Psychological Factors Affecting Other Medical Conditions (PFAOMC/PFAMC)

Psychological Factors Affecting Other Medical Conditions (PFAOMC/PFAMC) is a mental disorder that is diagnosed when clinically significant psychological or behavioural factors adversely affects an individual's medical condition and increases their risk for suffering, death, or disability. These factors include psychological distress, patterns of interpersonal interaction, coping styles, and maladaptive health behaviours (e.g. - denial of symptoms or poor adherence to medical recommendations).

• The prevalence of PFAOMC is unclear but thought to be more common than most somatic symptom disorders.^[1]

• PFAOMC can occur across the lifespan.
• Depending on the underlying medical condition, the prognosis can vary significantly.
  • Certain conditions include immediate medical consequences (e.g. - myocardial infarction, Takotsubo cardiomyopathy) to chronic consequences that persist over a long period of time (e.g. - chronic occupational stress leading to increased risk for hypertension).^[2]
• A range of medical conditions can be affected, including those with clear pathophysiology (e.g. - diabetes, cancer, coronary disease), to functional syndromes (e.g. - migraine, irritable bowel syndrome, fibromyalgia), to idiopathic medical symptoms (e.g. - insomnia, pain, fatigue, dizziness).^[3]

• PFAOMC must be differentiated from culture-bound or specific behaviours (e.g. - faith or spiritual healers) used in illness management common in cultures. These cultural approaches represent an attempt to help the medical condition rather than to interfere with it.^[4]

• Certain psychological factors can adversely influence medical conditions, including the presence of depression or anxiety, stressful life events, differences in relationship styles, personality traits, and coping styles.^[5]

A medical symptom or condition (other than a mental disorder) is present.

Psychological or behavioural factors adversely affect the medical condition in 1 of the following ways:

1. The factors have influenced the course of the medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the medical condition.
2. The factors interfere with the treatment of the medical condition (e.g. - poor adherence).
3. The factors constitute additional well-established health risks for the individual.
4. The factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention.

The psychological and behavioural factors in Criterion B are not better explained by another mental disorder (e.g. - panic disorder, major depressive disorder, posttraumatic stress disorder).

• Common examples include: asthma exacerbated by anxiety, denial of need for treatment for acute chest pain, avoidance of using antihypertensives to treat hypertension,^[6] and manipulation of insulin in individuals with diabetes attempting lose weight.^[7]

If an individual has a co-existing mental disorder that adversely affects or causes another medical condition, the diagnoses of that pre-existing mental disorder and the medical condition are usually sufficient. PFAOMC should only be diagnosed when the psychological traits or behaviours do not meet criteria for a mental diagnosis.

• Mental disorder due to another medical condition
  • In a mental disorder due to another medical condition, the medical condition is judged by the clinician to be causing the mental disorder through a direct physiological mechanism. In contrast, in psychological factors affecting other medical conditions (PFAOMC), the psychological/behavioural factors are judged by the clinician to affect the course of the medical condition. The main difference is that causality is reversed in these two disorders.
• Adjustment disorder
  • Abnormal psychological or behavioural symptoms that develop in response to a medical condition should be diagnosed as an adjustment disorder (a clinically significant psychological response to an identifiable stressor). For example, an individual that develops angina whenever he becomes angry would be diagnosed as having PFAOMC. On the other hand, an individual with angina who then develops maladaptive, anticipatory anxiety would be diagnosed with adjustment disorder with anxiety. In real-life clinical practice, however, psychological factors and a medical condition are often mutually exacerbating in a bidirectional relationship (e.g. - anxiety can be both a precipitant and a consequence of angina). Other mental disorders can also cause medical complications, in particular substance use disorders (e.g. - tobacco and alcohol use disorder).
• Somatic symptom disorder (SSD)
  • Somatic symptom disorder is characterized by distressing somatic symptoms plus excessive or maladaptive thoughts, feelings, and behaviour in response to these symptoms. In SSD, there may or may not be a diagnosable medical condition. In contrast, in PFAOMC, it is the psychological factors that adversely affect a medical condition – this means the individual's thoughts, feelings, and behavior are not necessarily excessive. This means in PFAOMC, the emphasis is on the psychological factor exacerbating the medical condition (e.g. - an angry individual precipitating angina). In SSD, the emphasis is on maladaptive thoughts, feelings, and behaviours (e.g. - an individual with regular angina who worries non-stop that she will have a heart attack, takes her blood pressure multiple times per day, and restricts her activities).
• Illness anxiety disorder
  • Illness anxiety disorder is characterized by high illness anxiety but minimal somatic symptoms. The focus of clinical concern is the individual's own worry about having a disease, but in most cases, no serious disease is present. In PFAOMC, anxiety could be a relevant psychological factor affecting a medical condition, but the clinical concern is the adverse effects on the medical condition.

• Approaches include education about the illness and risks of not treating it properly, and teaching individuals about the effects of psychological factors or behaviours on their health.
• Psychotherapies such as cognitive behavioural therapy and motivational interviewing may also be helpful