Psychological Factors Affecting Other Medical Conditions 323
This diagnosis should be reserved for situations in which the effect of the psychological
factor on the medical condition is evident and the psychological factor has clinically sig-
nificant effects on the course or outcome of  the medical condition. Abnormal psychologi-
cal or behavioral symptoms that develop in  response to a medical condition are more
properly coded as an adjustme nt disorder (a clinically significant psychological response
to an identifiable stressor). Th ere must be reasonable eviden ce to suggest an association
between the psychological factors and the medical condition, although it may often not be
possible to demonstrate direct causality or  the mechanisms underlying the relationship.
Prevalence
The prevalence of psychological factors affect ing other medical conditions is unclear. In
U.S. private insurance billing data, it is a more common diagnosis than somatic symptom
disorders.
Development and Course
Psychological factors affecting other medical conditions can occur across the lifespan. Par-
ticularly with young children, corroborative history from parents or school can assist the di-
agnostic evaluation. Some conditions are characteri stic of particular life stages (e.g., in older
individuals, the stress associated with acting as a caregiver for an ill spouse or partner).
Culture-Related Diagnostic Issues
Many differences between cult ures may influence psychologi cal factors and their effects
on medical conditions, such as those in la nguage and communication style, explanatory
models of illness, patterns of seeking health care, service availability and organization,
doctor-patient relationships and other healing practices, family and gender roles, and at-
titudes toward pain and death. Psychologica l factors affecting other medical conditions
must be differentiated from culturally specific  behaviors such as using faith or spiritual
healers or other variations in illness manageme nt that are acceptable within a culture and