Difficulty: Intermediate | Prerequisites: Stress and appraisal; coping and social support (PSY320 Exam 2, Parts 1 and 2)
This topic moves from internal stress processes to how people interact with the healthcare system. The central insight is that symptom recognition, interpretation, and the decision to seek care are all filtered through psychological processes. Understanding appraisal and coping from the earlier material is essential here, because the same person who appraises a stressor also appraises their own symptoms, and personality variables like neuroticism affect both.
Whether someone notices symptoms, how they interpret them, and whether they seek care are all heavily shaped by psychology. People hold commonsense models of illness that drive their health decisions. Many patients seeking care are depressed or anxious rather than physically ill, while others dangerously delay seeking treatment for serious symptoms.
Hypochondriasis (illness anxiety disorder)
A condition in which a person is convinced that normal bodily symptoms are indicators of serious illness. They are preoccupied with having or developing a disease and easily alarmed about their health. Estimated lifetime prevalence is 5 to 7%. In simple terms, a person with this condition reads ordinary body signals as danger signs.
Commonsense model of illness
The framework describing how people hold implicit, organised beliefs (illness representations or schemas) about their symptoms and illnesses, which in turn shape treatment decisions and adherence.
Illness representations
Organised sets of beliefs about an illness, including its nature, cause, duration, and consequences. These beliefs are formed through media, personal experience, and input from family and friends.
Lay referral network
The informal network of family and friends who help a person interpret and treat a disorder before they seek formal medical treatment. Think of it as the first filter between noticing a symptom and calling a doctor.
Delay behaviour
The act of delaying seeking treatment for recognised symptoms. Encompasses four subtypes.
Appraisal delay
Time between recognising that a symptom exists and deciding that it is serious.
Illness delay
Time between recognising that a symptom implies an illness and deciding to seek treatment.
Behavioural delay
Time between deciding to seek treatment and actually doing so.
Medical delay
Time between calling for an appointment and receiving appropriate medical care. More likely when a patient deviates from the typical profile for a given disease.
People with this condition interpret normal bodily symptoms as signs of serious illness. Common symptoms reported include back pain, joint pain, pain in extremities, headache, abdominal symptoms (bloating), food "allergies," and cardiovascular symptoms (palpitations).
Who is more affected:
Men are more likely to report these symptoms
Older people report more symptoms
People with low socioeconomic resources are at higher risk
People high in neuroticism recognise and report symptoms quickly, sometimes erroneously believing they have serious diseases
Several factors shape whether a person notices a symptom at all:
Social isolation: people who are isolated, have fewer distractions, keep house for a living, or live alone report more symptoms
Boredom: symptoms are more likely to be perceived on a boring day
Prior experience: interpretation of symptoms is shaped by what the person has experienced before
Expectations: people may ignore symptoms they do not expect
Body-part value: symptoms affecting highly valued parts of the body (heart, eyes) are interpreted as more serious than symptoms affecting less valued organs
People hold implicit, organised beliefs about their symptoms and illnesses. These beliefs form illness representations (schemas) that drive treatment decisions and adherence.
The seven components of an illness representation:
Identity: the label the person assigns to the illness
Causes: what the person believes gave rise to the illness
Consequences: the symptoms and outcomes the person expects
Timeline: how long the person expects the illness to last
Control/cure: whether the person believes the illness can be managed or cured through appropriate action
Emotional representations: how the person feels about the illness and its possible course and treatment
Coherence: how well these beliefs hang together in a consistent picture of the disorder
Conceptions of illness are gained through media, personal experience, and family and friends. These representations influence preventive health behaviours, reactions to diagnosis, adherence to treatment recommendations, expectations for future health, and actual health outcomes.
The very young and the elderly use health services most frequently
Young children develop many infectious childhood diseases as they build immunity and need paediatric care more often
Service use declines in adolescence and throughout young adulthood
Service use rises again in late adulthood as chronic conditions and age-related diseases emerge
Women use medical services more than men
Pregnancy and childbirth account for a significant portion of that difference
Women may have more sensitive homeostatic mechanisms (reporting pain earlier, detecting temperature changes and new smells faster)
Women also require visits to multiple specialists (GP, gynaecologist, mammography) that men do not, partly because the medical care system is not well structured for women's routine health needs
A large percentage of people who seek medical attention are depressed or anxious rather than physically ill.
Patients presenting with chest pain or cardiac symptoms are especially likely to have complicating anxiety or depressive disorders (an estimated 23% have mental health problems)
Anxiety can produce diarrhoea, upset stomach, sweaty hands, shortness of breath (sometimes mistaken for asthma), difficulty sleeping, poor concentration, and agitation
Depression can produce fatigue, difficulty performing everyday activities, listlessness, loss of appetite, and sleep disturbances
People can mistake mood disorder symptoms for physical illness and seek a physician's care
Psychologically-based complaints can lead to multiple visits, slow recovery, and prolonged hospital stays
People may use illness as a justification when they are psychologically burdened, and physicians may misdiagnose a psychological condition as physical
People should seek help immediately for lumps, chronic shortness of breath, blackouts, skin discolouration, radiating chest pain, seizures, and severe symptoms. Yet many delay.
The four types of delay:
Appraisal delay: time between noticing a symptom and deciding it is serious
Illness delay: time between recognising an illness and deciding to seek treatment
Behavioural delay: time between deciding to seek treatment and doing so
Medical delay: time between calling for an appointment and receiving care (more likely when the patient does not match the typical profile for the disease)
Students often think the commonsense model of illness has only a few components. There are seven: identity, causes, consequences, timeline, control/cure, emotional representations, and coherence.
Students sometimes assume delay behaviour is just laziness. It involves distinct stages (appraisal, illness, behavioural, medical), each with different causes.
Students may think hypochondriasis means a person is "making it up." The condition involves a real, distressing preoccupation with health, not fabrication.
Students sometimes forget that emotional disturbances (anxiety, depression) can produce physical symptoms that mimic organic illness.
Know all seven components of the commonsense model of illness and be able to define each.
Be able to distinguish the four types of delay behaviour.
Know the demographic patterns of health service use (age, gender) and the reasons behind them.
Understand how emotional disturbances (anxiety and depression) drive health service use and can be misdiagnosed as physical illness.
Know what hypochondriasis (illness anxiety disorder) is, its prevalence (5 to 7%), and who is most affected.
Understand the role of the lay referral network.
Fill in the blank: The seven components of illness representations are identity, causes, consequences, ______, control/cure, emotional representations, and ______. (Timeline, coherence.)
True or false: Medical delay is more likely when the patient fits the typical profile for a disease. (False: more likely when they deviate from the typical profile.)
Fill in the blank: An estimated ______% of patients presenting with cardiac symptoms have complicating mental health problems. (23%.)
True or false: Women use health services more than men solely because of pregnancy. (False: multiple factors, including more sensitive homeostatic mechanisms and the structure of the medical system.)
Q: Name the seven components of the commonsense model of illness.
A: Identity, causes, consequences, timeline, control/cure, emotional representations, and coherence.
Q: What are the four types of delay behaviour, and what does each measure?
A: Appraisal delay (symptom to deciding it is serious), illness delay (recognising illness to deciding to seek treatment), behavioural delay (deciding to seek treatment to doing so), and medical delay (calling for an appointment to receiving care).
Q: How can anxiety and depression lead to inappropriate use of health services?
A: Both conditions produce physical symptoms (diarrhoea, fatigue, shortness of breath, sleep disturbances) that can mimic organic illness. Patients and physicians may mistake these for physical disease, leading to unnecessary medical treatment, multiple visits, and prolonged hospital stays.
Q: What is the lay referral network, and how does it function?
A: An informal network of family and friends who help a person interpret symptoms and attempt treatment before the person seeks formal medical care. It acts as a filter between symptom recognition and professional consultation.
Q: What factors influence whether a person notices a symptom?
A: Personality and culture, focus of attention, distracting or involving activities, mood, salience of illness or symptoms, and individual differences in the tendency to monitor threats. Prior experience and expectations about symptom likelihood also shape interpretation.
This material connects back to stress appraisal (the same appraisal processes that determine stress also determine how people interpret symptoms) and to coping and social support (the lay referral network is a form of social support that shapes health behaviour). It feeds forward into patient-provider communication and adherence topics later in the course, and into discussions of chronic illness where delay behaviour and illness representations have direct consequences.
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