Secondary gains and losses in the medicolegal setting

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.