Primary gain and secondary gain, and more rarely tertiary gain, are terms used in

medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pr ...

and

psychology Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries between ...

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

, 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, blindnes ...

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

duty, obtain financial compensation, obtain drugs, avoid a jail 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 aff ...

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 '' G ...

wherein a person, such as a family member or healthcare 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 A medication (also called medicament, medicine, pharmaceutical drug, 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 medical field an ...

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