What are PTSD Comorbidities and How Do They Affect Treatment

PTSD or post-traumatic stress disorder is an anxiety disorder marked by the experience of a traumatic event. It can have long-lasting effects and often results in functional impairments and disability, which may seriously affect one’s wellbeing and quality of life. In addition to experiencing PTSD symptoms, those suffering from the disorder may also experience PTSD comorbidities which are secondary disorders that co-occur with their PTSD diagnosis. Unfortunately, comorbidities with mental illness are very common and it’s estimated that about 90% of those with PTSD will have at least one comorbid mental disorder in their lifetime. Some of the more notable PTSD comorbidities are substance use disorder, major depressive disorder, another anxiety disorder, or phobias. PTSD comorbidities can complicate a diagnosis and lead to potentially more complex and less effective treatment or a delayed response to treatment.


Mental Health
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What are comorbidities?

Comorbidity refers to the presence of one or more additional conditions that co-occur with a primary diagnosis. For example, if the primary condition is PTSD, a comorbid condition may be anxiety or depression. Comorbid conditions often co-occur with other conditions and can be both physiological or psychological. Many mental health conditions are comorbid with one another, meaning they often coexist simultaneously within one person. It’s not always clear if one disorder causes another, if the conditions exist simultaneously but independently from one another, or if the conditions are related.

Common PTSD comorbidities


Major depressive disorder (MDD)

A mood disorder characterized by persistent and extreme feelings of sadness and loss of interest. It’s very debilitating and affects how one feels, thinks, and behaves. Individuals suffering from MDD may have difficulty with daily tasks and performing basic day-to-day activities such as showering and eating. Common symptoms include feeling hopeless, loss of pleasure, sleep disturbances, fatigue, reduced appetite, suicidal thoughts, and unexplained physical pain.

Substance use disorders

Also referred to as drug addiction or substance abuse, is a disease that prevents someone from controlling themselves with the use of legal or illegal drugs, including prescription medications and alcohol. Those with substance use disorders will continue to use these substances even though they are causing harm and disrupting the other facets of their life. Those suffering from PTSD or other mental health disorders may turn to drugs or alcohol as a way to self soothe and self-medicate, which does not always lead to having a substance use disorder but can increase the likelihood of developing one.

Anxiety disorders

Having intense, excessive, frequent, and persistent worry and fear about daily life. These intense feelings can interfere with daily life and can result in panic attacks. Anxiety disorders are a very common PTSD comorbidity and they share some overlapping symptoms. Those with an anxiety disorder may avoid certain situations and places that make their anxiety symptoms worse. Common symptoms include feeling nervous or tense, having a sense of impending danger, shortness of breath, increase heart rate, upset stomach, fatigue, difficulty sleeping, and difficulty controlling worry.

Borderline personality disorder

A mental health disorder that impacts self-perception and the perception of others. Common symptoms include intense fear of abandonment, having frequent, unstable relationships, rapid shifts in self-identity, impulsivity and risky behaviour, self-injury, mood swings, and anger.

Physical health conditions as PTSD comorbidities

Comorbid PTSD disorders also include physical disorders such as bone and joint disease, neurological conditions, cardiovascular conditions, respiratory conditions, and metabolic disease. It’s theorized that PTSD may increase the risk of developing certain health conditions due to sleep disturbances, heightened stress, somatic symptoms, or substance abuse.


Trauma Anxiety
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Risk factors for developing PTSD and PTSD comorbidities


In addition to conditions co-occurring with PTSD, there are also certain risk factors that not only increase the likelihood of developing PTSD but also increase the risk of developing a comorbid disorder with PTSD.

  • Poverty
  • Genetics
  • Females have higher risk of developing PTSD
  • Males have higher rates of comorbidity
  • Type of trauma – gender based-violence such as rape or molestation may lead to higher levels of comorbidity
  • Cognitive vulnerabilities – low IQ, previous history of head injury or traumatic brain injury 
  • Exposure to life stressors before the traumatic event such as childhood maltreatment or other stressful life events
  • Previous history of mental health disorders such as anxiety, depression, or conduct disorder. Depressed individuals with PTSD often exhibit more severe psychiatric symptoms and require more complicated treatment
  • Personality factors – neuroticism, avoidance coping, and low extraversion

Effects of PTSD comorbidities

Having PTSD with a comorbid disorder can increase an individual’s suffering and may cause greater functional impairment and disability. Certain comorbid disorders, such as MDD increase the risk of suicide and suicide ideation. Alcohol abuse, depression, and panic attacks are all associated with increased risk for functional impairment and disability resulting in a reduced quality of life and a more complex treatment program. 


PTSD Treatment
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Treatment for PTSD comorbidities

PTSD treatment can be complicated, and often involves a combination of psychotherapy and pharmacotherapy, which may include the use of antidepressants or antianxiety medications. Drug therapies are typically more successful at treating hyperarousal and mood symptoms, and less effective with re-experiencing and avoidance symptoms. Other forms of therapy such as cognitive behavioural therapy (CBT), psychotherapy, My Recon Therapy, and Nature-based therapy have all been used to help treat PTSD, with varying degrees of success. Because one’s traumatic experience is complicated and unique to them, individuals may try several different therapeutic approaches before finding one that works for them. No matter what form of treatment or therapy an individual engages with, those suffering from PTSD or PTSD with a comorbid disorder should always seek the support of trained professionals, such as trauma counselors and therapists. Certain therapeutic approaches, such as exposure techniques or narrating the traumatic event can be unsafe if not done appropriately, therefore the safest treatment is with a professional mental healthcare worker. Unfortunately, drop-out rates for PTSD and PTSD comorbidity treatments remain high, which further emphasizes the need for appropriate and comprehensive treatment options.

My Recon Therapy is an effective treatment for PTSD and may be beneficial in helping alleviate the suffering associated with PTSD comorbidities as well. For more questions on My Recon Therapy and other treatment options, please review our programs for PTSD treatments or contact us with any questions regarding the best therapy option for you.

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