28.1 Introduction
Psychological factors affecting a medical condition (PFAMC) is a diagnostic category that recognizes the variety of ways in which specific psychological or behavioral factors can adversely affect medical illnesses. The diagnosis of PFAMC differs from most other psychiatric diagnoses in its focus on the interaction between the mental and medical realms.
The overall category of PFAMC includes situations in which psychological factors interfer with medical treatment, pose health risks, or cause stress-related pathophysiological changes. Such factors may contribute to the initiation or the exacerbation of the illness, interfere with treatment and rehabilitation, or contribute to morbidity and mortality. Psychological factors may themselves constitute risks for medical diseases, or they may magnify the effects of non-psychological risk factors. The effects may be mediated directly at a pathophysiologic level (e.g., stress inducing cardiac arrhythmias) or through the patient’s behavior (e.g., nonadherence with treatment).
The diagnosis is structured in DSM-IV-TR so that both the psychological factor and the general medical condition are to be specified. The psychological factor can be an Axis I or Axis II mental disorder (e.g., major depressive disorder aggravating coronary artery disease), a psychological symptom (e.g., anxiety exacerbating asthma), a personality trait or coping style (e.g., type A behavior contributing to the development of coronary artery disease), maladaptive health behaviors (e.g., unsafe sex in a person with HIV infection), a stress-related physiological response (e.g., tension headache), or other or unspecified psychological factors.
PFAMC requires that the patient have both a medical illness and contemporaneous psychological factors, because their coexistence does not always include significant interactions between them. To make the diagnosis of PFAMC, the factors must have either influenced the course of the medical condition, interfered with its treatment, contributed to health risks, or physiologically aggravated the medical condition. PFAMC has descriptive names for subcategories, described in Table 28.1.
Table 28.1 PFAMC subcategories.
| Subcategory | Comment |
| Mental disorder affecting a general medical condition | If the patient has a mental disorder meeting criteria for an Axis I or Axis II diagnosis, the diagnostic name is mental disorder affecting medical condition, with the particular medical condition specified |
| Psychological symptoms affecting a general medical condition | Patients who have psychological symptoms that do not meet the threshold for an Axis I diagnosis may still experience important effects on their medical illness, and the diagnosis would be psychological symptoms affecting a medical condition |
| Personality traits or coping style affecting a general medical condition | This may include personality traits or coping styles that do not meet criteria for an Axis II disorder and other patterns of response considered to be maladaptive because they may pose a risk for particular medical illnesses |
| Maladaptive health behaviors affecting a general medical condition | This refers to maladaptive health behaviors that have significant effects on the course and treatment of medical conditions |
| Stress-related physiologic response affecting a general medical condition | Used for cases in which stress is not the cause of the illness or symptoms; the patient has an underlying medical condition, and the stressor instead represents a precipitating or aggravating factor |
| Other or unspecified psychological factors affecting a general medical condition | Residual category referring to psychological phenomena that may not fit within one of the above subcategories, such as cultural or religious issues, family dysfunction, among others |
The close temporal association between psychiatric symptoms and a medical condition does not always reflect PFAMC. If the two are considered merely coincidental, then separate psychiatric and medical diagnoses should be made.
When a medical condition is judged to be pathophysiologically causing the mental disorder (e.g., hypothyroidism causing depression), the correct diagnosis is the appropriate mental disorder due to a general medical condition (e.g., mood disorder due to hypothyroidism, with depressive features). In PFAMC, the psychological or behavioral factors are judged to precipitate or aggravate the medical condition.
Substance use disorders may adversely affect many medical conditions, and this can be described through PFAMC. However, in some patients, all of the psychiatric and medical symptoms are direct consequences of substance abuse, and it is usually parsimonious to use just the substance use disorder diagnosis.
Patients with somatoform disorders (e.g., somatization disorder, hypochondriasis) present with physical complaints which may mimic a medical illness, but the somatic symptoms are actually accounted for by the psychiatric disorder.
Because this diagnosis describes a variety of possible interactions between the full range of psychiatric disorders as well as symptoms and behaviors, on the one hand, and the full range of medical diseases, on the other, it is impossible to estimate overall rates of prevalence or incidence.
Given the wide range of psychiatric disorders and psychological factors that may affect medical illness and the large number of different medical disorders that may be influenced, there are no general rules about the course of the PFAMC interaction. Psychological factors may have minor or major effects at a particular point or throughout the course of a medical illness.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
