I was wondering -
I have ADHD and a lot of comorbids.
I don't seem to be able to string words together very well this morning, so bear with me :D

If a person has ADD then OCD, PTSD, depression, etc. are comorbids, right?
But if a person doesn't have ADD, then OCD, PTSD, depression, etc. stand alone, right?

I guess I should wait for the answer to that before I continue my line of though, but if I wait I'll forget it, so here's the rest -

If I'm correct in my above assumptions, then it doesn't seem "fair" to the other disorders - like maybe they won't be treated as aggresively by docs. And isn't it possible that one of them can be just as big of the problem as the ADD? But since they're comorbids, they play second fiddle to the ADD.

I'll wait for responses. Thanks :)

Hi Chameleon,

I was wondering -
If a person has ADD then OCD, PTSD, depression, etc. are comorbids, right?
But if a person doesn't have ADD, then OCD, PTSD, depression, etc. stand alone, right? Your clinician probably diagnoses according to the DSM IV (http://www.psychnet-uk.com/dsm_iv/_misc/complete_tables.htm) or here (http://allpsych.com/disorders/dsm.html); they can pick a primary and secondary (or more) Axis I disorder (http://www.hopeallianz.com/Resources/MI2.html#Anchor-Axis-49575) depending on their assessment, their training and their experience.

But the primary is supposed to be one that is causing the most problems for you. (In some systems, though, the primary is what the clinician can bill for).


Example if you are BiPolar, that would be the most prominent and disabling disorder, so that's a primary, with ADHD of lesser importance, secondary,

If you have a major depression (primarily), your depression might actually minick ADHD symptoms, so your clinician may not give you a 2dy of ADHD. Reduce the depression and the ADHD symptoms are eliminated.

But, if your mood disorder (depression) is 'caused' by the disfunctions surrounding your ADHD; ADHD gets a primary and should be addressed first, or concurrently with the depression.

And these things change over time and different clinicians may come up with different assignments.



If I'm correct in my above assumptions, then it doesn't seem "fair" to the other disorders - like maybe they won't be treated as aggresively by docs. And isn't it possible that one of them can be just as big of the problem as the ADD? But since they're comorbids, they play second fiddle to the ADD.
Depends on the clinician and what she thinks is the most disabling, prominant or underlying problem to be addressed first and what else can be dealt with at the same time.

It's not about fair -- it's about the fact that ADHD is kind of like a conductor of an orchestra. When the conductor is off the whole orchestra will be off too. So trying to treat the other disorders without treating the ADD isn't likely to work as effectively. It's like working with the flutes won't fix the problem with the whole orchestra because the executive functions (which is what are impaired with ADD) have an influence over how all the others are expressed. (I borrowed the conductor illustration from Thomas Brown's book Attention Deficit Disorder -- he explains it much better).

For example, when my ADD was treated my anxiety and depression improved on their own without further medication. While that isn't always true, it happens a lot. On the other hand, many ADDers with depression, etc have had just their depression or whatever treated by itself unsuccessfully because the ADD thinking style was still messing things up.

BTW did you know that research indicates that 88% of adults have/or have had a comorbid condition with their ADD? That is six times the prevalence in the general non ADD population.

Scattered

I understand that ADHD can cause depression and anxiety and other comorbids. My point it - other disorders like that are often clumped together as comorbids of ADHD, when in fact, that isn't always the case.
Like with me, my depression and anxiety stand alone, as does my PTSD. I don't see them as being caused by my ADHD, they have their own roots. But I DO see my OCD as a comorbid of my ADHD.
Now I'm not saying that they always clump other disorders as ADD comorbids. But it seems to me that they do it a lot, perhaps too much.

Do you see your depression and anxiety as co-morbid upon your PTSD? I would think that could happen...

I agree with chameleon, I'm not sure how PTSD could be co-morbid with ADHD unless ADHD impulsivity caused you do to something really traumatizing to yourself or others...:eyebrow:

Do you see your depression and anxiety as co-morbid upon your PTSD? I would think that could happen...

I agree with chameleon, I'm not sure how PTSD could be co-morbid with ADHD unless ADHD impulsivity caused you do to something really traumatizing to yourself or others...:eyebrow:I had anxiety before PTSD, but the PTSD definately made it a lot worse, so in that light I see it's extreme as a comorbid of my PTSD.
My depression I've always had. Always. So I don't see it as a comorbid of my PTSD. The line blurs though at the question of whether it's a comorbid of my ADHD. Kind of like which came first, the chicken or the egg. Since my depression is due to a chemical imbalance, and I've had it for as long as I can remember, it might be a good sign that I was born with it, just as I was born with ADHD. So....I guess it wouldn't be a comorbid then.
So confusing! LOL

It is equally confusing to me...I have ADD, and I know that causes my depression.I am innatentive ADD so I am easely overwhelmed, plus the low self estime-I think Sari Solden describes it the best....

Now, anxiety this is part of "adjustment disorder"-but let me tell you why I can't adjust well -because I only feel happy and secure when I finally find structure, of course I do create the structure outside because in my mind everything flows randomly -but this exterior world changes too...so there goes my adjustment and strcture bye,bye...and my coping skills are usless...and here I have to start all over again-and sometimes I just get tired, wonder why am I depressed?

as for PTSD , that is another story...I guess I am just messed up in my head...wonder if I can ever live with me this way....

chameleon

It is a chicken-and-egg kind of problem. Which came first, which is the primary disorder??

If you have OCD , ADHD, and PTSD

Right off the bat, you can almost guess that OCD is likely to be associated with ADHD.

The stress of having ADHD leads to anxiety and the anxiety can be expressed as OCD. So, one can speculate that the OCD may be secondary to ADHD and is likely to improve if the ADHD is treated appropriately. (your mileage may vary)
This is clearly comorbid.

As far as PTSD is concerned, I don't know if it is typically comorbid with ADHD, so maybe it is a separate condition ?

I guess that having multiple disorders together can make them comorbid in that they will invariably have some affect on each other.


For example;

I have ADHD, anxiety disorder with ocd tendencies, sleep aphnia, insomnia, and epilepsy by history.

Are all of these comorbid ?? You bet! They are all related to each other. Now, my adhd has no effect on my epilepsy, but my sleep disorders do. Mmy epilepsy (if active) would definitely make my ADHD a lot worse. Also my sleep disorders are probably making my adhd worse, and my doctor has even speculated that my adhd is entirely due to sleep problems (doubtful).

In any case, my adhd and sleep disorders are identified as my primary problems and those are the issues that my doctors are targeting. Since my epilepsy is controlled with anticonvulsants, it is not one of the major problems I face.

So far I'm not doing so good on the sleep issues. :( But my adhd is sort of controlled, and my ocd tendencies have not surfaced in over a month. :)

I guess the answer is that comorbid is comorbid. It is all related.

ME :D



I was wondering -
I have ADHD and a lot of comorbids.
I don't seem to be able to string words together very well this morning, so bear with me :D

If a person has ADD then OCD, PTSD, depression, etc. are comorbids, right?
But if a person doesn't have ADD, then OCD, PTSD, depression, etc. stand alone, right?

I guess I should wait for the answer to that before I continue my line of though, but if I wait I'll forget it, so here's the rest -

If I'm correct in my above assumptions, then it doesn't seem "fair" to the other disorders - like maybe they won't be treated as aggresively by docs. And isn't it possible that one of them can be just as big of the problem as the ADD? But since they're comorbids, they play second fiddle to the ADD.

I'll wait for responses. Thanks :)

I believe that McT used to say that ADHD is primary with other disorders. Then again PTSD is something that you get because of your enivornment.

BTW did you know that research indicates that 88% of adults have/or have had a comorbid condition with their ADD? That is six times the prevalence in the general non ADD population.

Scattered wow, I am one of the lucky 22% who escaped it...I honestly think it was due to the fact I was so "away with the fairies" for 40 years I didn't even notice I have ADHD...
It was only when a few people FINALLY pointed it out, I started to take notice of my behaviour...and OMG! then I did start to worry..and if I didn't get help as quick as I did, I can see I probably would have ended up very depressed and lonely, and hidden away..and then included in the 88%:(

It is a chicken-and-egg kind of problem.it's the egg! the egg!!!!! *does a lil dance*

But the primary is supposed to be one that is causing the most problems for you. (In some systems, though, the primary is what the clinician can bill for).


Example if you are BiPolar, that would be the most prominent and disabling disorder, so that's a primary, with ADHD of lesser importance, secondary,

Stanzen stated this correctly!

If you have insurance then it is always the one that the insurance will cover!

Primary is always the one that is causing you the most "impairment" secondary are the others that come along with the primary....

You can have co morbid conditions but be only treated for one...example I have ADD and dyslexia which is two separate things however I am not being treated for the dyslexia therefore ADD is my primary diagnosis but because I have two conditions I have co-morbid condition even though they are only treating one!

When I lost a boy friend I had some anxiety issues-ADD remained my primary but anxiety issues was added in manner as being secondary to.....

If I had only the ADD and no dyslexia I would not be co-morbid.....even with the anxiety issues if the anxiety issues were associated with the ADD....it is written as

ADD-anxiety issues due to ADD and acute circumstances.............(NOT co-morbid)
because without the ADD the anxiety would not exist!

secondary to or due to is a condition that usually arise at least in part due to the first.......

Co-morbid is usually two conditions that may make each other worse but are not necessarily "related".......

Co-morbid- existing with as a separate entity- like co-pilot, co habitat, (together but separate)

Secondary caused by-like wetness accompanies water with out one you would not have the other............

I read a lot of charts and this is how the terms are normally used in my experience!

However Stanzen is correct often the folks in billing determine how diagnosis are written according to coverage by insurances and government agencies NOT what the doctor really thinks!

I'm not asking how a co-morbid is defined, I'm saying that I think maybe too many disorders get thrown into the co-morbid "basket" that really should be treated as primary disorders in their own right, and be approached with as aggressive a treatment as the ADD. I'm not saying this happens all the time, I'm just saying I think it happens too often.
To me, if a disorder gets labelled "co-morbid" than the docs tend to think that treating what they label the "primary" disorder will alleviate the co-morbid disorder. They label the primary the Father and the other disorders the Children.
My PTSD is not the child of my ADHD.
My OCD is the child of my ADHD.

Yes, sometimes treatment for the primary disorder relieves the co-morbids too, and in my case, treatment (Lexapro) for the co-morbid (anxiety) offered some relief to the primary (ADHD) and other co-morbids (OCD, agoraphobia, social phobia). So they're obviously intermingled.
Yet there sat the PTSD. The doctor, I believe, saw it as an offshoot of the anxiety, or another side of the anxiety, because it LOOKS like anxiety. The PTSD certainly caused it's share of anxiety, but it wasn't rooted in anxiety. Anxiety was not it's father. Therefor my PTSD was never treated, and never found relief.

Heck, maybe this problem has only ever happened to me. Maybe I just had bad treatment.
Of all the disorders I have (around 10) the one that makes me suffer the most is the PTSD. So the PTSD should have been diagnosed as a primary disorder then, shouldn't it?

I'm not asking how a co-morbid is defined, I'm saying that I think maybe too many disorders get thrown into the co-morbid "basket" that really should be treated as primary disorders in their own right, and be approached with as aggressive a treatment as the ADD. I'm not saying this happens all the time, I'm just saying I think it happens too often.
To me, if a disorder gets labelled "co-morbid" than the docs tend to think that treating what they label the "primary" disorder will alleviate the co-morbid disorder. They label the primary the Father and the other disorders the Children.
My PTSD is not the child of my ADHD.
My OCD is the child of my ADHD.

Yes, sometimes treatment for the primary disorder relieves the co-morbids too, and in my case, treatment (Lexapro) for the co-morbid (anxiety) offered some relief to the primary (ADHD) and other co-morbids (OCD, agoraphobia, social phobia). So they're obviously intermingled.
Yet there sat the PTSD. The doctor, I believe, saw it as an offshoot of the anxiety, or another side of the anxiety, because it LOOKS like anxiety. The PTSD certainly caused it's share of anxiety, but it wasn't rooted in anxiety. Anxiety was not it's father. Therefor my PTSD was never treated, and never found relief.

Heck, maybe this problem has only ever happened to me. Maybe I just had bad treatment.
Of all the disorders I have (around 10) the one that makes me suffer the most is the PTSD. So the PTSD should have been diagnosed as a primary disorder then, shouldn't it?Your PTSD may not be the off shoots of ADD but if your ADD is left untreated it will be difficult to effectively treat it. Most untreated ADDer for example have a very difficult time taking advantage of therapy because they forget the majority of what was discussed (I think my therapist said they're lucky to retain 20% of it). Plus their impulsivity and missing cues would make it difficult to implement the therapeutic suggestions at the right time. In addition most ADDers have trouble with handling stress which would make staying with any uncomfortable feelings long enough to work them through problematic, especially for the very traumatic feelings associated with PTSD. If your therapist didn't address these at all, that's definatley a problem. Making ADD primary only means you treat that first and then address the others (not then forget the others).

Scattered