SAFER ET AL (1979) devised a model on why patients delay treatment:

1. Appraisal delay – the time taken for a person to interpret a physical symptom as a  potential indicator of illness. This is affected by immediate sensory information.
2. Illness delay – the time taken between people recognizing that they are ill and  actually seeking some form of medical assistance. This is affected by  familiarity. 
3. Utilization delay – the time taken between deciding to seek medical attention and actually doing so. This is affected by cost, how severe the pain is and whether medication will cure the illness.

For more detailed information – Safer et al (1979)

Misuse: Hypochondriasis

Described by Sarafino (2006) as:

“The tendency of individuals  to worry excessively about their own health, monitor their bodily sensations closely, make frequent unfounded medical complaints, and believe they are ill despite reassurances by physicians that they are not.”

Fallon (2010) suggested there are three types of hypochondriasis:

1. The obsessive-anxious type – when people worry that they are ill despite the reassurances from doctors.
2. The depressive type – when people think they are dying and think it is worthless to do tests or refuse to go to the doctor.
3. The somatoform type – when people assume the worst when they are experiencing certain symptoms.

BARLOW AND DURAND (1995) researched a 21-year-old, who would think the worst whenever minor symptoms were experienced e.g. an headache would be associated to a brain tumor.

It was found out that the more common features showed when having this disorder are:

• The fear of aging and death
• Presenting medical records in great detail.
• Being especially concerned with one organ system.

The possible causes of the disorder could not be determined clearly but the factors below may play a role in developing it:

• Serious illness in childhood
• Past diseases in family members
• Psychological stressors
• Being highly sensitive to physical pain

Munchausen syndrome

The syndrome was named after Karl Van Munchausen, a German officer in the 18th century. It is a mental disorder in which a person repeatedly and deliberately acts as if they  have a physical or mental illness when they are not really sick to draw attention, sympathy or reassurance.

Turner and Reid (2002) found three main features of the mental illness:

1. Simulated illness – artificial symptoms draw upon one’s self.
2. Pseudologia fantastica – pathological lying of health conditions and identities.
3. Peregrination – constantly changing hospital or health care centers when discovered by previous doctors.

Munchausen syndrome by proxy – a condition where a caregiver or spouse fabricates, exaggerates, or induces mental or physical health problems in those who are in their care, with the primary motive of gaining attention or sympathy from others.

Criddle (2010) found out there are three levels of this condition:

1. Mild – fabrication of symptoms
2. Moderate – tampering evidence of illness
3. Severe – Induction of symptoms to cause an illness

ALEEM AND AJARIM (1995) was a case study on a 22-year-old female university student with Munchausen syndrome. She went to the hospital for painful swellings, but after a round of treatment, an abscess on her left breast was found.

One day, a nurse found needles and a syringe full of faecal matter under her bed after being tipped off by a patient, who shared a room with her. When she found out, the patient got angry, left the clinic and never returned.

Strengths:

• Cross-cultural study – most cases of the syndrome have been discovered in North  America and Western Europe since the societies are more educated and have easy access to hospitals. However, one case was reported from Saudi Arabia.
• Ecological validity – since it was a case study with a real patient, the evidence found is reliable since it could have not been affected by demand characteristics or social desirability.

Weaknesses:

• Case study – since the research was a case study, the evidence found is not generalizable or applicable to the general population due to individual differences.
• Ethical issues – the nurse was informed by another patient, therefore privacy/confidentiality was broken.