Describe what psychologists have discovered about misusing health services.

Mark scheme

Marking points from the official mark scheme (Feb/Mar 2020). The mark or mark type is shown in brackets.

1. [7-8] (a) Level 4 (7-8 marks): Description is accurate, coherent and detailed and use of psychological terminology is accurate and comprehensive. The answer demonstrates excellent understanding of the material and the answer is competently organised.
2. [5-6] (a) Level 3 (5-6 marks): Description is mainly accurate, reasonably coherent and reasonably detailed and use of psychological terminology is accurate but may not be comprehensive. The answer demonstrates good understanding of the material and the answer has some organisation.
3. [3-4] (a) Level 2 (3-4 marks): Description is sometimes accurate and coherent but lacks detail and use of psychological terminology is adequate. The answer demonstrates reasonable (sufficient) understanding but is lacking in organisation.
4. [1-2] (a) Level 1 (1-2 marks): Description is largely inaccurate, lacks both detail and coherence and the use of psychological terminology is limited. The answer demonstrates limited understanding of the material and there is little, if any, organisation.
5. [0] (a) Level 0 (0 marks): No response worthy of credit.
6. [8] (a) Misusing health services, including the following: Delay in seeking treatment (Safer, 1979); Misuse: hypochondriasis (Barlow and Durand, 1995); Munchausen syndrome (Aleem and Ajarim, 1995).
7. [8] (a) Delay in seeking treatment (Safer, 1979): There are three stages to this delay: appraisal, illness and utilisation. A variety of factors predict the length of the delay for each of the three stages. These include beliefs about symptoms and consequences of these symptoms, physical experiences of the illness and strategies used by the patient to resolve their own ailments. For example a patient who has an old illness and believes there are possible severe consequences of the illness may delay seeking treatment.
8. [8] (a) Misuse: hypochondriasis (Barlow and Durand, 1995): According to DSM-IV-TR, the central feature of hypochondriasis is the preoccupation with fears of having a serious medical illness based on misinterpretations of benign (or minor) bodily sensations. Barlow and Durand – The patient experiences physical sensations in a distorted way, often take a 'better safe than sorry' approach with their symptoms. There is evidence the condition may be a genetic component. Stressful life events, especially those involving exposure to death or serious illness may be a precipitating factor in the onset of the disease. Many also experience significant family illnesses during childhood. Assuming the 'sick role' may also be reinforced during childhood.
9. [8] (a) Munchausen syndrome (Aleem and Ajarim, 1995): Munchausen syndrome is a psychological disorder where someone pretends to be ill or deliberately produces symptoms of illness in themselves. Aleem and Ajarim report a case study of a 22 year old woman with Munchausen syndrome who reported with swelling on her body. She had been seen on numerous occasions in the hospital since she was 17 and given various treatments. Suspicions were raised by the hospital when it was felt that the ailments she had did not appear to have a physical cause. Upon admittance to the psychiatric ward the nursing staff eventually found a needle with faecal material in it. The patient left the hospital when confronted after becoming very angry and did not return again. Other appropriate responses should also be credited.
10. [9-10] (b) Level 4 (9-10 marks): Evaluation is comprehensive and the range of issues covered is highly relevant to the question. The answer demonstrates evidence of careful planning, organisation and selection of material. There is effective use of appropriate supporting examples which are explicitly related to the question. Analysis (valid conclusions that effectively summarise issues and arguments) is evident throughout. The answer demonstrates an excellent understanding of the material.
11. [7-8] (b) Level 3 (7-8 marks): Evaluation is good. There is a range of evaluative issues. There is good organisation of evaluative issues (rather than 'study by study'). There is good use of supporting examples which are related to the question. Analysis is often evident. The answer demonstrates a good understanding of the material.
12. [4-6] (b) Level 2 (4-6 marks): Evaluation is mostly accurate but limited. Range of issues (which may or may not include the named issue) is limited. The answer may only hint at issues but there is little organisation or clarity. Supporting examples may not be entirely relevant to the question. Analysis is limited. The answer lacks detail and demonstrates a limited understanding of the material.
13. [1-3] (b) Level 1 (1-3 marks): Evaluation is basic and the range of issues included is sparse. There is little organisation and little, if any, use of supporting examples. Analysis is limited or absent. The answer demonstrates little understanding of the material.
14. [0] (b) Level 0 (0 marks): No response worthy of credit.
15. [10] (b) A range of issues could be used for evaluation here. These include: Named issue – practical applications of theories about misuse of health service and various conditions. Can use Safer et al.'s findings to identify potential patients who might delay seeking treatment and target these type of patients with advertising via leaflets/letters/advertising to ensure that these patients do not delay seeking treatment. Helpful to practitioners as gives detailed symptoms of these disorders so that they can be spotted. Can also argue that the researchers do not give a treatment for the disorders and are therefore less useful e.g. Aleem and Ajarim - just state the patient left with no treatment put in place).
16. [10] (b) Other issues: Generalisability; Usefulness (application of psychology to everyday life); Evaluation of method for studies on delay in seeking treatment (interview) and Munchausen syndrome (case study); Reliability/validity of diagnosis of hypochondriasis and Munchausen syndrome; Reductionism; Determinism. Other appropriate responses should also be credited.