Primary gain and secondary gain, and more rarely tertiary gain, are

terms Term may refer to: Language *Terminology, context-specific nouns or compound words **Technical term (or ''term of art''), used by specialists in a field ***Scientific terminology, used by scientists *Term (argumentation), part of an argument in d ...

used in

medicine Medicine is the science and Praxis (process), practice of caring for patients, managing the Medical diagnosis, diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, ...

and

psychology Psychology is the scientific study of mind and behavior. Its subject matter includes the behavior of humans and nonhumans, both consciousness, conscious and Unconscious mind, unconscious phenomena, and mental processes such as thoughts, feel ...

to describe the significant subconscious

psychological Psychology is the scientific study of mind and behavior. Its subject matter includes the behavior of humans and nonhumans, both consciousness, conscious and Unconscious mind, unconscious phenomena, and mental processes such as thoughts, feel ...

motivators patients may have when presenting with symptoms. 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 personal gain, relief from duty or work, avoiding arrest, receiving medication, or mitigating prison se ...

. 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 A disease is a particular abnormal condition that adversely affects the structure or function (biology), function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical condi ...

, but is most typically demonstrated in

conversion disorder Conversion disorder (CD) was a formerly diagnosed psychiatric disorder characterized by abnormal sensory experiences and movement problems during periods of high psychological stress. Individuals diagnosed with CD presented with highly distressin ...

— 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 Murder is the unlawful killing of another human without justification (jurisprudence), justification or valid excuse (legal), excuse committed with the necessary Intention (criminal law), intention as defined by the law in a specific jurisd ...

. 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 A military, also known collectively as armed forces, is a heavily armed, highly organized force primarily intended for warfare. Militaries are typically authorized and maintained by a sovereign state, with their members identifiable by a d ...

duty, obtain

financial Finance refers to monetary resources and to the study and Academic discipline, discipline of money, currency, assets and Liability (financial accounting), liabilities. As a subject of study, is a field of Business administration, Business Admin ...

compensation, obtain

drugs A drug is any chemical substance other than a nutrient or an essential dietary ingredient, which, when administered to a living organism, produces a biological effect. Consumption of drugs can be via inhalation, injection, smoking, ingestio ...

, avoid a

jail A prison, also known as a jail, gaol, penitentiary, detention center, correction center, correctional facility, or remand center, is a facility where people are imprisoned under the authority of the state, usually as punishment for various cr ...

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 cramps 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 the manipulation of someone into questioning their perception of reality. The term derives from the 1944 film ''Gaslight (1944 film), Gaslight'' and became popular in the mid-2010s. Some mental health experts have expressed c ...

wherein a person, such as a family member or

healthcare Health care, or healthcare, is the improvement or maintenance of health via the preventive healthcare, prevention, diagnosis, therapy, treatment, wikt:amelioration, amelioration or cure of disease, illness, injury, and other disability, physic ...

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 Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the ...

company runs

advertisements Advertising is the practice and techniques employed to bring attention to a product or service. Advertising aims to present a product or service in terms of utility, advantages, and qualities of interest to consumers. It is typically us ...

to convince viewers they have symptoms which require treatment with the company's drug.{{Citation needed, date=July 2021

References

Psychiatric diagnosis