When a condition is co-morbid it means it exists alongside another. This means different conditions can co-exist with each other. It’s extremely common for neurodivergent individuals to be diagnosed with all sorts of other conditions.
It’s important to consider co-morbid conditions as the picture of traits/symptoms may be more complicated, the treatment for one may impact another and it’s important to consider the whole person holistically.
Neurodivergent conditions commonly occur together. Eg autism and ADHD or ADHD and dyslexia.
Being neurodivergent, living in a neurotypical world puts a huge stress on the body, the nervous and immune systems are particularly at risk from this stress. Some illnesses/disorders also have a genetic component that appears to be linked with neurodevelopmental conditions.
Table of Contents
Mental health
Depression
40% of autistic people also have depression, compared to non-autistic people where the prevalence is 8%. The exact causes are unknown but it is likely due to lack of support, the wrong support, social stigma or discrimination. Symptoms/traits may overlap or neurodivergent traits can increase the risk of depression e.g. sensory overload may lead to isolation. Find out more on the Healthline website.
Anxiety
Having a brain that works differently and being forced to ‘fit in’ to neurotypical society means anxiety is extremely common. Having sensory and social differences as well as the pressure to mask can increase risk of anxiety. Managing our environment and planning are key components to managing anxiety alongside neurodivergent conditions.
Eating disorders
Co-morbid eating disorders, especially anorexia are prevalent in the neurodivergent population. Within the general population about 1% are autistic and 0.3% have anorexia, however it’s estimated that 20% of autistics have anorexia. The interplay between the conditions is complex.
Restrictive eating in neurodivergent individuals may be due to sensory challenges and/or the need for routine (may be diagnosed as avoidant/restrictive food intake disorder, ARFID), rather than the focus on weight/shape as in anorexia.
Obsessive compulsive disorder (OCD)
While it is part of autism/ADHD to focus on routines and hyperfocus can be beneficial at times, OCD is different. In OCD intrusive irrational persistent thoughts and beliefs exist alongside a need to carry out rituals or repetitive activities in an attempt to relieve fears or anxiety.
Research has shown that OCD in the general population is 1.6%, however 17% of autistic individuals have OCD.
It maybe helpful to understand the difference by looking at what motivates the action, relieving fear and anxiety or pleasure seeking.
When engaging in therapies, it’s important neurodivergent difficulties with change are taken into account. Find more information on the National Autistic Society website.
Post-traumatic stress disorder and complex post-traumatic stress disorder
Symptoms may be due to a one off event such as a car accident or multiple traumatic events such as bullying or abuse. This impacts daily living, ability to regulate emotions, interactions with others and difficulties sustaining relationships. 3.9% of the general population and 40% of the autistic population experience PTSD. Further information can be found on the UK trauma council website.
Burnout
A state of emotional, mental and physical exhaustion brought about by prolonged stress. Workplace burnout may be due to excessive stress at work however neurodivergent individuals are more likely to experience burnout due to the pressures of everyday life.
Alexythymia
Not usually a diagnosis in its own right but up to 50% of autistic individuals are unable to identify, name and communicate their moods and emotions. Read more about this experience with Neuroclastic.
Rejection sensitivity dysphoria (RSD)
Often co-morbid with ADHD, RSD is an extreme emotional sensitivity/pain triggered by the perception that a person has been rejected or criticised by important people in their life. Find out more on the Psychology Today website.
Pathological demand avoidance (PDA)
Also known as persistent drive for autonomy, this names helps us understand the motivation behind the behaviour.
Often co-morbid with autism, this is a persistent and marked resistance to ‘the demands of everyday life’, which may include essential demands such as eating and sleeping as well as expected demands such as going to school or work. The sufferer may even struggle with demands they put on themselves. Read more about it here.
Oppositional defiance disorder (ODD)
A separate diagnosis, may be co-morbid with ADHD. ODD includes frequent and ongoing anger, irritability, arguing and defiance toward authority figures. Individuals may also appear spiteful and focus on seeking revenge. A combination of a genetic component and inconsistency of discipline/abuse or neglect may contribute. Treatment involves rebuilding a positive relationship with care-givers. Read more about ODD on the Mayoclinic website.
Speech and language communication needs
This is an umbrella term used to describe difficulties across one or more aspects of communication. For example, conditions such as aphasia and dysarthria (difficulty controlling the muscles used in speech), stammering, difficulty pronouncing sounds, hoarseness and loss of voice, difficulties with the flow or tone of speech, language comprehension and difficulty using words and sentences. Read more about speech and language needs here.
Addiction
Research has shown that a neurodivergent individual may be twice as likely to misuse substances. Additionally, 25% of those with a substance misuse disorder, also meet the criteria for ADHD. The desire to mask and/or the stress of coping in a neurotypical world means neurodivergent people are more at risk if predisposition is present. See more here and read about what help is available.
Physical health
Irritable bowel syndrome (IBS)
Closely linked to stress and interoception challenges irritable bowel syndrome is a collection of symptoms including diarrhoea, constipation, bloating, indigestion and wind. Read more about it on the NHS website.
Epilepsy
The incidence of epilepsy increases in those with an intellectual disability (ID). 1 % of the general population has epilepsy, this increases to 4% in those with an ID; autistic individuals without an ID co-morbid epilepsy is seen in 8%, increasing to 20% with an ID and up to 40% with a severe ID. This leaflet from Autistica, may help with management.
Functional neurological disorder
Caused by a ‘software’ issue ie the way the neurological system work; functional neurological disorder can cause debilitating tremors, weakness, paralysis, blackouts and seizures. Although stress can play a part, the unpredictability of this condition can be difficult to manage.
Headaches and migraines
Research shows that migraines are twice as likely in autistic individuals. The causal link is unknown, however it may be connected to abnormal serotonin levels, genetic factors, dysregulation in immune system or dysfunctional gut-brain axis. Sensory sensitivities and anxiety may increase the risk for a migraine occurring. For more information see Medical News Today article.
Fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
Chronic conditions with debilitating symptoms including fatigue, joint problems, muscle pain, disordered sleep and brain fog. The link between neurodevelopmental conditions and these pain conditions may be related to daily stresses of living in a neurotypical world having a detrimental impact on the immune system. Mental health conditions and trauma often go hand-in-hand with these conditions.
As fibromyalgia is a diagnosis of exclusion, patients may feel ‘fobbed off’ if they don’t receive diagnostic tests they feel could provide answers. As very little is known about these conditions, there are limited options for management, often relying on life-style changes and trial-and-error when trying various techniques.
Hormonal conditions
Individuals with autism/ADHD and a uterus/ovaries suffer with polycystic ovarian syndrome (PCOS) more often than the non-autistic/ADHD population. Features of PCOS include irregular, longer and/or more painful periods, excessive facial and body hair due to increased androgens and enlarged ovaries with fluid-filled sacs (follicles) that surround the eggs (2 features are required for a diagnosis). Other symptoms include difficulty getting pregnant, thinning of hair on head, weight gain and oily skin or acne.
Pre-menstrual syndrome (PMS) and pre-menstrual dysphoric disorder (PMDD) is seen more often in autistic/ADHD individuals. Psychological symptoms include unstable mood, irritability, anxiety, depression, fatigue, difficulty concentrating, insomnia and feeling overwhelmed. Physical symptoms include breast tenderness, muscle pains, weight gain and bloating. Symptoms occur 1-2 week prior to menstruation and disappear when menstruation occurs. PMDD can be so severe that individuals are at risk of suicide.
Considering the interplay between autism/ADHD and PMS or PMDD is important. Managing the sensory changes and discomfort throughout the menstrual cycle may lead to meltdowns and emotional dysregulation.
Read more about hormones and ADHD here.
Joint and muscle disorders
Hypermobility is more common in neurodivergent individuals and may not be a cause for concern. If, however, the individual experiences widespread pain and frequent injuries, a co-morbid diagnosis may be helpful as specific treatments may be helpful. Research has shown a specific link between autism and Ehlers Danlos Syndrome.
Mast Cell Activation Syndrome (MCAS) and Histamine Intolerance
MCAS occurs when the mast cells become over-reactive and over release inflammatory chemicals into the body. These conditions cause symptoms such as: headaches and brain fog, memory issues and attention problems, depression and anxiety, dizziness, tinnitus, insomnia and temperature intolerance. The reason for the co-morbid connection is unknown but there appears to be higher rates of MCAS in individuals with neurodevelopmental conditions.
Learning disabilities
Learning or intellectual disabilities can impact an individual’s ability to carry out everyday tasks such as washing and dressing. A learning disability is different from a learning difficulty as the individual will have a lower than average IQ. Mencap is a good source of information.
Individuals with ADHD, dyslexia and dyspraxia may have difficulties learning due to executive function differences or sensory processing issues; these difficulties may or may not be co-morbid with a specific learning disability.
Sensory conditions
Neurodivergent individuals experience sensory differences, however some individuals will have a co-morbid specific sensory disorder.
Difficulties in processing visual information may lead to a diagnosis of Irlen syndrome or prosopagnosia. Sensory processing disorder occurs when an individual is unable to process and interpret input from all senses. Auditory processing disorder is a term for a number of issues arising from an inability to process auditory input; the individual can hear but may not be able to differentiate between words that sound similar, filter out background noise or may not be able to sense the direction from which sound it coming.
Aphantasia is a lack of mind’s eye, individuals cannot think in pictures of imagine a scene. Senses may be involuntarily joined in synaesthesia, e.g. seeing colours connected with specific sounds, this isn’t usually harmful and can increase creativity.
How can counselling help co-morbid conditions?
It’s important to engage with a counselling or psychotherapist who understands and has experience with neurodivergence and co-morbid conditions. Any chronic conditions can seriously impact our ability to manage the challenges that come with being neurodivergent and vice versa.
The counsellor’s knowledge and expertise will ensure you’re supported holistically. Understanding the interplay and how each condition impacts the other can improve management, reduce symptoms and improve well-being. Understanding that chronic conditions will never be cured but pacing, rest and self-compassion are part of the picture in supporting an individual work towards the life they want.
If you would like to work with a counsellor who understands what it’s like to live with co-morbid chronic mental and physical health conditions and will support you in your journey with compassion and understanding, please contact me here.