What is Egosyntonic and Egodystonic?

Introduction

In psychoanalysis, egosyntonic refers to the behaviours, values, and feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one’s ideal self-image.

Egodystonic (or ego alien) is the opposite, referring to thoughts and behaviours (dreams, compulsions, desires, etc.) that are in conflict, or dissonant, with the needs and goals of the ego, or, further, in conflict with a person’s ideal self-image.

Applicability

Abnormal psychology has studied egosyntonic and egodystonic concepts in some detail. Many personality disorders are egosyntonic, which makes their treatment difficult as the patients may not perceive anything wrong and view their perceptions and behaviour as reasonable and appropriate. For example, a person with narcissistic personality disorder has an excessively positive self-regard and rejects suggestions that challenge this viewpoint. This corresponds to the general concept in psychiatry of poor insight. Anorexia nervosa, a difficult-to-treat (formerly considered an Axis I disorder before the release of the DSM 5) characterised by a distorted body image and fear of gaining weight, is also considered egosyntonic because many of its sufferers deny that they have a problem. Problem gambling, however, is only sometimes seen as egosyntonic, depending partly on the reactions of the individual involved and whether they know that their gambling is problematic.

An illustration of the differences between an egodystonic and egosyntonic mental disorder is in comparing obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder. OCD is considered to be egodystonic as the thoughts and compulsions experienced or expressed are not consistent with the individual’s self-perception, meaning the patient realises the obsessions are unreasonable and are often distressed by their obsessions. In contrast, obsessive-compulsive personality disorder is egosyntonic, as the patient generally perceives their obsession with orderliness, perfectionism, and control, as reasonable and even desirable.

Freudian Heritage

“Ego syntonic” was introduced as a term in 1914 by Freud in On Narcissism, and remained an important part of his conceptual armoury. Freud saw psychic conflict arising when “the original lagging instincts…come into conflict with the ego (or ego-syntonic instincts)”.

Otto Fenichel distinguished between morbid impulses, which he saw as ego-syntonic, and compulsive symptoms which struck their possessors as ego-alien. Anna Freud stressed how defences which were ego-syntonic were harder to expose than ego-dystonic impulses, because the former are familiar and taken for granted. Heinz Hartmann, and after him ego psychology, also made central use of the twin concepts.

Later psychoanalytic writers emphasised how direct expression of the repressed was ego-dystonic, and indirect expression more ego-syntonic.

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