Controversies in the contemporary understanding of comorbidity in psychiatry

ABSTRACT The pre-therapeutic classification of comorbidity in chronic disease has been excessively broadened and distorted since A. R. Feinstein’s initial definition of the concept in 1970. Examinations more often than not establish the ‘comorbidity’ of depression and anxiety, instead of looking for a common pathological core of the two conditions. The ‘concurrence’ of symptoms of depression and anxiety, which is indeed very frequent in clinical practice, would be a more acceptable concept. It is even stranger to talk about the comorbidity of obsessive-compulsive disorder and schizophrenia: the question is what constitutes the primary disorder in such a combination. Schizophrenia or affective disorders are also very often categorized as being comorbid with personality disorders, without taking into account the manifestation of some behavioural personality disorders as pre-conditions or a prodrome of more serious disorders. For the purposes of treatment, taking into consideration the comorbidity of mental disorders and somatic illnesses is of paramount importance. Here we can mention, for example, the comorbidity of schizophrenia and AIDS or tuberculosis, recurrent depression and cardiovascular disease or diabetes, generalized anxiety disorder and asthma. The cases of comorbidity of affective disorders and abuse of alcohol or other psychoactive substances seem to be more disputable, since affective disturbances very often provoke alcohol excesses or temporary drug abuse not necessarily leading to dependency.