Secondary Gains and Losses in the Medicolegal Setting

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Freud first proposed the concept of secondary gain, which he described as “… interpersonal or social advantage attained by the patient as a consequence of … illness” (Freud, 1917). This is to be differentiated from primary gain, an intrapsychic phenomenon by which anxiety is reduced through an unconscious defensive operation resulting in symptoms of a physical illness. Blindness or limb paralysis for which a medical etiology cannot be demonstrated are examples of symptoms of illness mediated by primary gain. Ultimately, the psychiatric diagnosis of “hysteria,” a somatoform conversion disorder, may be made in these patients.