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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.
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.
- 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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