What is the Difference Between Ego Syntonic and Ego Dystonic?

Where does our understanding of the ego come from? Freud, the founding father of psychology, believed that much of what ails us mentally was located in the unconscious aspects of the mind and that the way we were raised by our parents and carers created “conflicts” there. He also believed that we went through stages of mental development from birth to adult life and if we got “stuck” in any one of these stages it could cause mental illness.

He believed that children got stuck in a developmental stage because of trauma for example; mum or dad being taken into hospital could cause severe anxiety which would be repressed. Now, while this of itself seems logical, Freud claimed that the trauma would be locked into the unconscious and cause anxiety, phobia, neuroses and depression later in life without the sufferer being aware of the cause. The job of the therapist was therefore to unlock these hidden traumas and help the individual recover.

Freud stated that the human mind termed, psyche (and co-incidentally where the word psychology comes from) is divided into three parts, the id, the ego and the super ego. While we tend to use these terms loosely in our everyday language such as “she’s got a big ego”, Freud had very precise ideas about what they meant. The “id” is the part of the psyche concerned with the thoughtless and immediate gratification of drives such as eating, sex, anger and this part of the psyche developed first as we can see in very young children, they are only interested in having their own needs met , for example a hungry baby will cry. The “super ego” is like the conscience our inner voice which acts as a morality check e.g. “I shouldn’t enjoy this cake when there are people in the world who are starving”. Having the id or the super ego in charge of your personality is not a good idea at all. One would generate a thoughtless and perhaps dangerously out of control person, the other a someone so wracked by moral pain that they wouldn’t be able to eat, sleep or do anything. This is where the ego comes in. The “ego” is the balancing force in a mature personality. A strong ego takes into account drives such as hunger, sex in decision making and also morality or conscience. In this state decisions are good and the person is happy. If the ego is weak however, a person may become mentally ill. The ego is the last part of the psyche to mature and it is really analogous to the self-concept or how we see ourselves.

The ego and its relationship to our mind is crucial for good mental health. In treating mental illness there is a further consideration. Is our mental illness who we think we really are? For example, a psychopath like the fictional Dr Hannibal Lecter, may not realise or accept that there is anything wrong with their behaviour at all, whereas Hamlet is wracked by guilt and knows he is mentally unstable. There are two terms used to describe these differing states: ego syntonic and ego dystonic.

What is ego syntonic?

Ego syntonic means to be in a state which is consistent with one’s self concept. “Syn” is used in a lot of words and means “to be the same”. Being is a syntonic ego state is a good thing provided that the self-concept reflects reality. For example, to believe that you are moderately intelligent, have a good sense of humour and slow to anger is a good thing, if that is what you are. To choose to eat another’s liver with fava beans and washed down with Chianti, is not. But both of these states are ego syntonic.

Ego syntonic disorders are more difficult to treat because they are in tune with the self-concept. One of the most commonly recognised ego syntonic disorders is the eating disorder, anorexia nervosa. The term anorexia nervosa literally means a nervous loss of appetite, but it is so much more than that. A person with anorexia nervosa sees themselves differently. They suffer from a condition known as “body dysmorphia”. When they look in a mirror they see themselves as fat even if they weigh next to nothing. They develop elaborate routines to avoid eating and other mental gymnastics to avoid challenges to their view of the world as one former sufferer recounted:

I was about 16 and someone had called me fat at school. I became determined to lose some weight. I started hiding my food and throwing it away. Avoiding meals at school was easy and I increased the amount of exercise I did to burn calories. I worked in a chemist shop so bough laxatives at discount prices and just flushed food away, if you get my drift. Soon I was around 6 stones and I felt great and I thought I looked marvellous. At the same time I went from being bottom of the class to being top and passed my A levels with terrific grades with my newly found will power. I loved this new, successful, attractive me. Everyone who loved me and cared for me though, was tearing their hair out with worry. I just couldn’t see it at the time, I thought they were jealous. It is only now, years and years later I look at pictures of myself and realise how lucky I am not to have ended my life like Karen Carpenter”

Ego syntonic disorders are notoriously difficult to treat because the disordered thinking is in harmony with the ego state so the person cannot see the need for change and indeed might be hostile to it. Many personality disorders are considered to be ego syntonic including some, though not all cases of borderline personality disorder. Therapists would suggest that people with personality disorders that are also ego syntonic lack insight.

What is Ego dystonic?

Ego dystonic means to be suffering from a mental health issue which is inconsistent with one’s self concept or ego state. The syllable “dys” is generally part of words which means disconnected or not well matched as in the term used above “dysmorphia” which means wrong shape. A person suffering from an ego dystonic state knows there is something wrong and can feel the conflict within their mind which their behaviours, thought and feelings are causing them.

The most commonly quoted example of an ego dystonic condition is obsessive compulsive disorder (OCD). People with OCD are aware that their behaviours are abnormal and to have to respond to their compulsions causes them pain and distress. As Jack Nicholson’s brilliantly observed characterisation of Melvin Udall in “As Good As It Gets”, people with OCD really suffer and they know it. From the hoarding of one-time-only-use bars of soap (because of germs) , the bringing of his own disposable cutlery to a smart restaurant, not being able to step on the cracks in the pavement to the more expected multiple checks of the door lock, Melvin suffers. He is alone and unhappy, by the end there is progress through love, but then this is Hollywood so what other outcome would you expect?

Because ego dystonic conditions cause mental pain they are much easier to treat, after all, most people want to feel healthy and good about themselves and free from pain. In cognitive behavioural therapy (CBT) which is recommended for the treatment of ego dystonic disorders, the therapist helps the client challenge their unhelpful thoughts feelings and behaviours and develop a more rational self-concept. Freud himself suggested that the correct approach was to try to strengthen a healthy ego syntonic state as a control mechanism and “inner voice” to manage unwanted thoughts.

References:

  1. Ronald J. Comer: Abnormal Psychology 3rd Edition, Freeman Press, 1998
  2. American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) 2013 and 4th Edition 1994 (ISBN: 9780890425558)
  3. Stacy Kuhl-Wochner : Pure Obsessional OCD — Symptoms and TreatmentSocial Work TodayVol. 12 No. 4 P. 22

 

 

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