Most involved in patient care are familiar with secondary gain. It occurs when a patient’s symptoms are maintained because of the impact of attention, affection, remuneration, access to medication and other incentives.
Sometimes the patient is aware of these sources of secondary gain, but often they lack insight that it is occurring and need to be shown the ways in which they are gaining from their health problems.
Primary gain is quite different:
It occurs when physical complaints solve an internal conflict for the individual. For example, the patient may have a fear or aversion to something at work (or at home), and their symptoms prevent them from having to be exposed to it.
These may range avoiding intimate contact with their spouse to avoiding work tasks over which they are phobic (heights, closed spaces, etc).
For some patients, there are elements of both primary and secondary gain occurring at the same time.
In a recent case, a patient with a minor injury was able to use his injury to:
a. manipulate his girlfriend into marrying him (secondary gain),
b. avoid a physical relationship with her (primary gain),
c. gain access to narcotics (secondary gain) and
d. avoid competing in the workforce (primary gain).