Psychological Factors Affecting Other Medical Conditions
Overview
Psychological factors affecting other medical conditions (PFAOMC) is classified as a somatic symptom disorder1 in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). Somatic symptom disorders are psychosocial mental health conditions that are directly related to or manifest as symptoms of medical conditions impacting physical health.
Many somatic symptom disorders involve a mental health condition that specifically causes experiences of pain or illness in the body (as opposed to those experiences having a medical cause such as an infection). Psychological factors affecting other medical conditions is distinct in that, with psychological factors affecting other medical conditions, a diagnosed medical condition is comorbid, or already present, but psychological and mental health-related factors are making the medical condition worse—the medical condition may include gastrointestinal, neurological, and rheumatological disorders, and maladaptive health behavior affects medical outcomes. Behavioral factors can potentially affect virtually all general medical conditions. Though these psychological factors may resemble symptoms of certain mental health conditions (e.g., depressive disorders, personality disorders), they do not meet the criteria for a mental disorder.
Psychological factors affecting other medical conditions can include psychological, cognitive, emotional, or behavioral factors that can all influence health and affect symptoms. Some examples of psychological factors affecting other medical conditions behaviors include:
- Denying one’s symptoms or diagnosis2
- Refusing to comply with a physician’s recommendations for treatment
- Deliberately engaging in activity that could heighten the impacts of the medical condition (for instance, continuing to smoke after a lung cancer diagnosis)
Symptoms
The DSM-V outlines specific criteria for a person’s symptoms to rise to the level of receiving a diagnosis of psychological factors affecting other medical conditions. These symptoms of psychological factors affecting other medical conditions include:
- The person has a diagnosed medical condition or symptom that is not a mental health disorder.
- The medical condition or symptom is being negatively affected by psychological factors in at least one of the following ways:
- Around the time the psychological factors emerged, the medical condition developed or was exacerbated, or the individual experienced a delayed recovery, indicating a clear link between the condition and the psychological factors.
- The psychological factors prevent adequate treatment of the medical condition.
- The psychological factors lead to additional health risks for the individual.
- The psychological factors have impacted the development of the medical condition to the point where professional medical attention is required.
The symptoms of psychological factors affecting other medical conditions can be defined as mild, moderate, severe, or extreme, with the following definitions:
- Mild: Mild PFAOMC increases the risk of the medical condition worsening. An example would be an individual with high blood pressure not taking their medication.
- Moderate: Moderate PFAOMC actively makes medical conditions worse, such as overwhelming anxiety intensifying asthma attacks.
- Severe: Severe PFAOMC worsens the medical condition to the point where an emergency room visit or hospitalization is necessary.
- Extreme: Extreme PFAOMC puts the patient’s life at risk. An example would be a patient ignoring the symptoms of a heart attack despite knowing they are occurring or ignoring a tumor and not seeking medical help.
To be diagnosed with psychological factors affecting other medical conditions, a person can’t have another mental health condition that better explains the adverse medical results. For instance, a person with agoraphobia who refuses to leave their house even when they require medical care would not be eligible for a psychological factors affecting other medical conditions diagnosis. Somatic symptom disorder, adjustment disorder,3 and illness anxiety disorder4 are other differentials that are not classified as psychological factors affecting other medical conditions.
Causes
Psychological factors affecting other medical conditions are not caused by any specific experience or predisposition. Several risk factors may make it more likely that a person navigating the medical system may develop psychological factors affecting other medical conditions, such as traumatic or stressful events or psychological distress.
The risk of psychological factors affecting other medical conditions increases for people with a history of maladaptive health behaviors. These behaviors can include smoking, unsafe sex, interpersonal problems, avoiding exercise and remaining mostly sedentary, substance use, poor nutrition, and not following a doctor’s recommendations or prescriptions. A history of mental health concerns, particularly depression, dysphoria, anxiety, and suicidal thoughts, can heighten the risk of psychological factors affecting other medical conditions associated with an unhealthy lifestyle, as can a history of stressful life events.
Additional risk factors
Some psychological factors can be more prevalent in medical settings than others. Researchers have identified more concrete risk factors for psychological factors affecting other medical conditions in the following situations.
Anxiety
Individuals are more likely to experience anxiety that is severe enough to negatively impact their medical prognosis if:
- They have lost someone close to them.
- The pain level associated with their medical condition is high.
- They have had previous unpleasant experiences in healthcare settings.
- They know other people who have become disabled or died as a result of their medical condition.
- They fear death or disability.
- There is a risk of suffering.
- Regression
Regression is a partial or complete return to immature and childlike patterns of behavior, including dependency on others and avoiding responsibilities. Individuals are more likely to experience regression that rises to the level of psychological factors affecting other medical conditions if they have a history of childhood trauma, particularly physical or emotional abuse or neglect.
Denial
Denial, as one of the coping styles, can be a dangerous psychological factor in a medical setting, as it may lead to not accepting care or following instructions. The risk of a client using denial as a coping mechanism increases for people who have a history of denying other life stressors (such as minimizing marital issues), people who have a difficult time being dependent on others, and people whose self-image is inconsistent with their medical diagnosis.
Treatments
The goal of treatment for psychological factors affecting other medical conditions is often to reduce the negative impact the psychological or behavioral factors are having on the medical prognosis. In some cases, this process can involve attempting to eliminate the factor entirely if it is problematic behavior, such as poor medication adherence, or it can focus more on mitigating the factor’s effects, such as developing coping mechanisms for addressing the presence of psychological conditions like depression or anxiety.
Therapy
Some individuals with psychological factors affecting other medical conditions may not understand that their emotions and behaviors are having a negative impact on the course of their medical treatment. Psychotherapy, in which clients develop an understanding of their thoughts and belief systems, may help them recognize these effects.
Cognitive-behavioral therapy (CBT) is another form of psychotherapy that can be effective in treating psychological factors affecting other medical conditions. Cognitive-behavioral therapy is based on the theory that a person’s thoughts and behaviors are connected. With an individual with psychological factors affecting other medical conditions, a therapist practicing CBT may guide them toward a more complete conception of the underlying causes of their behavior, as well as ways to adjust thought patterns about their medical condition.
If an individual is having a difficult time developing healthy coping mechanisms for living with their medical condition, group therapy with other people with the same or similar medical conditions can be beneficial.
Medication
No medication has been approved by the US Food and Drug Administration (FDA) to treat psychological factors affecting medical conditions, in part because the factors can be varied. However, there are some situations where pharmacological intervention via medications might be helpful.
Experiences of anxiety can have a direct physical effect on medical conditions like hypertension or asthma. Prescription anti-anxiety medication in these circumstances may be beneficial. Beta-blockers may lower blood pressure (many anxiety-exacerbated medical conditions are cardiovascular) and reduce anxiety symptoms simultaneously.
For individuals with depressive or dysthymic symptoms, thoughts of hopelessness may cause them to struggle to meaningfully engage in therapy. In these situations, a prescription antidepressant may be appropriate. Medication may also be used to treat the underlying medical condition.
Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.
Self-care
For some people with psychological factors affecting other medical conditions, the first step in self-care is developing an understanding and acknowledgment of their medical condition and the way their emotions and behaviors may be impacting their prognosis. This acceptance of medical disorders can be difficult, particularly for people who are using denial as a coping mechanism. In this situation, self-care can involve more education about one’s medical condition and any risks associated with not treating it properly.
For people seeking healthier coping strategies in addressing their emotions related to their medical condition or medical illness, self-care can be an effective and beneficial step forward. Ensuring one regularly gets enough sleep, eats a nutritious diet, and participates in an exercise or physical activity routine can significantly improve overall well-being.
Resources
Coping with psychological factors affecting other medical conditions can seem overwhelming. While any medical condition can precipitate a psychological factors affecting other medical conditions diagnosis, some people with psychological factors affecting other medical conditions are also experiencing serious medical concerns like diabetes or cancer. Living with a major medical diagnosis can take up one’s time and energy, and speaking to an in-person therapist may seem like yet another task on an ever-growing to-do list.
In these situations, online therapy through a platform like BetterHelp may be helpful. With a legitimate online therapy provider, individuals with psychological factors affecting other medical conditions can find a database with thousands of therapists with whom they can meet in the comfort and convenience of their homes.
Because of the varied experiences and manifestations of psychological factors affecting other medical conditions, few resources exist specifically to support those with the condition. However, there are a multitude of groups available for conditions that are commonly associated with psychological factors affecting other medical conditions. These groups include the American Diabetes Association’s Diabetes Self-Management Education and Support Network, the National Cancer Institute’s database of support services, and the American Chronic Pain Association’s support group list.
For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988. Please also see our Get Help Now page for more immediate resources.
For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).
For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.
Research
While several psychological factors may negatively impact medical conditions, factors related to symptoms of depression and anxiety can be among the most damaging. Depressive and anxious thoughts and behaviors are associated with significantly higher mortality rates in several chronic diseases, including renal disease, coronary artery disease, and cancer.
One study examined the effectiveness of cognitive-behavioral therapy on cancer patients who were experiencing symptoms of depression and anxiety. Individuals who completed a course of CBT reported both reduced depression and anxiety symptoms and overall improved treatment outcomes.
Developing psychological factors affecting other medical conditions in childhood can heighten the risk of more chronic and severe psychological factors affecting other medical conditions later in life. To this end, researchers studied the impact of cognitive-behavioral therapy treatment on depressive symptoms in adolescents and young adults who had been diagnosed with cancer. The study found that an online-delivered course of CBT treatment was effective in reducing symptoms of depression in this vulnerable population.
Statistics
Below are several statistics on psychological factors affecting other medical conditions:
- According to the DSM-V, while the exact prevalence of PFAOMC is not clear, it is currently understood to be more common than other somatic symptom disorders.
- In a global analysis of risk factors for worsening cardiovascular disease, symptoms of anxiety and distress were found to have similar impacts on disease progression as smoking, drinking alcohol, eating poorly, and not exercising.
- One study examined medication non-adherence in people with a history of heart attacks and found that excessive worrying about future medical conditions was associated with a higher likelihood of not complying with prescribed medication regimes.
- Group therapy for cancer patients experiencing depressive symptoms was found to not only reduce those symptoms but also reduce hostility, stress, and pain levels.