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Primary and secondary gain

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In medicine, the reporting of symptoms by a patient may have significant psychological motivators. Psychologists sometimes categorize these motivators into primary or secondary gain.

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, gains him/her sympathy, or avoids 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.[1]

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


Theoretical modelsEdit

Learning theoryEdit

PsychoanalysisEdit

See alsoEdit

ReferencesEdit

  1. Jones, Robert, Carmel Harrison, and Melany Ball. "Secondary Handicap & Learning Disability: A Component Analysis." Mental Health and Learning Disabilities Research and Practice, 2008, 5, 300-311.


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