Psychiatric Comorbidity as a Function of Severity: DSM-5 Alcohol Use Disorder and HiTOP Classification of Mental Disorders.
BACKGROUND
Understanding the comorbidity of alcohol use disorder (AUD) and other psychiatric diagnoses has been a long-standing interest of researchers and mental health professionals. Comorbidity is often examined via the diagnostic co-occurrence of discrete, categorical diagnoses, which is incongruent with increasingly supported dimensional approaches of psychiatric classification and diagnosis, and for AUD more specifically. The present study examined associations between DSM-5 AUD and psychiatric symptoms of other DSM-IV and DSM-5 disorders categorically, and dimensionally organized according to the Hierarchical Taxonomy of Psychopathology (HiTOP) spectra (e.g., Internalizing, Disinhibited Externalizing).


METHODS
The comorbidity of AUD with other psychological disorders was examined in 2 independent nationally representative samples of past-year drinkers via an initial examination in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) Wave 2 and replicated in NESARC-III.


RESULTS
Analyses focusing on psychopathology symptom counts organized by spectra demonstrated that greater AUD severity was associated with a higher number of symptoms across HiTOP spectra. Traditional categorical analyses also demonstrated increasing prevalence as a monotonic function of DSM-5 AUD severity gradients.


CONCLUSIONS
This study indicates that AUD and other psychiatric disorder comorbidity implies increased presence of multiple forms of psychopathology with a corresponding increased number of symptoms across hierarchical spectra. Greater AUD severity increases the likelihood of other psychopathology and, when present, "more severe" presentations. That is, on average, a given disorder (e.g., depression) is more severe when copresenting with an AUD, and increases in severity along with the AUD.
['Helle|Ashley C|AC|0000-0002-9115-777X', 'Trull|Timothy J|TJ|0000-0001-9935-7939', 'Watts|Ashley L|AL|0000-0002-8210-4748', 'McDowell|Yoanna|Y|0000-0003-3766-9165', 'Sher|Kenneth J|KJ|0000-0002-4420-8546']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000437:Alcoholism D015897:Comorbidity D003430:Cross-Sectional Studies D006801:Humans D008297:Male D001523:Mental Disorders D008875:Middle Aged D012720:Severity of Illness Index
Comorbidity Alcohol Use Disorder Psychopathology Dimensional Models