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The Role of Psychological Factors in Medical Presentations

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Abstract

Research shows that a large number of medical presentations do not result in a medical diagnosis but rather are related to behavioral health problems. Factors such as age, lower education and economic status, health beliefs, and medical and psychological factors are linked to high medical service utilization. Research consistently shows that patients with psychological problems use more services than those without diagnosable psychological problems. The purpose of this paper is to provide a more detailed analysis of the roles of psychological factors in medical presentations. We present three kinds of pathways by which psychological factors lead to medical presentations. These include the (1) primary or direct medical presentation of a clinical problem, (2) secondary presentation or the impact of the clinical problem on patients’ general physical, psychological, or psychosocial health, and (3) the complex presentation or the impact of multiple diagnoses on the presentation of the clinical problem. Examples of each of these pathways are presented for each axis of the DSM-IV.

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References

  • Acorn, S. (1993). Mental and physical health of homeless persons who use emergency shelters in Vancouver. Hospital and Community Psychiatry, 44(9), 854–857.

    Google Scholar 

  • American Diabetes Association. (2004). All about diabetes. Retrieved March 6, 2004, from http://www.diabetes.org/about-diabetes.jsp.

  • American Heart Association. (2004). Obesity and overweight. Retrieved March 6, 2004, from http://www.americanheart.org/ presenter.jhtml?identifier=4639.

  • American Obesity Association. (2004). AOA fact sheets. Retrieved March 6, 2004, from http://www.obesity.org/subs/ fastfacts/obesity_US.shtml.

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

  • Abela, J. R., Payne, V. L., & Moussaly, N. (2003). Cognitive vulnerability to depression in individuals with borderline personality disorder. Journal of Personality Disorders, 17(4), 319–329.

    Google Scholar 

  • Anderson, G. & Knickman, J. R. (1984). Patterns of expenditures among high utilizers of medical care services. Medical Care, 22, 143–149.

    Google Scholar 

  • Ash, A., Zhao, Y., Ellis, R. P., & Kramer, M. S. (2001). Finding future high-cost cases: Comparing prior cost versus diagnosis-based methods. Health Services Research, 36, 194–206.

    Google Scholar 

  • Balog, P., Janszky, I., Leineweber, C., Blom, M., Wamala, S. P., & Orth-Gomer, K. (2003). Depressive symptoms in relation to marital and work stress in women with and without coronary heart disease. The Stockholm female coronary risk study. Journal of Psychosomatic Research, 54(2), 113–119.

    Google Scholar 

  • Barrett, J. E., Williams, J. W., Oxman, T. E., Katon, W., Frank, E., Hegel, M. T., (1999). The treatment effectiveness project. a comparison of the effectiveness of paraxotine, problem-solving therapy, and placebo in the treatment of minor depression and dysthymia in primary care patients: background and research plan. General Hospital Psychiatry, 21, 260–273.

    Google Scholar 

  • Bateman, A., & Fonagy, P. (2003). Health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care. The American Journal of Psychiatry, 160(1), 169–171.

    Google Scholar 

  • Bell, D. (2002). Chronic complications of diabetes. The Southern Medical Journal, 95(1), 30–34.

    Google Scholar 

  • Bender, D. S., Dolan, R. T., Skodol, A. E., Sanislow, C. A., Dyck, I. R., McGlashan, T. H., (2001). Treatment utilization by patients with personality disorders. The American Journal of Psychiatry, 158(2), 295–302.

    Google Scholar 

  • Berkanovic, E., Telesky, C., & Reeder, S. (1981). Structural and social psychological factors in the decision to seek medical care for symptoms. Medical Care, 19, 693–709.

    Google Scholar 

  • Blom, M., Janszky, I., Balog, P., Orth-Gomer, K., & Wamala, S. P. (2003). Social relations in women with coronary heart disease: The effects of work and marital stress. Journal of Cardiovascular Risk, 10(3), 201–206.

    Google Scholar 

  • Borras, J. M. (1994). Utilization of health care services. Graceta Sanitaria, 8(40), 30–49.

    Google Scholar 

  • Borson, S., Barnes, R. A., Kukull, W. A., Okimoto, J. T., Veith, R. C., & Inui, T. S., (1986). Symptomatic depression in elderly medical outpatients: Prevalence demography, and health service utilization. Journal of the American Geriatrics Society, 34(5), 341–347.

    Google Scholar 

  • BPD Sanctuary. (2004). Borderline personality disorder. Retrieved March 4, 2004, from http://www.mhsanctuary.com/ borderline/bpd.htm.

  • Bromet, E. J., Dew, M. A., Parkinson, D. K., Cohen, S., & Schwartz, J. E. (1992). Effects of occupational stress on the physical and psychological health of women in a microelectronics plant. Social Science and Medicine, 34(12), 1377–1383.

    Google Scholar 

  • Bulpitt, C. J., Palmer, A. J., Battersby, C., & Fletcher, A. E. (1998). Association of symptoms of type 2 diabetics patients with severity of disease, obesity, and blood pressure. Diabetes Care, 21(1), 111–115.

    Google Scholar 

  • Caetano, R., Schafer, J., & Cunradi, C. B. (2001). Alcohol -related intimate partner violence among white, black, and Hispanic couples in the United States. Alcohol Research and Health, 25(1), 58–65.

    Google Scholar 

  • Cano, A., & O’Leary, K. D. (2000). Infidelity and separations precipitate major depressive episodes and symptoms of nonspecific depression and anxiety., Journal of Consulting and Clinical Psychology, 68(5), 774–781.

    Google Scholar 

  • Carrington, A. L., Mawdsley, S. K., Morley, M., Kincey, J., & Boulton, A. J. (1996). Psychological status of diabetic people with or without lower limb disability. Diabetes Research and Clinical Practice, 32(1–2), 19–25.

    Google Scholar 

  • Cherpitel, C. J. (1993). Alcohol and violence-related injuries: An emergency room study. Addiction, 88(1), 79–88.

    Google Scholar 

  • Ciechanowski, P. S., Katon, W. J., & Russo, J. E. (2000). Depression and diabetes: Impact of depressive symptoms on adherence, function, and costs. Archives of Internal Medicine, 160(21), 3278–3285.

    Google Scholar 

  • Clouse, R., Lustman, P. J., Freedland, K. E., Griffith, L. S., McGill, J. B., & Carney, R. M. (2003). Depression and coronary heart disease in women with diabetes. Psychosomatic Medicine, 65(3), 376–383.

    Google Scholar 

  • Coulehan, J. L., Zettler-Segal, M., Block, M., McClelland, M., & Schulberg, H. C. (1987). Recognition of alcoholism and substance abuse in primary care patients. Archives of Internal Medicine, 147, 349–352.

    Google Scholar 

  • Coyne, J. C., Thompson, R., Klinkman, M. S., & Nease, D. E., Jr. (2002). Emotional disorders in primary care. Journal of Consulting and Clinical Psychology, 70, 798–809.

    Google Scholar 

  • Cummings, N. A., Cummings, J. L., & Johnson, J. N. (1997). Behavioral health in primary care: A guide for clinical integration. Connecticut: Psychosocial Press.

    Google Scholar 

  • Cummings, N. A. (1997). Behavioral health in primary care: Dollars and sense. In N. A. Cummings, J. L. Cummings, & J. N. Johnson (Eds.), Behavioral health in primary are: A guide for clinical integration (pp. 3–31). Connecticut: Psychosocial Press.

    Google Scholar 

  • De Sonnaville, J. J., Colly, L. P., Wijkel, D., & Heine, R. J. (1997). The prevalence and determinants of foot ulcerations in type II diabetic patients in a primary health care setting. Diabetes Research and Clinical Practice, 35(2–3), 149–156.

    Google Scholar 

  • Desai, H. D., & Jann, M. W. (2000). Major depression in women: A review of the literature. Journal of American Pharmaceutical Association, 40(4), 525–537.

    Google Scholar 

  • DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patients adherence. Archives of Internal Medicine, 160, 2101–2107.

    Google Scholar 

  • Doghramji, K., & Fredman, S. (1999). Clinical frontiers in the sleep/psychiatry interface. Medscape (from WebMD). Retrieved October 26, 2003, from http://www.medscape.com/ viewarticle/423662_1.

  • Dong, C., Sanchez, L. E., & Price, R. A. (2004). Relationship of obesity to depression: a family based study. International Journal of Obesity and Related Metabolic Disorders, 28(6), 190–195.

    Google Scholar 

  • Friedman, R. A. (2003, September 9). When the mind tortures the body with illnesses unseen. The New York Times, p. D5.

  • Friedman, R., Sobel, D., Myers, P., Caudill, M., & Benson, H. (1995). Behavioral medicine, clinical health psychology, and cost offset. Health Psychology, 14, 509–518.

    Google Scholar 

  • Frumkin, H., Williamson, M., Magid, D., Holmes, J. H., & Grisso, J. A. (1995). Occupational injuries in a poor inner-city population. Journal of Occupational and Environmental Medicine, 37(12), 1374–1382.

    Google Scholar 

  • Garis, R. I., & Farmer, K. (2002). Examining costs of chronic conditions in a medicaid population. Managed Care, 11, 43–50.

    Google Scholar 

  • Gerber, P. D., Barrett, J. E., Barrett, J. A., Oxman, T. E., Manheimer, E., Smith, R., (1992). The relationship of presenting physical complaints to depressive symptoms in primary care patients. Journal of General Internal Medicine, 7, 170–173.

    Google Scholar 

  • Goodwin, R., Olfson, M., Feder, A., Fuentes, M., Pilowsky, D. J., & Weissman, M. M. (2001). Panic and suicidal ideation in primary care. Depression and Anxiety, 14, 244–246.

    Google Scholar 

  • Gross, R., Olfson, M., Gameroff, M., Shea, S., Feder, A. Fuentes, M., (2002). Borderline personality disorder in primary care. Archives of Internal Medicine, 162(1), 53–60.

    Google Scholar 

  • Hays, J. C., Krishnan, K. R., George, L. K., & Blazer, D. G. (1998). Age of first onset of bipolar disorder: Demographic, family history, and psychosocial correlates. Depression and Anxiety, 7(2), 76–82.

    Google Scholar 

  • Herpertz, S., Johann, B., Lichtblau, K., Stadtbaumer, M., Kocnar, M., Kramer-Paust, R., (2000). Patients with diabetes mellitus: Psychosocial stress and the use of psychosocial support: a multicenter study. Medizinische Klinik, 95(7), 369–377.

    Google Scholar 

  • Hodgson, T. A., & Cohen, A. J. (1999). Medical care expenditures for diabetes, its chronic complications, and its comorbidities. Preventive Medicine, 29, 173–186.

    Google Scholar 

  • Hueston, W. J., Mainous, A. G., & Schilling, R. (1996). Patients with personality disorders: Functional status, health care utilization, and satisfaction with care. The Journal of Family Practice, 42, 54–60.

    Google Scholar 

  • Iacovidas, A., Fountoulakis, K. N., Kaprinis, S. t., & Kaprinis, G. (2002). The relationship between job stress, burnout and clinical depression. Journal of Affective Disorders, 75, 209–221.

    Google Scholar 

  • Jain, R., & Russ, N. (2003, March 21). Addressing both the emotional and physical symptoms in depression. Medscape. Retrieved March 18, 2004, from http://www.medscape.com/ viewprogram/2240_pnt.

  • Katon, W. J. (1986). Panic disorder: Epidemiology, diagnosis, and treatment in primary care. The Journal of Clinical Psychiatry, 47(suppl 21–30), 21–30.

    Google Scholar 

  • Kushel, M. B., Vittinghoff, E., & Haas, J. S. (2001). Factors associated with the health care utilization of homeless persons. Journal of the American Medical Association, 285(2), 200–206.

    Google Scholar 

  • Ko, G. T., Chan, W. B., Chan, J. C., Tsang, L. W., & Cockram, C. S. (1999). Gastrointestinal symptoms in Chinese patients with type 2 diabetes mellitus. Diabetic Medicine, 16(8), 670–674.

    Google Scholar 

  • Liptzin, B., Regier, D. A., & Goldberg, I. D. (1980). Utilization of health and mental health services in a large insured population. American Journal of Psychiatry, 137, 553–558.

    Google Scholar 

  • Lundy, J. W. (1999). The burden of comorbidity among the homeless at a drop-in clinic. Official Journal of the American Academy of Physician Assistants, 12(4), 32–34.

    Google Scholar 

  • Lydiard, R. B., & Brawman-Mintzer, O. (1998). Anxious depression. The Journal of Clinical Psychiatry, 59(suppl 18), 10–17.

    Google Scholar 

  • Marin, R., Coca, A., Tranche, S., Rodriguez, M. L., Abellan, J., & Moya, A. (2002). Prevalence of renal involvement in a population of type II diabetics followed up in primary care. Nefrologia, 22(2), 152–161.

    Google Scholar 

  • Mauksch, L. B., Tucker, S. M., Katon, W. J., Russo, J., Cameron, J., Walker, E., (2001). Mental illness, functional impairment, and patient preference for collaborative care in an uninsured, primary care population.Journal of Family Practice, 50(1), 41–47.

    Google Scholar 

  • McGill, J. B., Lustman, P. J., Griffith, L. S., Freedland, K. E., Gavard, J. A., & Clouse, R. E. (1992). Relationship of depression to compliance with self-monitoring of blood glucose. Diabetes, 41, A84.

    Google Scholar 

  • Melamed, S., Ugarten, U., Shirom, A., Kahana, L., Lerman, Y., & Froom, P. (1999). Chronic burnout, somatic arousal and elevated salivary cortisol levels. Journal of Psychosomatic Research, 46(6), 591–598.

    Google Scholar 

  • Moriya, N., Miyake, Y., Minakawa, K., Ikuta, N., & Nishizono-Maher, A. (1993). Diagnosis and clinical features of borderline personality disorder in the east and west: A preliminary report. Comprehensive Psychiatry, 34(6), 418–423.

    Google Scholar 

  • Myrick, H., & Brady, K. (2003). Editorial review: current review of the comorbidity of affective, anxiety, and substance use disorders. Current Opinion in Psychiatry, 16(3), 261–270.

    Google Scholar 

  • National Institute of Mental Health (2001). The numbers count: Mental disorders in America (NIMH Publication No. 01-4584). Retrieved March 3, 2004, from http://www.nimh.nih.gov/ publicat/numbers.cfm.

  • Neu, A., Willasch, A., Ehehalt, S., Hub, R., & Ranke, M. B. (2003). Ketoacidosis at onset of type 1 diabetes mellitus in children: frequency and clinical presentation. Pediatric Diabetes, 4(2), 77–81.

    Google Scholar 

  • O’Donohue, W., & Cucciare, M. A. (2004). Pathways to medical utilization. Manuscript submitted for publication.

  • O’Farrell, T. J., Choquette, K. A., Cutter, H. S., & Birchler, G. R. (1997). Sexual satisfaction and dysfunction in marriages of male alcoholics: Comparison with nonalcoholic maritally conflicted and nonconflicted couples. Journal of Studies on Alcohol, 58(1), 91–99.

    Google Scholar 

  • Olfson, M., Marcus, S. C., Druss, B., Elinson, L., Tanielian, T., & Pincus, H. A. (2002). National trends in the outpatient treatment of depression. Journal of the American Medical Association, 287(2), 203–209.

    Google Scholar 

  • Palmer, N. B., Salcedo, J., Miller, A. L., Winiarski, M., & Arno, P. (2003). Psychiatric and social barriers to HIV medication adherence in a triply diagnosed methadone populations. AIDS Patient Care and STDS, 17(12), 635–644.

    Google Scholar 

  • Ragnarson-Tennvall, G., & Apelqvist, J. (2000). Health -related quality of life in patients with diabetes mellitus and foot ulcers. Journal of Diabetes and its Complications, 14(5), 235–241.

    Google Scholar 

  • Regier, D. A., Narrow, W. E., Rae, D. S., Manderscheid, R. W., Locke, B. Z., & Goodwin, F. K. (1993). The de facto US mental and addictive disorder service system: epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry, 50, 85–94.

    Google Scholar 

  • Reidenberg, M. M., & Lowenthal, D. T. (1968). Adverse nondrug reactions. New England Journal of Medicine, 279, 678–679.

    Google Scholar 

  • Roy-Byrne, P. P., Stein, M. B., Russo, J., Mercier, E., Thomas, R., McQuaid, J., (1999). Panic disorder in the primary care setting: Comorbidity, disability, service utilization, and treatment. The Journal of Clinical Psychiatry, 60(7), 492–499.

    Google Scholar 

  • Salas, M., Bubolz, T., & Caro, J. J. (2000). Impact of physical functioning of health status on hospitalizations, physician visits, and costs in diabetic patients. Archives of Medical Research, 31, 223–227.

    Google Scholar 

  • Sansone, R. A., & Sansone, L. A. (1995). Borderline personality disorder: interpersonal and behavioral problems that sabotage treatment success. Postgraduate Medicine, 97(6), 169–171.

    Google Scholar 

  • Sansone, R. A., Sansone, L. A., & Wiederman, M. W. (1996). Borderline personality disorder and health care utilization in a primary care setting. Southern Medical Journal, 89, 1162–1165.

    Google Scholar 

  • Sansone, R. A., Weidermann, M. W., & Monteith, D. (2001). Obesity, borderline personality symptomology, and body image among women in a psychiatric outpatient setting. The International Journal of Eating Disorders, 29(1), 76–79.

    Google Scholar 

  • Sansone, R. A., Weiderman, M. W., & Sansone, L. A. (1998). Borderline personality symptomology, experience of multiple types of trauma, and health care utilization among women in a primary care setting. The Journal of Clinical Psychiatry, 59(3), 108–111.

    Google Scholar 

  • Sansone, R. A., Weiderman, M. W., Sansone, L. A., & Monteith, D. (2000). Patterns of self-harm behavior among women with borderline personality symptomology: Psychiatric versus primary care samples. General Hospital Psychiatry, 22, 174–178.

    Google Scholar 

  • Saper, J. R., & Lake, A. E. (2002). Borderline personality disorder and the chronic headache patient: Review and management recommendations. Headache, 42(7), 663–674.

    Google Scholar 

  • Schmid, H., Ter Bogt, T., Godeau, E., Hublet, A., Dias, S. F., & Fotiou, A. (2003). Drunkenness among young people: A cross-national comparison. Journal of Studies on Alcohol, 64(5), 650–661.

    Google Scholar 

  • Simon, G. E., Revicki, D., Heiligenstein, J., Grothaus, L., VonKorff, M., Katon, W. J., (2000). Recovery from depression, work productivity, and health care costs among primary care patients . General Hospital Psychiatry, 22, 153–162.

    Google Scholar 

  • Simon, G. E., VonKorff, M., Piccinelli, M., Fullerton, C., & Ormel, J. (1999). An international study of the relation between somatic symptoms and depression. New England Journal of Medicine, 341(18), 1329–1335.

    Google Scholar 

  • Simpson, C. R., Helms, P. J., Taylor, M. W., & Baxter-Jones, A. D. (2000). Respiratory morbidity in primary care: A population based study, using practices from the Scottish continuous morbidity recording research database. Health Bulletin (Edinb), 58(6), 489–496.

    Google Scholar 

  • Springhouse Corporation’s pathophysiology made incredibly easy. (1998). Springhouse, PA: Springhouse Corporation.

  • Stratigos, A. J., Stern, R., Gonzalez, E., Johnson, R. A., O’Connell, J., & Dover, J. S. (1999). Prevalence of skin disease in a cohort of shelter-based homeless men. Journal of the American Academy of Dermatology, 41, 197–202.

    Google Scholar 

  • Substance Abuse and Mental Health Services Administration. (2002). Overview of findings from the 2002 national survey on drug use and health. Retrieved March 6, 2003, from http://www.samhsa.gov/oas/nhsda/2k2nsduh/Overview/ 2k2Overview.htm#chap8.

  • Testa, M., & Leonard, K. E. (2001). The impact of marital aggression on women’s psychological and marital functioning in a newlywed sample. Journal of Family Violence, 16(2), 115–130.

    Google Scholar 

  • Thomas, J., Jones, G., Scarinci, I., & Brantley, P. (2003). A Descriptive and comparative study of the prevalence of depressive and anxiety disorders in low-income adults with type 2 diabetes and other chronic illnesses. Diabetes Care, 26, 2311–2317.

    Google Scholar 

  • Travassos, C., Viacava, F., Pinheiro, R., & Brito, A. (2002). Utilization of health care services in Brazil: gender, family characteristics, and social status. Pan American Journal of Public Health, 11(5–6), 365–373.

    Google Scholar 

  • Van der Does, F. E., De Neeling, J. N., Snoek, F. J., Kostense, P. J., Grootenhuis, P. A., Bouter, L. M., & Heine, R. J. (1996). Symptoms and well-being in relation to glycemic control in type II diabetics. Diabetes Care, 19(3), 204–210.

    Google Scholar 

  • WebMDHealth. (2004). Your guide to diabetes. Retrieved March 15, 2004, from http://my.webmd.com/content/ article/45/1667_50910#5.

  • Weinreb, L., Goldberg, R., Bassuk, E., & Perloff, J. (1998). Determinants of health and service use patterns in homeless and low-income housed children. Pediatrics, 102, 554–5562.

    Google Scholar 

  • Whittemore, R., Melkus, G. D., & Grey, M. (2004). Self -report of depressed mood and depression in women with type 2 diabetes. Issues in Mental Health Nursing, 25(3), 243–260.

    Google Scholar 

  • Wu, L. R., Parkerson, G. R. Jr., & Doraiswamy, P. M. (2002). Health perception, pain, and disability as correlates of anxiety and depression symptoms in primary care patients. The Journal of the American Board of Family Practice, 15(3), 183–190.

    Google Scholar 

  • Younis, N., Broadbent, D. M., Harding, S. P., & Vora, J. R. (2002). Prevalence of diabetic eye disease in patients entering a systematic primary care-based eye screening programme. Diabetic Medicine, 19(12), 1014–1021.

    Google Scholar 

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  1. Department of Psychology/296, University of Nevada, Reno, 89557, Nevada

    William O’Donohue & Michael A. Cucciare

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O’Donohue, W., Cucciare, M.A. The Role of Psychological Factors in Medical Presentations. J Clin Psychol Med Settings 12, 13–24 (2005). https://doi.org/10.1007/s10880-005-0908-x

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