Tertiary gain and disability syndromes

Since the introduction of the concept of tertiary gain by Dansak in 1973, there has been little further publication or research on this topic. Yet, tertiary gain is often the subject of debate amongst physicians, therapists, insurers, the media, and even at times the general public. Much of the controversy of disability syndromes and the health and economic burden they present has focused on secondary gain and illness behaviour. The role of tertiary gain in illness behaviour is likely also relevant, and a model of tertiary gain is needed to begin further understanding the implications of this phenomenon for patients and those who treat them. This article introduces a phraseology for tertiary gain, and models the effects of tertiary gain on illness behaviour and the interactions of secondary and tertiary gain in the setting of disability syndromes.