Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Primary gain
Introduction
Background
The reporting of symptoms by a patient may have significant psychological motivators. Psychologists sometimes categorize these motivators into primary or secondary gain.
Primary gain is internally good; motivationally. 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.
A less well studied process is tertiary gain: the extent to which the patient’s symptoms may become more pronounced to subconsciously please health care providers.
Source: DSM-IV-TR
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]