to time. OCD is more than that. A person experiencing OCD will live full-time within a cycle of obsessions and compulsions that disrupt daily life. The level of stress caused by these obsessions will cause them to act out the compulsions. Choosing to ignore these obsessions is not an option as they will continue to loop until appeased. This is the harsh cycle of OCD. These obsessions and compulsions will cause intense distress, interrupt normal activities, prevent social interaction & consume inordinate amounts of time.
The thoughts (obsessions, urges) are highly intrusive, and the compulsions very rigid. They commonly consist of irrational beliefs that are uncontrollable. Completing the compulsions is a way for someone with OCD to scratch these confounding itches. The distress a person with OCD experiences can be very, very high due to their obsessions being tied to the fear of dire consequences for themselves or for loved ones. Some people with OCD can also develop a tic disorder involving repetitive movements or sounds.
OCD and OCPD are comorbid, and hence featured in this resource. For some, this can be highly confusing. Externally, there can appear to be many similarities between the two. Many of those similarities are surface level, and the thought processes leading to the disordered behaviors could not be more different. In general, people with OCD are aware or suspect that their obsessional thoughts are disordered, irrational & illogical. This does not make living with the disorder any easier. However, the inverse tends to be true with OCPD. For those with obsessive compulsive personality disorder, it can feel like you’re the only normal one in a world full of people that “just don’t get it”. The most recent research indicates that 25% of individuals with OCD also meet full criteria for OCPD.
Examples of Obsessions:
Contamination obsessions
Violent obsessions
Responsibility obsessions
Perfectionism obsessions
Sexual obsessions
Religious obsessions
Identity obsessions
Examples of Compulsions:
Washing & cleaning
Checking
Repeating
Mental compulsions
Organizing
Avoiding situations
Causes & Risk Factors
Although the causes of OCD are not fully understood, there is compelling evidence to suggest that the following reasons are contributing factors. Biologically, there can be changes in your body’s chemistry and, in turn, this can affect brain function. Specific genes suggesting a genetic component have not been found, but that has yet to be ruled out as a possible cause.
Risk factors can include family history, stressful life events & the impacts of other mental health conditions. Obsessive compulsive behaviors can be learned through observing family members over long periods of time. This means that having family members with OCD can increase your risk of developing the disorder, both from the perspective of biological risk and learning.
Symptoms & Characteristics
Symptoms can start in childhood and tend to vary in how serious they are throughout life. Stress, including times of transition and change, have the ability to amplify symptoms. These manifestations can be so severe as to constitute a disability. The obsessions and compulsions can evolve over time and vary throughout a person’s lifetime.
A diagnosis of OCD requires the presence of obsessional thoughts and/or compulsions that cause significant distress, are time-consuming & impair work or social functioning.
Treatment
The two primary treatment methods used for people with OCD are psychotherapy and medicine. In terms of talk therapy, CBT (cognitive behavioral therapy) and ERP (exposure and response prevention) are the most widely used forms of therapy for patients with obsessive compulsive disorder. ERP is itself a form of cognitive behavioral therapy. The class of medicines used most often for people suffering with OCD would be SSRIs (selective serotonin reuptake inhibitors). These medications are not without side effects, and you should discuss these options with a medical professional.
There are additional treatment options that some seek out. As the efficacy of these alternative treatments has not been fully demonstrated and proven, it will be up to you as to whether or not you would like to explore these further.
For more information, please visit the International OCD Foundation.
ADHD (Attention-Deficit / Hyperactivity Disorder)
As with some of the other disorders we have covered in this article, many of the symptoms associated with ADHD can be found in people without this disorder. Ordinarily, it is the frequency and severity of these traits that determines whether or not someone has ADHD. In short, attention-deficit/hyperactivity disorder is discerned to be an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. It is considered to be one of the most common neurodevelopmental disorders of childhood.
ADHD encompasses a broad selection of traits, although there are some common symptoms that people generally associate with the disorder. These would include impulsivity, being overly active & difficulty paying attention. It is important to note that these issues are not due to a lack of comprehension or an intentionally defiant attitude. Poor academic and work functioning, unstable relationships & low self-esteem, highlight the seriousness of this disorder. Due to the higher levels of criticism that a person with ADHD may face throughout adolescence, adults with ADHD may experience sensitivity towards criticism, and an intensified self-judgment.
ADHD Types
There are three common classifications of ADHD. Depending on the strength of each symptom, a person could be considered to be one of the following:
Predominantly Inattentive Presentation: Difficulty in completing tasks, paying attention to details & struggles with following instructions and conversations.
Predominantly Hyperactive-Impulsive Presentation: Excessive movement, impulsive behavior & interrupting or speaking at inappropriate times.
Combined Presentation: Symptoms of the above two types are equally present.
Causes & Risk Factors
Thankfully, with ADHD awareness and research on the rise over the last few decades, more people are being diagnosed and helped than ever before. Although the exact causes are not fully understood, some of them have been identified. Genetics play an important role, as ADHD tends to run in families. Children with ADHD have a one in four chance of having a parent with ADHD.
Studies have shown differences in the brains of people with ADHD, and so we know that brain function and structure are involved. Premature births, prenatal exposures (e.g., alcohol, nicotine), significant head injuries & in some cases, toxins in the environment, have been shown to alter brain function and structure.
Symptoms & Characteristics
Short attention span
Easily distracted
Being unable to sit still
Daydreaming
Appearing forgetful
Inability to stick to tasks that are tedious or time-consuming
Appearing to be unable to listen
Constantly changing activity or task
Losing things
Inability to concentrate on tasks
Acting impulsively
Interrupting conversations
Little sense of danger
Treatment
In children, ADHD is best treated with behavioral modifications. The techniques required can be taught via parent management training and school intervention strategies. Additionally, parent-child interaction therapy (PCIT) has proven to be an effective therapy modality. This therapy has also been shown to work with young children suffering from oppositional defiant disorder (ODD).
For adolescents and adults, a combination of talk/behavior therapy and medication has yielded the most promising results. While on medication, a good treatment plan should involve close monitoring and adjustments to the medications where needed.
For more information, please visit The Chesapeake Center.
Autism
Autism and OCPD are not the same thing. Autism is classified as a developmental disorder and obsessive compulsive personality disorder does not currently fall under that umbrella. This is being stated at the outset, as there is debate within the OCPD community as to whether or not these two diagnoses are one and the same. Current medical research does not support this assertion.
We now know that there is not one single form of autism, although all forms of autism are developmental disabilities caused by differences in the brain. Due to the nature of spectrum disorders, each person with autism will have their own unique set of strengths and characteristics. These range from challenges with social communication to repetitive rituals. These differences also mean that for some with autism, living unassisted is an impossibility, while others may need little to no support at all.
In general, people with autism may exhibit alternative ways of learning, speaking, moving, interacting & paying attention. Autism starts before the age of three and can persist throughout a person's lifetime, although symptoms may get better as time goes on.
Causes & Risk Factors
There is much debate surrounding the causes and risk factors associated with autism. Most assuredly, there is not just one cause of autism. It is generally agreed upon that environment, biology & genetics factor into the development of autism.
As of this writing, available evidence suggests that having a sibling with autism, certain chromosomal conditions, birthing complications & being born to older parents may put children at greater risk for the disorder.
Symptoms & Characteristics
Fails to recognize when others are hurt or upset
Is focused on parts of objects
Distressed by minor changes in their environment or routine
Restricted range of interests, yet a fixation on those interests
Must follow specific routines
Avoids making eye contact
Does not show facial expressions
Minimal or no use of gestures
Does not share interests with others
Heightened reactions to sensory stimuli (prone to sensory overload)
Delayed cognitive skills
Hyperactive, impulsive, and/or inattentive behavior
Unusual mood or emotional reactions
Anxiety, stress, or excessive worry
Lack of fear or more fear than expected
Treatment
Before treatment, one must look at diagnosis. Autism may be detected in children as young as eighteen months of age, however, at ages two or older is generally considered to be the point at which a professional diagnosis could be considered reliable. For many, a diagnosis may come much later on in life. Until receiving a diagnosis, people with autism must go through life without the help that they need.
Autism may not have a cure, but there are treatments that have been shown to improve functioning and quality of life. It is not unusual for these treatment plans to involve the help of multiple professionals.
A structured behavioral plan can be achieved through applied behavioral analysis. This involves exploring each child’s functional challenges. Another technique that is necessary in a lot of cases is social skills training. This form of intervention is designed to improve a person’s ability to navigate social situations.
In some instances, speech therapy and language therapy can improve speech patterns and comprehension. For adults, occupational therapy can help to address skill deficits. Additionally, treating co-occurring conditions can lessen the overall distress and anxiety someone with autism may face on a daily basis. Medications may be available for some of the co-occurring conditions and it would be advisable to speak with a medical professional about what options are available to you.
ODD (Oppositional Defiant Disorder)
ODD is regarded as a potential outcome of developmental problems and is therefore deemed a developmental-behavioral condition. In order to meet the criteria for this condition, defiant and antagonistic behaviors would be frequent and ongoing. These behaviors can be intensely disruptive to school and workplace settings, cause family rifts & limit the ability to form lasting relationships. Contrarian may be an apt label for those with this disorder.
Oppositional defiant disorder is more commonly diagnosed in children. In most cases, ODD usually develops before the early teen years. Feelings of being misunderstood and/or controlled lead to aggression and anger. An individual with ODD is unlikely to back down in confrontations and may actively seek to intensify situations. Untreated, this disorder will continue to increase in severity, and it is estimated that up to 40% will develop antisocial personality disorder. Adults with this disorder will report that they feel angry all of the time.
Causes & Risk Factors
Although they may appear later, symptoms of ODD will generally surface as early as the preschool years. Similar to other mental health and developmental disorders, there may be a combination of genetic, familial & social conditioning that contribute to the underlying cause of this disorder.
On the developmental side, children may be susceptible if they are raised in an environment of constant conflict between caregivers, inconsistent levels of attention or discipline & exposure to abuse or neglect. Another leading theory suggests that these are “learned behaviors” and that a child is mirroring the effects of negative reinforcement methods.
Symptoms & Characteristics
Persistent angry or irritable mood
Quickly and easily loses temper
Frequently annoyed by others
Will intentionally upset others and uses mean and hurtful language
Resentful and feels oppressed
Argumentative (especially with authority)
Will blame others for their own behavior and mistakes
Refuses to follow rules, honor requests, accept criticism & take suggestions
Acts vindictively
Often feels misunderstood, under-appreciated & unloveable
Lacks patience
May escalate conflicts to the point of physical altercations
Angry at the “world” and feels the need to always “win”
Difficulty in maintaining relationships and employment
Treatment
Traditional types of talk therapy are believed to be the best form of treatment for ODD. The various modes of effective therapy include CBT and DBT. Cognitive behavioral therapy is helpful in that you will learn to find healthy ways of expressing anger and indignation. Dialectical behavioral therapy will focus on mindfulness, which will help to reduce those negative emotions.
In childhood, family therapy may be effective in teaching improved communication methods. In adulthood, group therapy can teach and reinforce acceptable social behaviors.
Additional
By no means is this an exhaustive list of possible OCPD comorbidities. If you are experiencing thoughts or feelings that do not match up with anything you’ve read today, please speak with a mental health professional about what you are experiencing. It is important to recognize that we are a complicated species, and that the knowledge surrounding mental health issues is constantly growing and evolving. As a Foundation, we plan to grow and evolve as well with the evidence based treatments available to us. We would encourage you to sign up for our mailing list in order to stay abreast of the latest research, studies & treatments.
Medically Reviewed by Anthony Pinto, Ph.D. on March 01, 2024 | Written by Darryl Rossignol