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Co-Occurring Mental Health Conditions

In both adult and aging populations, mental health conditions frequently occur at the same time, or co-occur, with other mental disorders, substance use disorders, or chronic medical illnesses, often complicating diagnosis and treatment.

Treating co-occurring disorders or health conditions at the same time, rather than separately, can lead to improved health outcomes.

Depression and Anxiety

Depression disorder is a mental disorder that involves depressed mood or loss of pleasure and interest in activities for long periods of time. Anxiety disorders are mental disorders that include experiencing fear and worry that is intense or excessive. Both depression and anxiety disorders are different than regular mood changes and worries.

Co-Occurring Disorders

Depression and anxiety disorders are two of the most commonly co-occurring conditions, especially in those with chronic illness or social isolation. Depression also frequently co-occurs with chronic medical conditions such as cardiovascular disease, stroke, cancer, diabetes, and substance use disorders.

Often, warning signs of depression and anxiety are discounted because we assume feeling depressed or anxious is normal for someone struggling with health conditions. However, it is important to note that depression or anxiety disorders are not a normal response to other illnesses. The symptoms of depression and anxiety can also be masked by other medical conditions, so it is important for primary healthcare settings to screen people with medical illnesses for depression.

Resources

Substance Use Disorder

Substance use disorder (SUD) is a disease that affects a person's brain and behavior which makes it hard to control the use of a drug or medicine (legal or illegal). Examples include alcohol, illegal drugs, prescription pain medicines, or nicotine. Changes in the brain make it difficult for a person to resist cravings, and these changes can persist, making it a "relapsing" disease. This means people often return to substance use even after long periods of sobriety. Because of this, treatment must be ongoing and adapted to the individual's needs.

Co-Occurring Disorders

Many adults with SUD also have co-occurring conditions such as depression, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, schizophrenia, or traumatic brain injury (TBI). SUD can worsen psychiatric symptoms and vice versa, creating a cycle that is difficult to break without treatment. People getting treatment for a mental health disorder should be screened for SUD, and people receiving treatment for SUD should be screened for mental health conditions.

Resources

  • If you are providing care for someone with SUD, check out the General Tips or Substance Use Disorders sections of the Caregiver Tips page.
  • North Dakota residents can apply for the Substance Use Disorder Voucher to help cover the costs of SUD treatment and recovery services.
  • The North Dakota Behavioral Health Program Directory can help you locate SUD programs and services across the state.
  • The Community Connect program helps provide care coordination, peer support, and recovery services.
  • The Free Through Recovery program is designed to increase recovery support services to individuals involved with the criminal justice system.
  • Recovery Talk connects you to a trained peer support specialist with experience in addiction.
  • The Opioids page of the Health and Human Services website can help you understand addiction, prevent overdoses, request free Narcan, and find treatment.
  • Visit AA North Dakota to find an Alcoholics Anonymous meeting near you.
  • Visit Find Recovery to find a Narcotics Anonymous meeting near you.
  • SMART Recovery can help connect you to meetings, educational blogs/podcasts, and a variety of helpful worksheets on topics such as goal setting, setting boundaries, and creating a balanced lifestyle.

Schizophrenia and Other Psychotic Disorders

Psychotic disorders, such as schizophrenia, are illnesses that result in changes in thinking, perceptions, behaviors, and/or emotions. People with a psychotic disorder will at times show signs of psychosis, which may include hallucinations, delusions, or disordered thinking.

Co-Occurring Disorders

Many mental health conditions co-occur with schizophrenia. Substance use disorder is the most common, although anxiety disorders, depression, and PTSD are also frequently seen. Schizophrenia can also co-occur with many physical conditions like diabetes, cardiovascular disease, and chronic pain. Co-occurring conditions can make treatment more complex and reduce quality of life for those with psychotic disorders.

Resources

Bipolar Disorder

Bipolar disorder is a mental health condition characterized by manic and depressive episodes. It can affect a person's mood, activity, thoughts, and energy.

Co-Occurring Disorders

Bipolar disorder frequently co-occurs with conditions including anxiety, depression, and chronic medical conditions. Co-occurrence with SUD is common, and SUD can deepen the manic and depressive symptoms associated with bipolar disorder. People with co-occurring alcohol use disorder are less likely to adhere to treatment and more likely to be hospitalized or attempt suicide. Early intervention for those with bipolar disorder and co-occurring conditions is important to improve treatment outcomes.

Resources

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a mental health disorder that can develop after someone goes through or sees a traumatic event. Symptoms may include reliving the event, avoiding things that remind them of the event, having negative thoughts and feelings, or feeling on edge or keyed up. PTSD is often linked to past military service, abuse, or caregiving stress.

Co-Occurring Disorders

Most people with PTSD have one or more additional mental health conditions, such as depression, anxiety, or SUD. They are also at risk for physical health problems and reduced quality of life. Some of these co-occurring conditions include increased risk of attempting suicide, sleep problems, TBI, dementia, chronic pain, cardiovascular disease, and diabetes.

Resources

Dementia/Cognitive Disorders

Cognitive disorders are disorders that significantly weaken someone's cognitive functions, such as memory, language, thoughts, and learning. The most well-known cognitive disorder is Alzheimer's disease.

Co-Occurring Disorders

Alzheimer's disease and other cognitive disorders frequently co-occur with depression, anxiety, and chronic medical illnesses such as cardiovascular disease and diabetes. The cognitive decline that an individual experiences can make psychiatric symptoms worse. Co-occurring conditions can complicate patient care, impact quality of life, and place additional burdens on caregivers. Because of this, an integrated approach to care is necessary.

Resources

Chronic Pain

Chronic pain is generally defined as pain that lasts or recurs for at least three months.

Co-Occurring Disorders

Chronic pain often co-occurs with mental health conditions such as depression, anxiety, substance use disorder, or PTSD. Effective treatment of chronic pain includes screenings and proper referrals for mental health treatments.

Resources

  • If you are providing care for someone with dementia or another cognitive disorder, check out the General Tips or Chronic Pain sections of the Caregiver Tips page.
  • The S. Pain Foundation offers educational information and support for those living in chronic pain and their caregivers.
  • The American Chronic Pain Association facilitates peer support and provides educational resources for individuals living with pain and those treating pain conditions.