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The old saying that birds of a feather flock together may hold even when people with psychiatric illnesses choose their partners. A recent JAMA Psychiatry study investigated whether parents were more likely to share mental and physical health conditions and how this pattern of pairing affects disease risk.

The researchers looked specifically at assortative mating, the tendency to choose romantic partners with similar traits, in relation to psychiatric disorders. After examining health and parental data from more than 4.2 million people in Denmark, they found that people with a psychiatric illness were more likely to have a partner with the same disorder or a related condition.

Parental couples with schizophrenia showed the strongest resemblance to each other of any disorder studied. Parents with different psychiatric conditions also commonly paired up. The clearest example was men with substance use disorder pairing with women who had ADHD. Across all these patterns, mental health conditions matched between partners far more strongly than physical illnesses did.

This pattern of partnering could help explain why mental illness can run so strongly in some families. When people with psychiatric conditions partner with each other, risks can accumulate within families in ways that go beyond what genetics alone would predict.

With something like height, it is easy to tell whether two partners are similar, but when it comes to behavior or mental health, things get much murkier.

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