Primary and secondary gain

For other uses, see Gain (disambiguation).

Primary gain or secondary gain are used in medicine to describe the significant psychological motivators patients may have in reporting symptoms.

Primary gain produces positive internal motivations. For example, a patient might feel guilty about being unable to perform some task. If he has a medical condition justifying his inability, he might not feel so bad. Primary gain can be a component of any disease, but is most dramatically demonstrated in conversion disorder (a psychiatric disorder in which stressors manifest themselves as physical symptoms without organic causes, such as a person who becomes blindly inactive after seeing a murder). The "gain" may not be particularly evident to an outside observer.

Secondary gain can also be a component of any disease, but is an external motivator. If a patient's disease allows him/her to miss work, avoid military duty, obtain financial compensation, obtain drugs, or avoid a jail sentence, these would be examples of secondary gain. These may, but need not be, recognized by the patient. If he/she is deliberately exaggerating symptoms for personal gain, then he/she is malingering. However, secondary gain may simply be an unconscious psychological component of symptoms and other personalities. In the context of a person with a significant mental or psychiatric disability, this effect is sometimes called secondary handicap.

Tertiary gain, a less well-studied process, is when a third party such as a relative or friend is motivated to gain sympathy or other benefits from the illness of the victim.

References

• DSM-IV-TR