(Criterion B). These factors can adversely affe ct the medical condition by influencing its
course or treatment, by constituting an additi onal well-established health risk factor, or by
influencing the underlying pathophysiology to  precipitate or exac erbate symptoms or to
necessitate medical attention. 
Psychological or behavioral factors include ps ychological distress, patterns of interper-
sonal interaction, coping styles, and maladaptiv e health behaviors, such as denial of symp-
toms or poor adherence to medical reco mmendations. Common clin ical examples are
anxiety-exacerbating asthma, denial of need for treatment for acute chest pain, and manip-
ulation of insulin by an individual with diab etes wishing to lose weight. Many different
psychological factors have been demonstrated  to adversely influence medical conditions—
for example, symptoms of depression or anxi ety, 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 sympto ms (e.g., pain, fatigue, dizziness).