The Importance of a Complete Diagnosis: Managing Multiple Mental Illnesses

Co-occurring disorders is a term often applied to having a mental illness and a substance use disorder, a situation that is very common. However, it is important to recognize that it’s also possible to have more than one mental illness at a time. Approximately 20 percent of U.S. adults have at least one mental illness during any given year, but three percent of adults have more than one mental illness at a time in any given year.

It is not as common as having a mental illness with substance abuse, but co-occurring mental disorders happens more often than most people realize. Additionally, many of these people who struggle with more than one mental illness also struggle with substance use.

Having co-occurring disorders is complicated. Living with just one condition, like depression, can be challenging. The symptoms cause dysfunction and make daily living difficult. When you have more than one, such as depression and obsessive-compulsive disorder (OCD), you have two sets of symptoms that can really impact your ability to function. Symptoms often overlap and can be additive. For instance, the anxiety triggered by OCD’s obsessive thoughts can add to feelings of hopelessness and guilt that come with depression.

Another issue that you may have to face along with mental illness is a traumatic past. Research has found there is a definite link between traumatic experiences, especially in childhood, and later mental health issues. If you are struggling with one or more mental illness, chances are you are also living with the painful memories of past trauma. When addressing mental health needs, trauma from the past must also be considered and addressed or it will continue to cause recurrences of symptoms and episodes.

The first step in successfully managing mental illnesses is to get a thorough and complete diagnosis. Until you know exactly what conditions are causing your symptoms, you will continue to struggle. For instance, if you are diagnosed with social anxiety disorder but your agoraphobia is missed, the latter will go untreated. You may learn some useful things in therapy to overcome your fear of making new friends and socializing, but without addressing agoraphobia you will still struggle to leave the home.

Mental health clustering is a useful tool that some professionals use to help place patients in groups that help describe their treatment needs. Clustering is used alongside traditional diagnosis as an additional tool. While it is not strictly needed to help patients coping with mental illnesses, clustering can be a helpful way to organize the needs and potential treatments for each individual.

Each mental illness that you have does not exist in a vacuum. Although they are diagnosed as separate conditions, the reality is that they are complexly intertwined. One impacts the other. This is why treatment has to address all mental illnesses to be effective. Trying to treat and manage just one mental illness is like trying to treat just one tumor in a cancer patient. The one that is ignored will continue to spread and make the patient ill.

In mental health, the most effective way to get a positive outcome from treatment is to address all conditions at one time, within the same program. Ignoring anxiety, for instance, and only treating depression will inevitably lead to recurrences of anxiety that trigger relapses of depression.

Treatment for more than one mental illness is not fundamentally different from treating just one. It is still based on a foundation of therapy and medications if appropriate, along with supportive and alternative therapies, and group and family support if possible. The difference is that the treatment professionals have to include both or multiple mental illnesses in the goals of care and the plan for treatment.

What this looks like in real life depends on each individual. But generally it means that therapy sessions include discussions of all symptoms, both mental illnesses, and how they impact each other. For example, if a patient is struggling with bipolar disorder and past trauma, therapists will explore how traumatic memories may trigger episodes of depression or contribute to psychotic symptoms during mania. Therapists can help this patient by helping them process the trauma and learn how to cope with it in a healthier way, so it does not exacerbate bipolar symptoms.