From the Guidelines
Ego dystonic thoughts are intrusive, unwanted thoughts that conflict with a person's self-image, values, or beliefs, and examples include a religious person having blasphemous thoughts, a loving parent experiencing unwanted thoughts of harming their child, or a heterosexual person having homosexual thoughts they find distressing. These thoughts cause significant distress precisely because they feel alien and contradictory to one's core identity. According to 1, obsessive sexual thoughts are a recognised phenomenon in OCD and are prominent within the unacceptable thoughts’ symptom dimension, which can include thoughts about unfaithfulness, pedophilia, incest, AIDS, profane thoughts combining religion and sex, and obsessions surrounding one’s sexual orientation.
Some key characteristics of ego dystonic thoughts include:
- Being intrusive and unwanted
- Conflicting with a person's self-image, values, or beliefs
- Causing significant distress
- Feeling alien and contradictory to one's core identity
- Common in various mental health conditions including OCD, anxiety disorders, and depression, but can also occur in people without mental illness
As noted in 1, individuals with sexual orientation OCD (SO-OCD) may experience thoughts that are inconsistent with their self-identified sexual orientation, leading to significant distress and anxiety. For example, a heterosexual person may experience unwanted thoughts about being attracted to someone of the same sex, which can lead to compulsive behaviors such as checking for signs of arousal or seeking reassurance from others.
It's also important to note that ego dystonic thoughts can be distinguished from ego syntonic thoughts, which align with one's self-concept, as mentioned in 1. Ego dystonic thoughts are typically experienced as unwelcome and inconsistent with who the person believes themselves to be, whereas ego syntonic thoughts are consistent with one's self-image and values.
In terms of the underlying cognitive-affective dysfunction, research suggests that individuals with OCD may exhibit deficits in extinction learning, as well as altered executive function and emotion regulation, as discussed in 1. These deficits can contribute to the development and maintenance of ego dystonic thoughts, and may be targeted in cognitive-behavioral therapies such as exposure and response prevention (ERP).
From the FDA Drug Label
Obsessive-compulsive disorder is characterized by recurrent and persistent ideas, thoughts, impulses, or images (obsessions) that are ego-dystonic and/or repetitive, purposeful, and intentional behaviors (compulsions) that are recognized by the person as excessive or unreasonable OCD is characterized by recurrent and persistent ideas, thoughts, impulses, or images (obsessions) that are ego–dystonic and/or repetitive, purposeful, and intentional behaviors (compulsions) that are recognized by the person as excessive or unreasonable
Ego dystonic thoughts are those that are inconsistent with an individual's self-image or values. Examples of ego dystonic thoughts may include:
- Recurrent and persistent thoughts of harming oneself or others
- Intrusive thoughts of a violent or aggressive nature
- Unwanted thoughts of a sexual nature that are inconsistent with one's sexual orientation or values
- Persistent thoughts of being a failure or inadequate, despite evidence to the contrary
These thoughts are often experienced as distressing and may interfere with an individual's daily functioning. It is essential to note that ego dystonic thoughts can be a symptom of various mental health conditions, including Obsessive-Compulsive Disorder (OCD) 2 3.
From the Research
Ego Dystonic Thoughts
Ego dystonic thoughts refer to unwanted, intrusive thoughts that are inconsistent with an individual's values, beliefs, or personality. Examples of ego dystonic thoughts may include:
- Recurring, unwanted thoughts about harming oneself or others
- Intrusive thoughts about taboo or forbidden topics, such as sex or violence
- Unwanted thoughts about being a bad person or having evil intentions
- Recurring doubts about one's own identity, sexuality, or sanity
Characteristics of Ego Dystonic Thoughts
Ego dystonic thoughts are often characterized by:
- Being unwanted and intrusive
- Causing significant distress or anxiety
- Being inconsistent with the individual's values, beliefs, or personality
- Being difficult to control or suppress
Relationship to Obsessive-Compulsive Disorder (OCD)
Ego dystonic thoughts are commonly experienced by individuals with Obsessive-Compulsive Disorder (OCD) 4, 5, 6, 7, 8. In OCD, these thoughts can become obsessive and interfere with daily life, leading to significant distress and impairment. Cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are commonly used treatments for OCD, and have been shown to be effective in reducing symptoms of ego dystonic thoughts 4, 5, 6, 7, 8.