Psychiatric comorbidity: theoretical and clinical dilemmas

The high prevalence of psychiatric comorbidity is usually considered to be a problematic artefact of the DSM. Clinicians appear to be reluctant to register comorbid diagnoses. To provide insight into the concept of 'psychiatric comorbidity', so that the phenomenon can be dealt with more efficiently in clinical practice. We studied the literature and performed a theoretical analysis. The high prevalence of psychiatric comorbidity is closely linked to the structure of the DSM and is leading increasingly to practical and theoretical problems. These problems have stimulated the development of several valuable alternative models of psychopathology. In the context of these developments, however, the use of terms such as 'artificial' has led to a needless and unfruitful polarisation of the debate. The debate needs to focus primarily on the usefulness of various models for patient care and research. Psychiatric comorbidity is an inevitable consequence of a categorical approach to psychopathology, which is basically legitimate. As long as the dsm in its current form constitutes an important part of our diagnostic 'arsenal', we advise clinicians to register comorbid classifications in as much detail as possible and at the same time to give close attention to the correct interpretation of the phenomenon.