A Comprehensive View of Secondary Gain in PTSD, Phobias, Physical or Emotional Pain
This is a 5 minute “Deep Dive Podcast on secondary gain:
Secondary gain refers to the hidden benefits a person may receive from holding onto symptoms or a condition. When someone with a DSM-diagnosed symptom doesn’t respond to interventions that are effective for others, it may indicate that unconscious secondary gains are interfering with their progress.
- Comprehensive View of Secondary Gain in PTSD, Phobias, Physical or Emotional Pain: secondary gain refers to the indirect benefits a person may receive from maintaining symptoms or a condition. In the case of someone with DSM symptoms who does not respond to psychological interventions that typically work for others, possible secondary gains could include:
- Avoidance of Overwhelm or Responsibility:
PTSD symptoms can serve as a shield, protecting the person from engaging in overwhelming environments (e.g., work, relationships, decision-making), which they may not feel emotionally equipped to handle. - Increased Attention, Care, or Protection:
The person may receive ongoing support, validation, or special treatment due to their condition, reinforcing the role of “wounded” or “fragile” which becomes hard to relinquish. - Preservation of Identity or Moral Narrative:
The trauma and its effects may become central to how the person sees themselves. Healing might feel like erasing or invalidating the depth of their suffering—or the suffering of others involved in the trauma. - Control and Emotional Distance:
Symptoms can serve to keep others at bay, protect against intimacy, or maintain emotional safety by discouraging closeness that feels threatening or undeserved. - Spiritual or Moral Self-Punishment:
The person may believe they deserve to suffer due to guilt, shame, or perceived moral failure related to the trauma. In this view, their symptoms are a form of penance or justice. - Perceived Divine Punishment:
Some may view their suffering as the will of God or a spiritual consequence for wrongdoing. Improvement would feel like rebellion against divine justice or a refusal to accept deserved judgment. - Concrete Rewards (Financial/Legal):
In some cases, staying symptomatic may sustain access to disability benefits or legal advantages. While not necessarily conscious or manipulative, this can create internal conflict around healing.
Why This Matters in Treatment
Importantly, secondary gain is often unconscious—it’s not manipulation or deceit. It reflects complex internal dynamics where the symptom serves a protective psychological or social function. In therapy, addressing this often involves gently exploring what the symptom does for the person – not just what it does to them.
If no secondary gain is present, it may signal that a different therapeutic approach is needed to support healing.
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- Avoidance of Overwhelm or Responsibility: