Diagnostic complexity and comorbidity: Implications for identification,outcomes,health care and involuntary treatment

Articles in this issue address the effect of comorbidity on clinical and social outcomes, including implications for identification and outcomes.

Two articles highlight the difficulty of making accurate diagnoses in two specific sub-populations. In older adults, the identification of autism spectrum disorder (ASD) remains limited by the absence of well-validated diagnostic tools for this age group (Chalk et al., 2025). Although multiple screening and assessment instruments are available, their applicability to older populations is uncertain. Similarly, clinically relevant symptoms of body dysmorphic disorder (BDD) may be overlooked in individuals experiencing ASD and attention-deficit hyperactivity disorder (ADHD), leading to possible underdiagnosis (Janus et al., 2026).

The importance of comorbidity is addressed in two further articles. Spike et al. (2026) studied the health characteristics of people admitted with psychosis who had subsequent contact with the New South Wales Local Court. In a data linkage study of 21,299 individuals, almost 71% of the sample presented with schizophrenia spectrum disorder (SSD), with co-occurring substance use, personality disorders and physical conditions being highly prevalent (Spike et al., 2026). Both substance use and psychosis type were independently associated with court diversion outcomes. For instance, those with SSD were more likely to be diverted than those with affective or substance-induced psychoses. In particular, substance-related harm appeared to reduce the probability of diversion, even among those experiencing SSD. By contrast, length of admission for psychosis and previous mental health service use were associated with a greater likelihood of diversion.

Similarly, psychiatric and physical comorbidities were common in an audit of 60 individuals who had been admitted involuntarily under Victoria’s Severe Substance Dependence Treatment Act (SSDTA) (English et al., 2026). Outcomes were poor for many: at 6 months, 15% of participants had died, and 48% had returned to their previous level of substance use. Early improvement in the minority who did respond was associated with more favourable outcomes, although no other consistent predictors were identified. However, the absence of controls limits any conclusions about the possible effects of the legislation. These findings therefore reflect ongoing uncertainty regarding the effectiveness and appropriate use of involuntary treatment in this population.

Beyond diagnosis and symptom change, there is increasing recognition of the importance of functional outcomes. A systematic review of interventions for borderline personality disorder indicated that impairments in daily living persisted despite engagement with established treatments (Tepper et al., 2025). Outcomes included health, self-care and psychosocial functioning, but evidence was heterogeneous, and no single approach encompassed all areas of functioning. This suggests that further work is required to define and evaluate interventions that support broader recovery.

Finally, Karaliuniene and colleagues conducted a narrative review of the role psychiatrists can play in disaster settings. These include clinical care, service coordination and capacity building, although the evidence base describing these roles remains limited, with the authors recommending further research (Karaliuniene et al., 2026).