Psychological factors affecting a medical condition: ischemic coronary heart disease

The criteria for scientific validation of the entities currently subsumed u nder the DSM-IV category of "Psychological Factors Affecting a Medical Cond ition" have never been clearly enumerated. Historically, its precursor cate gory ("Psychophysiological Disorder") was rarely used, and predicated upon clinical observation of personality styles among patients with specific phy sical illnesses, or clinical observations relating psychosocial events and symptom exacerbation. Because of logical flaws with either of these methods , clarification of the most rigorous criteria for demonstrating a cause-eff ect relationship is necessary. With the increase in well-designed and caref ully executed epidemiological and treatment studies, this diagnostic catego ry has evolved into an arena where cutting edge insights and therapies are becoming available for a growing variety of medical conditions, especially ischemic coronary heart disease. The present article reviews the nature of the scientific evidence necessary to accept an etiological or aggravating r ole for psychological events. (C) 2000 Elsevier Science Inc. All rights res erved.