What Is… Ego-Syntonic & Ego-Dystonic

In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s terms are ego-syntonic and ego-dystonic.

The terms ego-syntonic and ego-dystonic come from the field of psychoanalysis, and they were coined by Sigmund Freud in 1914. Ego-syntonic ideas match up with the ego’s needs, view of the self, and personality. Ego-dystonic beliefs do not match up with personal values, feelings, and self-image. While the Freudian concept of ego hasn’t been empirically proven, syntonicity and dystonicity are still useful if we consider ego as simply the sense of self.

The Ego-Dystonicity Questionnaire, a measure used in research, considers four dimensions of ego-dystonicity:

• consistency with morals, beliefs, values, and attitudes
• consistency with preferences and past behaviour
• consistency with one’s sense of what is rational
• emotional reaction and resistance

OCD

Much of the research literature around ego-dystonicity relates to obsessive compulsive disorder (OCD). In OCD, the obsessions are generally ego-dystonic; they’re experienced as distressing, intrusive, and unwanted.

Contamination-focused OCD, for example, doesn’t arise from a natural desire for neatness or cleanliness, and the person with that form of OCD will often recognize that their obsessions and compulsions are not reasonable and not something they would choose if given the option.

This ego-dystonic element is very much missing from pop culture’s understanding of OCD. Some people might call me “a little OCD” because I’m very organized, but that’s a) ego-syntonic and b) non-disordered, and it has nothing whatsoever to do with OCD.

Personality disorders

Personality disorders, on the other hand, often involve ego-syntonic beliefs. Even if these beliefs and the behaviours that arise from them cause distress, they’re still seen as arising from the self. Ego-syntonic beliefs that fuel problematic behaviours can be quite challenging to treat, as the individual holding these beliefs often won’t see them as problematic or requiring intervention.

Obsessive compulsive personality disorder (OCPD) provides an interesting contrast to OCD, with OCPD typically being driven by ego-syntonic perfectionism and a desire for neatness and order. The preoccupation with those beliefs is such that an inordinate amount of time is spent on associated tasks, to the point that overall functioning is impaired. This ego-syntonic perfectionism is actually closer to what people are referring to when they talk about being “a little OCD”; however, OCPD (or any other personality) being ego-syntonic doesn’t make it any less a disorder.

While delusional (i.e. psychotic) grandiosity may be ego-syntonic or dystonic, grandiosity in narcissistic personality disorder tends to be ego-syntonic, and it’s viewed as desirable rather than a problem. Again, this can present treatment challenges as someone with the disorder is likely to be reluctant to change something that they see as fitting with who they are.

Addictions

Both substance and behavioural addictions often start out as being ego-syntonic, in the sense that the individual is actively choosing to seek out a pleasure response. Compare this to OCD, where compulsive behaviours don’t serve as a source of pleasure, but rather as a way of suppressing obsession-related distress. As addictions develop and progress, however, they become increasingly ego-dystonic. Instead of a desire for the target of addiction, consumption may be compulsive or fuelled by a desire to avoid withdrawal.

Eating disorders

Disordered eating in anorexia nervosa may relate to ego-syntonic beliefs around the need for control and a desire to be thin, which can translate into strong resistance to treatment. Resisting the pull of hunger may be framed as a sign of virtue. Over time, though, an ego-dystonic element may develop, with an intrusive and commanding inner voice driving the disordered eating behaviours.

Bulimia nervosa and binge eating disorder, on the other hand, are more likely to revolve around ego-dystonic beliefs.

Psychosis

Hallucinations may be experienced as ego-syntonic, i.e. part of the self, or as ego-dystonic, i.e. coming from an external source. Similarly, delusions may be ego-dystonic or ego-syntonic, and this may influence the relationships a person experiencing psychosis has with their beliefs.

Sex-related beliefs

A Google search for the term ego-dystonic yields a number of hits that relate to sexual orientation or sexual practices. These unwanted sexual thoughts and desires don’t fit with the individual’s conception of the self, and they cause feelings of shame.

A study published in Sexual Medicine looked at ego-dystonic masturbation, i.e. masturbation despite personal beliefs that it’s wrong, or perhaps sinful. The paper called 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 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, so-called conversion therapy is wrapped up in this nonsense too.

What about suicidal thoughts?

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 depressed version of the self. When I’ve had thoughts of suicide, they’re 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-syntonic or dystonic?

References

• Aspen, V., Darcy, A.M., & Lock, J. (2014). Patient resistance in eating disorders. Psychiatric Times, 31(9).
• Belloch, A., Roncero, M., & Perpiñá, C. (2012). Ego-syntonicity and ego-dystonicity associated with upsetting intrusive cognitions. Journal of Psychopathology and Behavioral Assessment, 34(1), 94-106.
• Castellini, G., Fanni, E., Corona, G., Maseroli, E., Ricca, V., & Maggi, M. (2016). Psychological, relational, and biological correlates of ego-dystonic masturbation in a clinical setting. Sexual Medicine, 4(3), e156-e165.
• el-Guebaly, N., Mudry, T., Zohar, J., Tavares, H., & Potenza, M. N. (2012). Compulsive features in behavioural addictions: The case of pathological gambling. Addiction, 107(10), 1726-1734.
• Markham, S. (2019). Community service models for personality disorder. Royal College of Psychiatry.
• Noordenbos, G., Aliakbari, N., & Campbell, R. (2014). The relationship among critical inner voices, low self-esteem, and self-criticism in eating disorders. Eating Disorders, 22(4), 337-351.
• Rosen, C., et al. (2015). Self, voices and embodiment: A phenomenological analysis. Journal of Schizophrenia Research, 2(1).
• Wikipedia