Psychological or behavioral factors include psychological distress, patterns of interper- sonal interaction, coping styles, and maladaptive health behaviors, such as denial of symp- toms or poor adherence to medical recommendations. Common clinical examples are anxiety-exacerbating asthma, denial of need for treatment for acute chest pain, and manip- ulation of insulin by an individual with diabetes wishing to lose weight. Many different psychological factors have been demonstrated to adversely inﬂuence medical conditions— for example, symptoms of depression or anxiety, stressful life events, relationship style, personality traits, and coping styles. The adverse effects can range from acute, with imme- diate medical consequences (e.g., Takotsubo cardiomyopathy) to chronic, occurring over a long period of time (e.g., chronic occupational stress increasing risk for hypertension). Af- fected medical conditions can be those with clear pathophysiology (e.g., diabetes, cancer, coronary disease), functional syndromes (e.g., migraine, irritable bowel syndrome, fibro- myalgia), or idiopathic medical symptoms (e.g., pain, fatigue, dizziness).
This diagnosis should be reserved for situations in which the effect of the psychological factor on the medical condition is evident and the psychological factor has clinically sig- nificant effects ori the course or outcome of the medical condition. Abnormal psychologi- cal or behavioral symptoms that develop in response to a medical condition are more properly coded as an adjustment disorder (a clinically significant psychological response to an identifiable stressor). There must be reasonable evidence to suggest an association between the psychological factors and the medical condition, although it may often not be possible to demonstrate direct causality or the mechanisms underlying the relationship.
The prevalence of psychological factors affecting other medical conditions is unclear. In
US. private insurance billing data, it is a more common diagnosis than somatic symptom disorders.
Psychological factors affecting other medical conditions can occur across the lifespan. Par- ticularly with young children, corroborative history from parents or school can assist the di- agnostic evaluation. Some conditions are characteristic of particular life stages (e.g., in older individuals, the stress associated with acting as a caregiver for an ill spouse or partner).
on medical conditions, such as those in language and communication style, explanatory models of illness, patterns of seeking health care, service availability and organization, doctor-patient relationships and other healing practices, family and gender roles, and at- titudes toward pain and death. Psychological factors affecting other medical conditions must be differentiated from culturally specific behaviors such as using faith or spiritual healers or other variations in illness management that are acceptable within a culture and represent an attempt to help the medical condition rather than interfere with it. These local practices may complement rather than obstruct evidence-based interventions. If they do not adversely affect outcomes, they should not be pathologized as psychological factors affecting other medical conditions.
Functional Consequences of Psychological Factors
Psychological and behavioral factors have been demonstrated to affect the course of many medical diseases.
Mental disorder due to another medical condition. A temporal association between symptoms of a mental disorder and those of a medical condition is also characteristic of a mental disorder due to another medical condition, but the presumed causality is in the op- posite direction. In a mental disorder due to another medical condition, the medical condition is judged to be causing the mental disorder through a direct physiological mech- anism. In psychological factors affecting other medical conditions, the psychological or be- havioral factors are judged to affect the course of the medical condition.