Study Reveals Four Classes of Comorbidity for Anxiety and Depression

Comorbidity occurs when an individual has symptoms of more than one psychological condition. These symptoms can manifest simultaneously, appear at different times, or even overlap in occurrence. Depressive and anxious conditions are among the most commonly comorbid mental health problems. One method of classifying these comorbid events is confirmatory factor analysis (CFA), which has produced a consistent classification of three particular types of comorbid states. They include anxious misery and fear, both of which are internalizing states, and externalizing. Symptoms of posttraumatic stress, anxiety, and depression fall under the anxious-misery category, while symptoms of phobia fall under the fear category.

Although CFA is widely accepted, it does not account for personality factors involved in multiple comorbidity. Therefore, Philip Spinhoven of the Institute of Psychology and the Department of Psychiatry at Leiden University Medical Center in the Netherlands theorized that latent class analyses (LCA) might be a fruitful alternative to CFA in the assessment of comorbid psychiatric conditions. Spinhoven used a person-centered approach when he led a recent study on comorbidity. He examined the Big Five personality factors in a sample of 2,566 adults using both LCA and latent transition analysis (LTA) over a 2-year period. Spinhoven found a new classification of comorbidity based on traits and five classes based on personality.

Spinhoven evaluated panic disorders, depression, and social anxiety and was able to classify the participants as falling into one of the following classes: few disorders, distress disorders, fear disorders, or comorbid fear and distress disorders. He also discovered that the participants fell into unique categories of resilience and control. Those with the highest levels of control and the lowest levels of conscientiousness were the least likely to see symptoms decrease throughout the study period. Spinhoven believes that these findings imply that conscientiousness may be a factor that warrants further LCA and LTA research with respect to comorbidity of anxious or depressive conditions. He added, “These results suggest that factor analytic and latent class analysis may be complementary approaches for modeling a set of disorders as latent dimensions or as clusters or groups.”

Spinhoven, P., de Rooij, M., Heiser, W., Smit, J. H., Penninx, B. W. (2012). Personality and changes in comorbidity patterns among anxiety and depressive disorders. Journal of Abnormal Psychology. Advance online publication. doi: 10.1037/a0028234

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  • Jeff


    June 21st, 2012 at 3:05 PM

    Rarely have I ever seen someone who is depressed experience just depression.
    Just as noted here there are generally other disorders that go hand in hand with being depressed, and more often than not you will find that one only feeds into and causes the other to be even more evident than perhaps it would be if exhibited alone.

  • holly


    June 21st, 2012 at 11:51 PM

    if various disorders are so inter related then it only makes sense to look at them as one entity and try and get some form of treatment that helps both.

  • Cline


    June 22nd, 2012 at 4:17 AM

    To think that we can just treat one element would be very closed minded and really of no benefit to patients with these illnesses. You treat one and then the symptoms are then likely to show up in other ways. It’s kind of like liposuction- you suck the fat from one area, but then it always shows back up somewhere else.

  • Grant S

    Grant S

    June 22nd, 2012 at 11:26 AM

    Looks like there is always much more beneath the surface of an issue than we may have possibly realized in the past.

  • Chris horne

    Chris horne

    June 23rd, 2012 at 9:07 AM

    Personality does play such an important role in how one allows depression and other factors affect them. Some will easily be able to bouce back while some allow this to keep them down. A lot of how well someone does has to do with what kind of person they are, are they willing to fight for what they want or are they going to lie down and take it?

  • dahlia


    June 24th, 2012 at 8:18 AM

    I hope that as a result of all of this looking into how the disorders are classified that we don’t begin to overlook others who may be experiencing symptoms of some form of mental illness but don’t necessarily fall into any provided category. Those are the stories that you hear about that tend to fall through the cracks maybe they don’t always fit into any one classis definition of diagnosis. The more that we study should actually open our eyes to the possibility of all that is out there instead of somehow limiting and narrowing our vision.

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