A 45-year-old man with type 2 diabetes acknowledges that his anxiety about injections makes him skip insulin doses several times a week. His HbA1c is 10.2 percent despite an appropriate prescription, and he has developed early retinopathy. He shows no distorted perception of his symptoms and no preoccupation with imagined disease. What is the most appropriate diagnosis?

• A Psychological factors affecting other medical conditions ✓
• B Somatic symptom disorder
• C Adjustment disorder with anxious mood
• D Illness anxiety disorder

Explanation

Psychological factors affecting other medical conditions applies when a psychological or behavioural factor, here injection-related anxiety causing non-adherence, adversely affects a known general medical condition, evidenced by the raised HbA1c and retinopathy. Unlike somatic symptom disorder there are no medically unexplained symptoms, and unlike illness anxiety disorder there is no fear of having an illness. The medical condition must be demonstrably worsened by the factor.

Reference: Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed.

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Written and medically reviewed by the StethoPrep medical team.