In this series, I dig a little deeper into the meaning of psychology-related terms.
This week’s term: ego dystonic & ego sytonic
The terms ego dystonic and ego syntonic come from the field of psychoanalysis, and were coined by Sigmund Freud in 1914. Ego syntonic ideas match up with the ego’s needs and view of the self. Ego dystonic beliefs do not match up with personal values and self-image.
In obsessive compulsive disorder (OCD), the obsessions are often ego dystonic. They are experienced as distressing and unwanted. A paper in The Psychiatric Quarterly described a very small study that found ego dystonic grandiose beliefs (i.e. wishing not to have the special identity/abilities that one delusionally believes they have) may be a warning sign for risk of dangerous behaviour directed at the self or possibly towards others.
Ego syntonic beliefs that fuel problematic behaviours can be challenging to treat. In obsessive compulsive personality disorder (OCPD), behaviours may be consistent with perfectionist beliefs. In narcissistic personality disorder, elements like grandiosity tend to be viewed as desirable.
In anorexia nervosa, disordered can be seen as compatible with ego syntonic beliefs around the need for control, which can translate into strong resistance to treatment. Bulimia nervosa and binge eating disorder are more likely to revolve around ego dystonic beliefs.
A Google search for the term ego-dystonic yields a number of hits related to ego-dystonic sexual orientation or sexual practices. These do not fit with the individual’s conception of the self, and cause feelings of guilt. A study published in Sexual Medicine looked at ego-dystonic masturbation, calling it “a clinically relevant cause of disability, given the high level of psychological distress reported by subjects with this condition and the severe impact on quality of life in interpersonal relationships.”
I also discovered a page on Conservapedia (yes, such a thing exists) devoted to ego-dystonic homosexuality. Regarding the American Psychiatric Association’s decision to do away with homosexuality as a mental disorder, it says “The APA made their 1973 decision, only after active, practicing homosexuals gained a majority in the APA through totalitarian zapping the shrinks method and took over the editorship of the DSM.” Um, okay then. Presumably this idea of ego-dystonic sexuality is what proponents of so-called conversion therapy latch onto.
It would be interesting to consider suicidal ideation in terms of being ego syntonic or dystonic. One factor would be whether you consider the ego to be the intact well ego, or if you consider the depression version of the self. When I’ve had thoughts of suicide, they are distressing but I don’t experience them as unwanted. They are highly compatible with my depressed self, but not compatible with my well self.
Do you have elements of your illness that you would consider ego dystonic or ego syntonic?
You can find the rest of my What Is series here.
Have you checked out my new book Making Sense of Psychiatric Diagnosis? It’s available on Amazon and other major ebook retailers. It’s also available on the Mental Health @ Home Store, along with my first book, Psych Meds Made Simple.