What Are Co-Occurring Disorders?

Dealing with the many challenges that come with an addiction or mental health disorder is certainly no simple feat. Now imagine battling two or more at the same time. This scenario is the complex reality of living with co-occurring disorders, where multiple addictions and mental health conditions not only co-exist but also intertwine and potentially worsen one another.

For those battling sex or pornography addiction, this overlap is surprisingly common. Compulsive sexual behaviors rarely exist on their own. A significant number of people with sex addiction also grapple with co-occurring mental health conditions.

Since co-occurring disorders are so interconnected, learning more about how they interplay to treat them is essential. Addressing the problems in an integrated treatment approach is the best way to overcome both effectively.

Begin Again Institute’s unique trauma-focused treatment approach is well suited for healing co-occurring disorders. By stripping addiction down to its root cause and addressing the underlying issues first, we can help you effectively process unresolved trauma while treating an intimacy disorder like sex addiction.

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Defining Co-Occurring Disorders

Co-occurring disorders refer to when a person has both an addiction and a mental health condition at the same time. According to the National Survey on Drug Use and Health, there are approximately 21.5 million adults in the United States with some form of co-occurring disorders.

Co-occurring disorders are complex diagnoses that can come in many shapes and sizes. No specific or universal combination of disorders leads to a diagnosis.

Addiction can coexist with any mental illness. Some of the most common conditions include depression, anxiety, Post-Traumatic Stress Disorder (PTSD), schizophrenia, or bipolar disorder.

Similarly, a mental illness may co-occur alongside a variety of addictions. These might be substance use disorders, such as those related to drugs or alcohol. Co-occurring disorders can also include behavioral addictions, such as gambling, sex, and pornography addictions.

But while the exact disorders may vary, one common signifier of co-occurring disorders is that the conditions are interconnected. One disorder may contribute to the development of the other. Or they may develop from the same underlying issue. They can also influence each other's symptoms over time.

This interconnectedness makes the treatment of co-occurring disorders unique and complex. You can't effectively treat them separately. Co-occurring disorders need an integrated treatment approach for the most successful outcome.

What Causes Co-Occurring Disorders?

About half of people who experience a mental illness during their lives will also experience an addiction or substance use disorder and vice versa. It isn’t a coincidence.

Various factors, many of which overlap, cause mental health disorders and addictions. Certain disorders can also trigger each other and worsen each other’s severity.

Reasons for the prevalence of co-occurring disorders include:

• Common Risk Factors. Addiction and mental health disorders can stem from the same underlying issues. Genetics is a common risk factor for both. Environmental factors like childhood trauma can also greatly increase a person’s likelihood of developing both a mental health disorder and addiction later in life.
• Self-Medicating. Those with mental illnesses may turn to substances or specific behaviors as a way of coping with their symptoms. For example, someone with unresolved trauma may view pornography to help them feel better. This approach can lead to addiction and the worsening of their mental health.
• Brain Changes. Addiction and mental health disorders have overlapping effects on the brain. Both impact the areas associated with reward, motivation, and emotional regulation. One disorder can cause brain structure and function changes, increasing the likelihood of developing another.

Co-Occurring Disorders and Sex/Pornography Addiction

Co-occurring disorders are particularly prevalent among those with Compulsive Sexual Behavior Disorder (CSBD).

Also known as hypersexuality disorder or sex addiction, CSBD is a preoccupation with sexual fantasies, urges, or behaviors that are difficult to control.

CSBD encompasses three main types of compulsive sexual behaviors:

• Sex Addiction. Compulsive sexual behaviors like sex with strangers, participating in illegal sexual activities, and an inability to control sexual thoughts.
• Porn Addiction. The uncontrollable need to use or consume pornography.
• Masturbation Addiction. The compulsive need to masturbate.

Research estimates that 60-80% of people with compulsive sexual behaviors also have one or more co-occurring disorders. Some studies even put this number as high as 100%. These rates are significantly higher than co-occurring disorders in the general population.

Compulsive sexual behaviors have unique complexities and interconnectedness with various mental health issues.

Sex addiction commonly co-occurs alongside:

• Depression and Anxiety. Around 40% of people with a sexual addiction also have a history of mood disorders such as depression. Depression and anxiety can trigger unhealthy sexual behaviors as a coping mechanism. Sex provides a temporary escape from difficult emotions. The shame, guilt, and isolation associated with compulsive sexual behavior can also fuel these conditions, creating a vicious cycle.
• Trauma and PTSD. Trauma is a significant risk factor in developing a sexual addiction. Past traumatic experiences such as abuse or neglect can inflict lasting damage on the nervous system. The compulsion to engage in unhealthy sexual behaviors can be a way of self-soothing or trying to control the traumatic experience.
• Bipolar Disorder. During manic episodes, those with bipolar disorder may experience hypersexuality. This symptom can lead to increasingly risky sexual behaviors, compulsive pornography, or compulsive masturbation to satisfy sexual urges.
• Substance Abuse. Between 40-60% of people with a sex addiction also have an alcohol or drug addiction (source). Substances can lower inhibitions, making it easier to engage in uncomfortable and compulsive sexual behaviors. They can also numb the shame and guilt felt by those with a sex addiction.

Sex Addiction, Trauma, and Co-Occurring Disorders

To understand the interconnectedness of sex addiction and other addictions and disorders, it’s essential to look at the underlying risks and root causes.

Begin Again Institute views sex addiction from a trauma-focused perspective. We believe that unresolved trauma is the most common cause of intimacy disorders and sexual addictions. This trauma often occurs early in life.

Experiencing trauma at a young age can disrupt the nervous system and cause the brain to rewire itself. It puts you in a constant state of fight-or-flight.

The only way to get out of this fight-or-flight is to find a source of dopamine. Dopamine is the feel-good neurotransmitter released when you do something pleasurable. And sexual activities offer an easily accessible dopamine hit.

But, using sex as a coping mechanism teaches the brain to seek more, increasingly intense, and riskier behaviors to replicate the same calming effect. The next thing you know, an addiction is formed, and you can’t stop the behavior, even if you try.

Trauma and the resulting brain changes can also contribute to the development of other mental illnesses and substance use issues.

Past trauma can increase the likelihood of a person developing mental health conditions such as PTSD, depression, and anxiety. Substances may also be used in the same way as sex to provide a temporary dopamine hit and soothe the brain.

When we put trauma at the forefront, it can explain the strong relationship between mental health and addiction.

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Identifying Co-Occurring Disorders

Identifying co-occurring disorders can present a significant challenge. Many symptoms of addiction and mental illness overlap, making it tricky to pinpoint the source. The web of intertwined symptoms can also influence and worsen each other over time, creating a vicious cycle. Untangling this complex web requires specialized evaluation by a skilled professional.

At Begin Again Institute, our Certified Sex Addiction Therapists (CSATs) have special training to work with people living with sex addiction and their partners. They understand how trauma is related to intimacy disorders, including sex addiction, and the potential for other mental health concerns. We can help you uncover these issues.

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But what should you do if you are worried that you or a loved one have co-occurring disorders? How do you know it’s time to seek professional help?

The exact symptoms of co-occurring disorders can differ depending on the exact disorders involved. But there are some general signs and symptoms you can look out for. These are compound problems that may arise from one or both disorders.

Compound signs of co-occurring disorders:

• Social withdrawal and difficulty maintaining friendships and relationships
• Difficulty managing daily responsibilities like work, school, or personal hygiene
• Financial problems
• Frequent mood swings, irritability, or intense emotional reactions
• Changes in sleep patterns, either insomnia or excessive sleeping
• Loss of interest in previously enjoyable activities
• Physical symptoms like headaches, fatigue, digestive issues, or changes in appetite
• Engaging in risky or harmful behaviors

Compared to those with a single disorder (addiction or mental health condition), people with co-occurring disorders often experience the most severe of symptoms and negative consequences when left untreated.

Co-occurring disorders also put you at a heightened risk of additional problems such as hospitalizations, social isolation, financial issues, incarceration, and serious medical issues.

Treatment Approaches for Co-Occurring Disorders

Traditionally, if you received a dual diagnosis, professionals would treat each disorder separately. Let’s say you were diagnosed with depression and sex addiction. You would go to one clinic for mental health treatment and another for sex addiction treatment.

But, due to the intertwined nature of co-occurring disorders, treating each disorder separately is rarely effective. Disjointed treatment can lead to conflicting messages and strategies.

This approach also tends to focus on treating the symptoms. It doesn’t place as much importance on understanding the underlying causes of the disorders.

For more effective and long-term recovery, co-occurring disorders need an integrated approach to treatment. An integrated treatment approach addresses both conditions simultaneously. It weaves together interventions for more holistic healing.

Benefits of an integrated treatment approach include:

• Personalized and comprehensive treatment plan based on your unique diagnoses
• Identifies and treats the underlying causes of both disorders
• Therapists communicate with each other to coordinate your treatments
• Increased recovery rate and reduced risk of relapse
• More streamlined care without any confusing or conflicting advice
• Reduced cost compared to treating conditions separately

What exactly does an integrated treatment plan look like?

All co-occurring disorders are unique, and each treatment plan will look different depending on your unique diagnoses and needs. Below are some of the most common techniques used in integrated treatment.

Modalities used in integrated treatment:

• Behavioral Therapies. Evidence-based therapies such as Cognitive-Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) can help reshape unhelpful thinking patterns and build emotional regulation and stress tolerance.
• Trauma-Focused Therapies. Identifying and addressing past traumatic experiences can help to heal the root cause of co-occurring disorders.
• Group Therapy. Finding your community is vital in any form of recovery. Group therapy offers understanding and shared experiences, creating a safe space for encouragement and accountability.

Co-occurring disorders also require more intensive treatment than single diagnoses. This is due to the severity of the symptoms.

Inpatient treatment facilities provide the ideal environment for receiving comprehensive integrated care. Undergoing treatment in a controlled environment that’s free from everyday triggers can help jumpstart your recovery.

The Role of Trauma-Focused Therapy in Recovery

At Begin Again Institute, trauma-focused therapy is the cornerstone of effective integrated treatment for sex addiction and co-occurring disorders.

Matt Wenger, Clinical Director at Begin Again Institute, said the focus on trauma matters.

“We are a trauma program that treats sex addiction,” he said. “We understand where the cart and horse belong.”

BAI uses the Trauma-Induced Sexual Addiction Therapy (TINSA) treatment model for addiction. TINSA theorizes that the origin of sexual addiction lies in a damaged autonomic nervous system (ANS) caused by early developmental trauma.

Rather than simply treating the symptoms of co-occurring disorders, our trauma-informed approach helps unpack the underlying causes of addictions and mental illnesses.

“TINSA helps people understand why,” Matt said. “It helps them get in touch with the wounds and the trauma that precipitated the addiction.”

Identifying and dealing with the root causes of your disorders can lead to more successful and long-term integrated recovery.

Trauma-focused therapy techniques:

• Eye Movement Desensitization and Reprocessing. EMDR helps heal emotional distress from trauma by reshaping how the brain stores memories. It can help in identifying and resolving the underlying traumas causing addiction.
• Brainspotting. A relatively new psychotherapeutic technique, Brainspotting involves focusing on specific eye positions to access and process stored traumatic experiences.
• Dialectical Behavior Therapy. DBT is a form of talk therapy that teaches you how to observe and process your emotions rather than reacting to them. It emphasizes mindfulness, distress tolerance, and developing healthy coping mechanisms.
• Internal Family Systems. IFS is a form of talk therapy that helps identify the “parts,” or sub-personalities, that live within you. These parts all interact and may end up in conflict with each other due to trauma. The goal is to heal the wounded parts and bring them all back together to create an integrated whole.

Co-Occurring Disorders vs. Dual Diagnosis

The terms “co-occurring disorders” and “dual diagnosis” are often used interchangeably. But while the two are very similar, they’re not identical.

Dual diagnosis is a broad term that refers to the presence of two or more medical conditions at the same time. But it does not necessarily imply any connection between these conditions. They could be completely independent of each other. And they are often treated separately.

When two disorders are “co-occurring,” they are seen as related and are likely to interact with each other. One condition may contribute to the development of the other, or they may worsen each other's symptoms.

So why is it so important to distinguish these two terms?

Understanding the terminology helps emphasize the need for an integrated treatment for co-occurring disorders.

When a mental health condition and addiction co-exist and interact, it’s crucial to find a treatment approach that addresses both simultaneously. Treating the conditions together is more effective for long-term recovery than treating each separately.

Let Begin Again Institute Help You Overcome Co-Occurring Disorders

Overcoming sexual addiction is challenging enough on its own. Let alone when it's intertwined with another mental health condition or substance use issue.

Due to the complex web of interconnected symptoms, seeking integrative care for co-occurring disorders is crucial. Addressing your conditions simultaneously can greatly increase the effectiveness of treatment. It can also decrease the risk of relapse.

At Begin Again Institute, we take an integrated and trauma-focused approach to treating sexual addiction and any co-occurring disorders. We don’t just focus on your symptoms. We help you identify and address the root cause of your disorders. By treating the root causes, we can then control the resulting behaviors.

Our 14-Day Men’s Intensive is ideal for men with intimacy disorders, including sex or pornography addiction, who may also have unresolved trauma.

This program also includes a virtual Partner Support Program at no additional cost.

Contact Begin Again Institute today to start your journey toward recovery.