Owners can distinguish between behavioral litter box avoidance and medical issues by observing their cat's overall behavior and health. Behavioral causes often correlate with changes in the cat's environment, such as a dirty litter box, poor placement, or stress from multiple cats. Medical issues, on the other hand, may present additional symptoms like frequent urination, straining, blood in the urine, or general signs of illness such as lethargy and loss of appetite. If a medical issue is suspected, a prompt veterinary examination is crucial to diagnose and treat any underlying conditions.