How commonly are psychological factors affecting other medical conditions?
The term “psychological factors affecting other medical conditions” refers to the influence of psychological factors such as stress, emotions, thoughts, and behavior on a person’s physical health and the course or outcome of various medical conditions.
These psychological factors can either exacerbate or alleviate the symptoms and progression of medical conditions. For example:
- Stress and anxiety can worsen symptoms in conditions like irritable bowel syndrome or migraine headaches.
- Positive thinking and emotional support may aid in the recovery of a patient with a serious illness.
- Depression can impact the management and outcomes of conditions like diabetes or heart disease.
The prevalence of psychological factors that affect patients with medical conditions is unclear; however, it is believed to be higher than that of other somatic disorders.
Children are more likely to develop psychological symptoms with medical conditions that are chronic and severe. Adults may choose to ignore certain life-threatening symptoms, such as acute chest pain. This could stem from either their being in denial or due to comorbid depression.
It is important to differentiate between the presence of outside reasons for delayed treatment (such as financial issues, spiritual beliefs, employment status, relationships, and cultural differences) and the presence of a mental disorder.
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What is a psychosomatic illness?
Psychosomatic refers to a specific type of medical condition where physical symptoms are primarily caused or significantly influenced by psychological factors. In psychosomatic disorders, there is a strong connection between the individual’s mental state, emotions, and the development of physical symptoms. These symptoms are real and can be distressing, but they don’t have a purely physical cause. Examples of psychosomatic disorders include somatic symptom disorder and conversion disorder.
What is the difference between psychosomatic conditions and psychological factors affecting medical conditions?
“Psychological factors affecting other medical conditions” is a broader concept that encompasses the role of psychological factors in various medical conditions, whether they are primary or secondary to the condition. “Psychosomatic” is a term used specifically to describe medical conditions where psychological factors are the primary drivers of physical symptoms. While related, they are not synonymous.
What is psychosomatic pain?
Psychosomatic pain refers to physical pain or discomfort that is primarily or significantly influenced by psychological factors such as stress, anxiety, or emotional distress. In these cases, the pain is real and experienced by the individual, but it does not have a clear underlying physical cause.
During which stage of the stress response are psychosomatic responses most likely to occur?
Psychosomatic responses are most likely to occur during the “alarm” or “fight-or-flight” stage of the stress response. This initial stage is characterized by the body’s immediate physiological reactions to a perceived threat or stressor. During this stage, the body releases stress hormones like adrenaline, which can affect various bodily functions.
How to recognize psychological factors affecting other medical conditions
Patients should display a medical symptom or condition in addition to certain psychological or behavioral factors that are adversely affecting their medical condition for this diagnosis to be made.
Behaviors due to psychological reactions to a medical condition can constitute an additional health risk to the patient by potentially aggravating an existing medical condition. For instance, anxiety can aggravate a secondary condition such as asthma. Other examples could be an intentional delay in the presentation of a patient with acute coronary syndrome to the emergency department, or poor adherence to prescribed medications. A patient ignoring the symptoms of a heart attack, although he is aware of this condition, is an example of an extreme psychological factor that might affect a medical condition.
To confirm the presence of psychological factors that adversely affect a patient with an established medical condition, the DSM-5 criteria or the Diagnostic Criteria for Psychosomatic Research may be used. Although the DSM-5 criteria are stricter, they are more widely accepted by psychiatrists:
- The presence of a medical condition in the patient other than a mental condition has been established.
- The patient presents with psychological or behavioral factors that are clearly and adversely affecting his medical condition and can exacerbate illness, delay recovery, or interfere with treatment.
- The behavioral traits are not better explained as panic disorders, major depressive disorders, or other mental disorders.
When the presence of psychological factors affecting a medical condition in a patient is confirmed, it is important to note the severity of these factors; these factors can be classified as mild, moderate, severe, or extreme, based on the degree of risk posed by the particular behavior.
The most common psychological factors include abnormal coping styles, denial of symptoms, poor adherence to medical treatment, and maladaptive health behavior. Patients may stop medicating either because they are in denial, want to achieve other goals such as weight loss (a diabetic patient on insulin), or are having problems coping with an illness.
The effects of such psychological factors on the patient’s health may be immediate, subacute, or chronic. For instance, severe sadness and grieving might cause takotsubo cardiomyopathy. On the other hand, prolonged anxiety about a trivial medical condition might be associated with temporary weakening of the heart and an increased risk of hypertension. Certain psychological factors might be also associated with recurrent exacerbations of a medical condition. For instance, anxiety-induced asthma might be prominent in a child newly diagnosed with asthma.
Mental disorders due to medical conditions
It is important to differentiate between the mere presence of psychological factors in a patient with a medical condition and actually having a medical condition that is known to cause abnormal behavior and mental illness.
For instance, Cushing syndrome has been associated with psychosis (can also be triggered by strokes, migraines, CNS tumors, infections, and endocrine disorders.). Systemic lupus erythematosus can cause mild psychiatric abnormalities related to mood disorders or may cause psychosis.
Seizures as disorders should be excluded reliably as they can cause abnormal behavior that could be interpreted as psychogenic. Somatic symptom disorder should be also excluded in patients with medical conditions, as a study has found that patients recently diagnosed with myocardial infarctions are more likely to suffer from somatic symptom disorder compared to the general population.
Illness anxiety disorder is a condition that is characterized by severe anxiety that is distressing to the patient and causes significant impairment in daily function. The anxiety is about developing a certain medical condition that is not currently present.
Treatment and interventions
Patients should be counselled about how psychological factors might affect their condition. Cognitive behavioral therapy might be useful and the physician should aim to understand the underlying cause of the behavior and focus on changing the patient’s beliefs and ideas pertaining to their condition.
Medical treatment of anxiety in a patient with hypertension or asthma can be reasonable.
Patients who have difficulty coping with their illness should be offered group therapy. Upon meeting other people with similar conditions, they tend to better understand their own condition, which may help them cope better.