Egosyntonicity

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In psychoanalysis, egosyntonic behaviors, values, and feelings 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 [1] ) behaviors are the opposite, referring to thoughts and behaviors (dreams, compulsions, desires, etc.) that are conflicting or dissonant with the needs and goals of the ego, or further, in conflict with a person's ideal self-image.

Contents

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 behavior as reasonable and appropriate. [2] 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 disorder (formerly considered an Axis I disorder before the release of the DSM-5) characterized 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. [3] 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. [4] [5]

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 thoughts are unwanted, distressing, and reflect the opposite of their values, desires, and self-construct. 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. [6] [7]

Freudian heritage

The words "egosyntonic" and "egodystonic" originated as early-1920s translations of the German words "ichgerecht" and "nicht ichgerecht", "ichfremd", or "ichwidrig", [8] which were introduced in 1914 by Freud in his book On Narcissism [9] and remained an important part of his conceptual inventory. [10] Freud applied these words to the relationship between a person's "instincts" and their "ego." Freud saw psychic conflict arising when "the original lagging instincts ... come into conflict with the ego (or ego-syntonic instincts)". [11] According to him, "ego-dystonic" sexual instincts were bound to be "repressed." [8] Anna Freud stated that psychological "defences" which were "ego-syntonic" were harder to expose than ego-dystonic impulses, because the former are 'familiar' and taken for granted. [12] Later psychoanalytic writers emphasised how direct expression of the repressed was ego-dystonic, and indirect expression more ego-syntonic. [13]

Otto Fenichel distinguished between morbid impulses, which he saw as ego-syntonic, and compulsive symptoms which struck their possessors as ego-alien. [14] Heinz Hartmann, and after him ego psychology, also made central use of the twin concepts. [9]

See also

Related Research Articles

Psychoanalysis is a therapeutic method and field of research developed by Sigmund Freud. Founded in the early 1890s, initially in co-operation with Josef Breuer and others' clinical research, he continued to refine and develop theory and practice of psychoanalysis until his death in 1939. It conceptualizes the human psyche as consisting of three primary instances: the id, the ego, and the superego, which interact to satisfy the instinctive needs. Creation and transmission of civilisation serves this biological processes of self-preservation and reproduction.

Neurosis is a term mainly used today by followers of Freudian thinking to describe mental disorders caused by past anxiety, often that has been repressed. In recent history, the term has been used to refer to anxiety-related conditions more generally.

Psychology is an academic and applied discipline involving the scientific study of human mental functions and behavior. Occasionally, in addition or opposition to employing the scientific method, it also relies on symbolic interpretation and critical analysis, although these traditions have tended to be less pronounced than in other social sciences, such as sociology. Psychologists study phenomena such as perception, cognition, emotion, personality, behavior, and interpersonal relationships. Some, especially depth psychologists, also study the unconscious mind.

<span class="mw-page-title-main">Obsessive–compulsive personality disorder</span> Personality disorder involving orderliness

Obsessive–compulsive personality disorder (OCPD) is a cluster C personality disorder marked by a spectrum of obsessions with rules, lists, schedules, and order, among other things. Symptoms are usually present by the time a person reaches adulthood, and are visible in a variety of situations. The cause of OCPD is thought to involve a combination of genetic and environmental factors, namely problems with attachment.

<span class="mw-page-title-main">Kleptomania</span> Inability to resist the urge to steal

Kleptomania is the inability to resist the urge to steal items, usually for reasons other than personal use or financial gain. First described in 1816, kleptomania is classified in psychiatry as an impulse control disorder. Some of the main characteristics of the disorder suggest that kleptomania could be an obsessive-compulsive spectrum disorder, but also share similarities with addictive and mood disorders.

Anal retentiveness is a personality trait that is characterized by excessive concern with details. The concept originated in Freudian psychoanalytic theory, where one aspect of the anal stage of psychosexual development is pleasure in the retention of feces. Fixation in this stage can potentially result in a personality marked by frugality, obstinacy and orderliness. Despite its psychoanalytic roots and the literal meaning of the words, in common usage the term generally refers merely to certain kinds of obsessive behaviour.

Ego psychology is a school of psychoanalysis rooted in Sigmund Freud's structural id-ego-superego model of the mind.

Repetition compulsion is the unconscious tendency of a person to repeat a traumatic event or its circumstances. This may take the form of symbolically or literally re-enacting the event, or putting oneself in situations where the event is likely to occur again. Repetition compulsion can also take the form of dreams in which memories and feelings of what happened are repeated, and in cases of psychosis, may even be hallucinated.

<span class="mw-page-title-main">Intrusive thought</span> Unwelcome involuntary thought, image or idea

An intrusive thought is an unwelcome, involuntary thought, image, or unpleasant idea that may become an obsession, is upsetting or distressing, and can feel difficult to manage or eliminate. When such thoughts are paired with obsessive–compulsive disorder (OCD), Tourette syndrome (TS), depression, body dysmorphic disorder (BDD), and sometimes attention deficit hyperactivity disorder (ADHD), the thoughts may become paralyzing, anxiety-provoking, or persistent. Intrusive thoughts may also be associated with episodic memory, unwanted worries or memories from OCD, post-traumatic stress disorder (PTSD), other anxiety disorders, eating disorders, or psychosis. Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, and generally have aggressive, sexual, or blasphemous themes.

The Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) is a test to rate the severity of obsessive–compulsive disorder (OCD) symptoms.

In psychoanalysis, resistance is the individual's efforts to prevent repressed drives, feelings or thoughts from being integrated into conscious awareness.

The obsessive–compulsive spectrum is a model of medical classification where various psychiatric, neurological and/or medical conditions are described as existing on a spectrum of conditions related to obsessive–compulsive disorder (OCD). "The disorders are thought to lie on a spectrum from impulsive to compulsive where impulsivity is said to persist due to deficits in the ability to inhibit repetitive behavior with known negative consequences, while compulsivity persists as a consequence of deficits in recognizing completion of tasks." OCD is a mental disorder characterized by obsessions and/or compulsions. An obsession is defined as "a recurring thought, image, or urge that the individual cannot control". Compulsion can be described as a "ritualistic behavior that the person feels compelled to perform". The model suggests that many conditions overlap with OCD in symptomatic profile, demographics, family history, neurobiology, comorbidity, clinical course and response to various pharmacotherapies. Conditions described as being on the spectrum are sometimes referred to as obsessive–compulsive spectrum disorders.

Sexual obsessions are persistent and unrelenting thoughts about sexual activity. In the context of obsessive-compulsive disorder (OCD), these are extremely common, and can become extremely debilitating, making the person ashamed of the symptoms and reluctant to seek help. A preoccupation with sexual matters, however, does not only occur as a symptom of OCD, they may be enjoyable in other contexts.

<span class="mw-page-title-main">Compulsive behavior</span> Habit and impulse disorder

Compulsive behavior is defined as performing an action persistently and repetitively. Compulsive behaviors could be an attempt to make obsessions go away. Compulsive behaviors are a need to reduce apprehension caused by internal feelings a person wants to abstain from or control. A major cause of compulsive behavior is said to be obsessive–compulsive disorder (OCD). "Compulsive behavior is when someone keeps doing the same action because they feel like they have to, even though they know these actions do not align with their goals." There are many different types of compulsive behaviors including shopping, hoarding, eating, gambling, trichotillomania and picking skin, itching, checking, counting, washing, sex, and more. Also, there are cultural examples of compulsive behavior.

Primarily obsessional obsessive–compulsive disorder, also known as purely obsessional obsessive–compulsive disorder, is a lesser-known form or manifestation of OCD. It is not a diagnosis in the DSM-5. For people with primarily obsessional OCD, there are fewer observable compulsions, compared to those commonly seen with the typical form of OCD. While ritualizing and neutralizing behaviors do take place, they are mostly cognitive in nature, involving mental avoidance and excessive rumination. Primarily obsessional OCD takes the form of intrusive thoughts often of a distressing, sexual, or violent nature.

<span class="mw-page-title-main">Obsessive–compulsive disorder</span> Mental and behavioral disorder

Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and feels the need to perform certain routines (compulsions) repeatedly to relieve the distress caused by the obsession, to the extent where it impairs general function.

<span class="mw-page-title-main">Jonathan Abramowitz</span> American clinical psychologist

Jonathan Stuart Abramowitz is an American clinical psychologist and Professor in the Department of Psychology and Neuroscience at the University of North Carolina at Chapel Hill (UNC-CH). He is an expert on obsessive-compulsive disorder (OCD) and anxiety disorders whose work is highly cited. He maintains a research lab and currently serves as the Director of the UNC-CH Clinical Psychology PhD Program. Abramowitz approaches the understanding and treatment of psychological problems from a cognitive-behavioral perspective.

The Dimensional Obsessive-Compulsive Scale (DOCS) is a 20-item self-report instrument that assesses the severity of Obsessive-Compulsive Disorder (OCD) symptoms along four empirically supported theme-based dimensions: (a) contamination, (b) responsibility for harm and mistakes, (c) incompleteness/symmetry, and (d) unacceptable (taboo) thoughts. The scale was developed in 2010 by a team of experts on OCD led by Jonathan Abramowitz, PhD to improve upon existing OCD measures and advance the assessment and understanding of OCD. The DOCS contains four subscales that have been shown to have good reliability, validity, diagnostic sensitivity, and sensitivity to treatment effects in a variety of settings cross-culturally and in different languages. As such, the DOCS meets the needs of clinicians and researchers who wish to measure current OCD symptoms or assess changes in symptoms over time.

Inference-based therapy (IBT), also known as inference-based cognitive behavioral therapy (I-CBT), originated as a form of cognitive therapy developed for treating obsessive-compulsive disorder. IBT followed the observation that people with OCD often inferred danger on the basis of inverse inference. Later the model was extended to inferential confusion, where inverse inference leads to distrust of the senses and investment in remote possibility. In this model, individuals with obsessive-compulsive disorder are hypothesized to put a greater emphasis on an imagined possibility than on what can be perceived with the senses, and to confuse the imagined possibility with reality. According to inference-based therapy, obsessional thinking occurs when the person replaces reality and real probabilities with imagined possibilities; the obsession is hypothesized to concern a doubt about a possible state of affairs.

Inferential confusion is a meta-cognitive state of confusion that becomes pathological when an individual fails to interpret reality correctly and considers an obsessional belief or subjective reality as an actual probability. It causes an individual to mistrust their senses and rely on self-created narratives ignoring evidence and the objectivity of events. These self-created narratives come from memories, information, and associations that aren't related- therefore, it deals with the fictional nature of obsessions. It causes the individual to overestimate the threat.

References

  1. ↑ Howard Rosenthal, Human Services Dictionary (2003) p. 102
  2. ↑ Williams, Donna (2008-11-24). The Jumbled Jigsaw: An Insider's Approach to the Treatment of Autistic Spectrum 'Fruit Salads'. Jessica Kingsley. ISBN   978-1-84310-281-6.
  3. ↑ E. Hollander, Obsessive-Compulsive Spectrum Disorders (2010) p. 44
  4. ↑ Jon Halliday/Peter Fuller eds., The Psychology of Gambling (London 1974) p. 236 and p. 31
  5. ↑ E. Hollander, Obsessive-Compulsive Spectrum Disorders (2010) p. 92
  6. ↑ Aardema, F. & O'Connor. (2007). The menace within: obsessions and the self. International Journal of Cognitive Therapy, 21, 182–197.
  7. ↑ Aardema, F. & O'Connor. (2003). Seeing white bears that are not there: Inference processes in obsessions. Journal of Cognitive Psychotherapy, 17, 23–37.
  8. 1 2 Janssen, Diederik F. (2016). ""Psychosexual Development Disorders": Calling and Recalling for Declassification". Archives of Sexual Behavior. 45 (7): 1601–1604. doi:10.1007/s10508-016-0787-2. ISSN   0004-0002. PMID   27393036. S2CID   29031029.
  9. 1 2 J. Palombo et al., Guide to Psychoanalytic Developmental Theories (2009) p. 55
  10. ↑ Teresa Brennan, The Interpretation of the Flesh (1992) p. 82
  11. ↑ Sigmund Freud, Case Studies II (PFL 9) p. 206
  12. ↑ Janet Malcolm, Psychoanalysis: The Impossible Profession (London 1988) p. 36
  13. ↑ Daniel Rancour-Laferriere, Sign and Subject (1978) p. 52
  14. ↑ Otto Fenichel, The Psychoanalytic Theory of Neurosis (London 1946) p. 382 and p. 367-8
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