The historical development of the concept of “secondary gain” is described in this article. Freud introduced this concept as a complement to “primary gain.” Freud modified the scope of both concepts during his career, but they remained within the boundary of an intrapsychological mechanism. Outside psychoanalysis, the concept of secondary gain has acquired further meaning with higher emphasis on interpersonal and social aspects. Consequently, it is often unclear what a writer or speaker means when he uses the term secondary gain. The different meanings of secondary gain in and outside psychoanalysis are illustrated with reference to literature and case reports.