Secondary gains and losses in the medicolegal setting

Abstract

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. © 2005 Springer-Verlag US.