Dual Diagnosis and Complex Cases
One of the major specialty areas of NBI is “complex cases.” Many patients struggle to find the help they need when they don’t fit exactly into the mold of standard treatment protocols. Other cases are complicated to treat because they present with multiple problems or the patient has not been able to engage in past treatment efforts successfully, for whatever the reason might be.
Examples of our complex cases include:
- OCD combined with an Autism Spectrum Disorder (ASD)
- Personality disorder ASD combined with tics and ADHD
- Any diagnoses combined with a Substance Use, Eating Disorder, or Personality Disorder
Severity or duration of symptoms should not be equated with “complexity” per se. There is no single answer to this question, but here are five possibilities.
One reason for considering a case to be complex is that that there are co-occurring diagnoses. Having more than one clinical condition can result in a synergistic effect in which each one feeds into and complicates the other(s). This makes it difficult to set priorities and organize an effective treatment plan.
Another reason for a case being complex is that it defies clear diagnostic understanding. Some cases are “a little of this and a little of that,” which can add up to a whole lot of complexity that is far more difficult to address than the sum of its parts. Sometimes the best that can be done is to place the case into a “diagnostic ballpark” and work from there versus searching for a diagnostic needle in a haystack.
A third reason that makes a case complex is that standard treatment protocols have not been successful despite being well designed and implemented.
A fourth reason is that the “best practice” approach to treatment is not acceptable to the patient and/or their significant others. This is not uncommon when treatment is counter-intuitive or involves discomfort, fear, or logistical concerns. This certainly can be the case with exposure-based behavioral therapies or recommendations for intensive treatment or inpatient/residential care.
Finally, some cases are complex more because of their context than their clinical factors. Examples of complicating contexts include lack of accessible resources in the patient’s vicinity and the presence of others in the patient’s environment that impede their progress. This can be a family member who is involved in substance abuse or legal problems, or at the other end of the spectrum, a significant other with whom the patient is so enmeshed that making improvements in their presence is unlikely (even if that person has the best of intentions).