Comorbid Disorders

The article “Developmental Trauma Merits DSM Diagnosis, Experts Say” in the February 2 issue was excellent and raises important issues in psychiatric nosology.

Dr. Bessel van der Kolk implies that the frequent diagnosis of comorbid mood and ADHD syndromes in children and adults may often result from a failure to diagnose “complex” posttraumatic stress disorder. Fair enough. Nonetheless, there is extensive epidemiological data supporting the high incidence of inherited comorbidity of childhood-onset affective disorders and ADHD. There is also a high incidence of trauma and familial instability in bipolar families.

Before jumping on the “complex trauma” bandwagon, we should think carefully about what actually causes the observed symptoms of these complex disorders: the inherited, comorbid ADHD and affective disorder, the trauma resulting from affective dysregulation in genetically affected families, or both?