Which Patients Are Less Likely to Believe They Have a Comorbid Mental Health Disorder?

CONFERENCE REPORTER

Mark Zimmerman, MD, shared insights from his poster presentations at the 2026 American Society of Clinical Psychopharmacology Annual Meeting with Psychiatric Times. One of the posters, “The Complex Diagnostic Profile of Psychiatric Outpatients Presenting for the Treatment of Bipolar Depression,”¹ focused on the challenge of identifying comorbidity in patients with bipolar depression. Interestingly, Zimmerman’s research found that certain patient groups are less likely to believe they have a comorbid disorder. Can you guess what they are?

Zimmerman analyzed 131 patients using the Structured Clinical Interview for DSM-IV and Structured Interview for DSM-IV Personality interviews and found that 80% had comorbid psychiatric disorders (n=104). Additionally, more than 60% were diagnosed with 2 or more comorbid psychiatric disorders (n=60) and almost half were diagnosed with 3 or more comorbid psychiatric disorders. Approximately two-thirds of the patients wanted treatment for their comorbidities, with many having 2 or more conditions.

In patients with attention-deficit disorder, more than 90% wanted treatment, but patients with comorbid substance use disorder or specific phobias felt differently, and ranked amongst the least likely to want treatment.

Zimmerman rightly points out that many controlled studies on bipolar depression exclude patients with comorbid conditions,² which may limit the generalizability of treatment efficacy findings to real-world clinical practice. Bipolar depression rarely occurs in isolation, as psychiatric and medical comorbidities are the rule rather than the exception. The most common comorbid conditions are: anxiety, substance use, and conduct disorders. In clinical samples, investigators have also found instances of eating disorders, sexual behavior, attention-deficit/hyperactivity disorder, and impulse control, as well as autism spectrum disorders and Tourette disorder.³

Dr Zimmerman is the director of the Adult Partial Hospital Program and outpatient psychiatry at Rhode Island and The Miriam hospitals, and a professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University.

References

1. Zimmerman M. The complex diagnostic profile of psychiatric outpatients presenting for the treatment of bipolar depression. Poster presented at: 2026 ASCP Annual Meeting; May 26-29; Miami Beach, FL. Accessed March 15, 2016.

2. Wong JJ, Jones N, Timko C, Humphreys K. Exclusion criteria and generalizability in bipolar disorder treatment trials. Contemp Clin Trials Commun. 2018;9:130-134.

3. McElroy SL. Diagnosing and treating comorbid (complicated) bipolar disorder. J Clin Psychiatry. 2004:65 Suppl 15:35-44.