Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-06T05:10:08.707Z Has data issue: false hasContentIssue false
  • English
  • Français

Secondary gain as hidden motive for getting psychiatric treatment

Published online by Cambridge University Press:  16 April 2020

Jacques Van Egmond ,
Ischa Kummeling  and
Ton aan Balkom
Jacques Van Egmond*
Affiliation:
Deventer Ziekenhuizen, Polikliniek Hanzepoort, Pikeursbaan 3, 7411 GT Deventer, The Netherlands
Ischa Kummeling
Affiliation:
Department of Epidemiology, Universiteit Maastricht, Maastricht, The Netherlands
Ton aan Balkom
Affiliation:
Department of Psychiatry, VU University Medical Center, The Netherlands
*
*Corresponding author. E-mail address: [email protected] (J. Van Egmond).
Get access

Abstract

Background

A high proportion (42.4%) of outpatients attending a psychiatric hospital appears to harbor expectations of secondary gain and hide this from their psychiatrists. This study investigated whether the prevalence of expectations of secondary gain could be replicated in a different sample, namely, a general hospital outpatient clinic attended by patients with less severe mental disorders, and whether patients hid these expectations from the psychiatrists they consulted.

Methods

The study was performed at a Dutch psychiatric outpatient department of a general hospital. In a prospective cohort, expectation of secondary gain was assessed by directly asking the patients via questionnaires whether they expected gaining specific ‘benefits’ from being in therapy.

Results

Of 99 patients, 41 (41.4%) expected secondary gain while being in therapy. In contrast, only nine patients (9.5%) told their diagnosing psychiatrist of these expectations.

Discussion

The present finding of a large proportion of patients expecting secondary gain is consistent with the results of an earlier study. Again, in most cases the diagnosing psychiatrists were unaware of their patients’ expectations. Thus many patients have hidden expectations of what therapy will do for them, in terms of material or non-material benefits other than getting better. Earlier empirical studies have shown that harboring expectations of benefits other than therapeutic benefits may be detrimental to therapeutic success.

Keywords

Secondary gainHidden motives
Type
Original article
Information
European Psychiatry , Volume 20 , Issue 5-6 , August 2005 , pp. 416 - 421
Copyright
Copyright ©Elsevier SAS 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abrahamson, JH, Abrahamson, ZHSurvey methods in community medicine. Epidemiologal research, program evaluation, clinical trials EdinburgChurchill Livingstone 1992Google Scholar
American Psychiatric Association Diagnostic and statistical manual of mental disorders 3rd edWashington, DCAPA 1980Google Scholar
American Psychiatric Association Diagnostic and statistical manual of mental disorders 4th edWashington, DCAPA 1994Google Scholar
Anderson, K.E.Psychogenic movement disorders. Curr. Treat. Options Neurol. 2003; 5: 169–176CrossRefGoogle ScholarPubMed
Barksy, A.J., Klerman, G.L.Overview: hypochondriasis, bodily complaints, and somatic styles. Am. J. Psychiatry 1983; 140: 273–283Google Scholar
Cassidy, J.D., Carroll, L.J., Cote, P., Lemstra, M., Bergland, A., Nygren, A.Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury. N. Engl. J. Med. 2001; 342: 179–186Google Scholar
Emsley, R.A., Seedat, S., Stein, D.J.Posttraumatic stress disorder and occupational disability in eight South African Security Force Members. J Nerv Ment Dis 2003; 191: 237–2419CrossRefGoogle Scholar
Van Egmond, J.Multiple meanings of secondary gain. Am. J. Psychoanal. 2003; 63: 135–145CrossRefGoogle ScholarPubMed
Van Egmond, J.Multiple meanings of secondary gain. Am. J. Psychoanal. 2003; 63: 135–145CrossRefGoogle ScholarPubMed
Van Egmond, J., Kummeling, I.A blind spot for secondary gain affecting therapy outcomes. Eur. Psychiatry 2002; 17: 46–54CrossRefGoogle ScholarPubMed
Fenichel, O.The psychoanalytic theory of neurosis New YorkW.W. Norton & Company 1972Google Scholar
Ferrari, R., Kwan, O., Friel, J.Cognitive theory and illness behavior in disability syndromes. Med. Hypotheses 57 2001 46–54 68–7517CrossRefGoogle ScholarPubMed
Ferrari, R., Kwan, O.The no-fault flavor of disability syndromes. Med. Hypotheses 2001; 56: 77–84CrossRefGoogle ScholarPubMed
Fisbain, D.A.Secondary gain concept. Definition problems and its abuse in medical practice. APS J. 1994; 3: 264–273Google Scholar
Freud, S.Introductory lectures on psychoanalysis. Standard ed., vol. 16, chapter 24 LondonHogarth Press 1963 91–358 1917Google Scholar
Gatchel, R.J., Gardea, M.A.Psychosocial issues: their importance in predicting disability, response to treatment, and search for compensation. Neurol. Clin. 1999; 17: 149–166CrossRefGoogle ScholarPubMed
Kwan, O., Friel, J.Clinical relevance of the sick role and secondary gain in the treatment of disability syndromes. Med. Hypotheses 2002; 59: 129–134CrossRefGoogle ScholarPubMed
Pearce, J.M.Psychosocial factors in chronic disability. Med. Sci. Monit. 2002; 8: 275–281Google ScholarPubMed
Schoen, M.Resistance to health: When the mind interferes with the desire to become well. Am. J. Clin. Hypn. 1993; 36: 47–54CrossRefGoogle ScholarPubMed
Shilling, C.Culture, the ‘sick role’ and the consumption of health. Br. J. Sociol. 2002; 53: 621–638CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.