324 Somatic Symptom and Related Disorders
vidual with angina that is precipitated when ever he becomes enraged would be diagnosed
as having psychological factors affecting ot her medical conditions, whereas an individual
with angina who developed maladaptive anticipatory anxiety would be diagnosed as hav-
ing an adjustment disorder with anxiety. In clinical practice, however, psychological fac-
tors and a medical condition are often mutua lly exacerbating (e.g., anxiety as both a
precipitant and a consequence of angina), in which case the distinction is arbitrary. Other
mental disorders frequently result in medica l complications, most notably substance use
disorders (e.g., alcohol use disorder, tobacco use disorder). If an indi vidual has a coexisting
major mental disorder that adversely affects or causes another medical condition, diagno-
ses of the mental disorder and the medical co ndition are usually sufficient. Psychological
factors affecting other medical conditions is diagnosed when the psychological traits or
behaviors do not meet criteria for a mental diagnosis. 
Somatic symptom disorder. Somatic symptom disorder is characterized by a combina-
tion of distressing somatic symptoms and ex cessive or maladaptive thoughts, feelings,
and behavior in response to these symptoms or associated health co ncerns. The individual
may or may not have a diagnosable medical cond ition. In contrast, in psychological factors
affecting other medical conditions, the psycho logical factors advers ely affect a medical
condition; the individual’s th oughts, feelings, and behavior  are not necessarily excessive.
The difference is one of emphasis, rather than a clear-cut distinction. In psychological fac-
tors affecting other medical conditions, the emphasis is on the exacerbation of the medical
condition (e.g., an individual with angina th at is precipitated whenever he becomes anx-