The place of comorbidity and of subtle psychopathological evaluation
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EDITORIAL
The place of comorbidity and of subtle psychopathological evaluation Hans‑Jürgen Möller1 Published online: 23 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
While in the traditional disorder-related classification systems and in the early versions of DSM and ICD an individual diagnosis referred to only one disease or disorder and other potential concurrent diagnoses were not permitted because of hierarchical rules, the modern versions of ICD and DSM allow comorbidity in the sense, that a person can have e.g. a major depressive disorder and an obsessive- compulsive disorder [1]. The introduction of the concept of comorbidity, partially a consequence of the restrictive operationalisation of the different mental disorders, was understood as important step forward in the description of mental disorders. These kinds of comorbidities are quite common. While in the traditional psychopathology these additional symptoms, now diagnosed as comorbidity, were seen as part of the respective disorder, as a special enrichment of the core pathognomonic clinical picture, or as pre-runner of the fullblown illness (e.g. compulsive symptoms in the predromal state of schizophrenia, e.g. anxiety symptoms as precursor of MDD), the concept of comorbidity regards them as a disorder per se and thus opens a plethora of opportunities for specifically related research activities. This can be seen in the current literature where results on comorbidity and co-symptomatology seem sometimes to predominate studies on disorders without comorbid conditions [2–7]. However, depending on the design of the studies, it is not always clear whether e.g. the neurobiological research result is really related to the comorbid condition or to the first diagnosis. Additionally, the question, whether the result, e.g. a neurobiological finding, for the comorbid diagnosis is congruent with respective results for the same diagnosis/disorder in a non-comorbid condition, often cannot be answered. Does all this lead to a better/additional understanding of the neurobiological underpinnings of each of the respective disorders, to more than can be reached by
* Hans‑Jürgen Möller Hans‑[email protected]‑muenchen.de 1
Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, München, Germany
studying each of the respective disorders separately? Do we learn something more about the neurobiological background of the interaction of two comorbid disorders? Are these questions, which should be considered in all the studies on comorbidity? Does this finally lead to a new perspective beyond the frame of categorical or dimensional diagnostic approaches to these disorders? Will finally new concepts of psychopathology or of disorders be a result of all these research activities? Are there other ways to address the issue of comorbidity without using the concepts of given disorders and without throwing away the primary symptoms based approach, as done by the RDoC, which focuses primarily on a neurobiological conceptualiza
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