Primary gain and secondary gain, and more rarely tertiary gain, are
terms used in
medicine and
psychology to describe the significant subconscious
psychological motivators patients may have when presenting with symptoms. It is important to note that if these motivators are recognized by the patient, and especially if symptoms are fabricated or exaggerated for personal gain, then this is instead considered
malingering
Malingering is the fabrication, feigning, or exaggeration of physical or psychological symptoms designed to achieve a desired outcome, such as relief from duty or work.
Malingering is not a medical diagnosis, but may be recorded as a "focus of c ...
. The difference between primary and secondary gain is that with primary gain, the reason a person may not be able to go to work is because they are injured or ill, whereas with secondary gain, the reason that person is injured or ill is so that they cannot go to work.
Primary gain
Primary gain produces positive internal motivations. For example, a patient might feel guilty about being unable to perform some task. If a medical condition justifying an inability is present, it may lead to decreased psychological stress. Primary gain can be a component of any
disease, but is most typically demonstrated in
conversion disorder
Conversion disorder (CD), or functional neurologic symptom disorder, is a diagnostic category used in some psychiatric classification systems. It is sometimes applied to patients who present with neurological symptoms, such as numbness, blindness ...
— a psychiatric disorder in which stressors manifest themselves as physical symptoms without organic causes, such as a person who becomes
blind after seeing a
murder. The "gain" may not be particularly evident to an outside observer.
Secondary gain
Secondary gain can also be a component of any disease, but is an external motivator. If a patient's disease allows them to miss work, avoid
military duty, obtain
financial compensation, obtain
drugs, avoid a
jail
A prison, also known as a jail, gaol (dated, standard English, Australian, and historically in Canada), penitentiary (American English and Canadian English), detention center (or detention centre outside the US), correction center, correct ...
sentence, etc., these would be examples of a secondary gain. For instance, an individual having household chores completed by someone else because they have
stomach cramp
A cramp is a sudden, involuntary, painful skeletal muscle contraction or overshortening associated with electrical activity; while generally temporary and non-damaging, they can cause significant pain and a paralysis-like immobility of the af ...
s would be a secondary gain. In the context of a person with a significant psychiatric disability, this effect is sometimes called "secondary handicap".
Tertiary gain
Tertiary gain, a less well-studied process, is the benefit that a third-party receives from the patient's symptoms.
It includes
gaslighting
Gaslighting is a colloquialism, loosely defined as manipulating someone so as to make them question their own reality. The term derives from the title of the 1944 American film ''Gaslight'', which was based on the 1938 British theatre play '' Ga ...
wherein a person, such as a family member or
healthcare
Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health prof ...
worker for financial or other reasons, manipulates a patient into believing that they are ill. Tertiary gain can also be received when, for example, a
pharmaceutical company runs
advertisements
Advertising is the practice and techniques employed to bring attention to a product or service. Advertising aims to put a product or service in the spotlight in hopes of drawing it attention from consumers. It is typically used to promote a ...
to convince viewers they have symptoms which require treatment with the company's drug{{Citation needed, date=July 2021.
References
Psychiatric diagnosis