In ego syntonia, patients of mental illness perceive their thought patterns and behaviors as making sense, belonging to themselves, and being appropriate. Ego syntonia often characterizes delusional disorders and obsessive-compulsive personality disorders. The phenomenon makes illnesses more difficult to treat because sufferers do not show insight.
What is ego syntonia?
Psychology distinguishes various compulsions and compulsive behaviors. Such deviance patterns are associated with either the term ego syntonia or the term ego dysontonia. As ego syntonia is present in deviant thoughts and behaviors with which the affected person identifies. The patient does not perceive ego-syntonic deviations from the social norm itself as deviations, but considers them normal, correct and coherent. Thoughts and behaviors with ego dystonia a patient performs because he has to. That is, obsessive-compulsive disorder with ego dystonia is perceived as compulsion by the patient himself. Ego-dystonic patients perceive their compulsive thoughts and behaviors themselves as wrong or inconsistent. The actions and thoughts of OCD with ego dystonia are not experienced as compulsions by the patient themselves. For example, patients of obsessive-compulsive personality disorder like to think that an extreme need for order is sensible and right. Obsessive-compulsive disorder patients are usually ego-dystonic and thus usually experience the pressure of individual thoughts and impulses. Partly, patterns and thoughts with ego-syntonia and ego-dystonia are present in the same patient at the same time.
Causes
Ultimately, ego syntonia is the symptom of various psychiatric disorders. The most common associations with ego syntonia are delusion and obsessive-compulsive personality disorder. Obsessive-compulsive personality disorder is a group of mental illnesses. In addition to rigidity and perfectionism, control compulsions and the compulsion to have certain feelings of doubt or anxious caution are classified as obsessive-compulsive personality disorders. In its visible symptomatology, obsessive-compulsive personality disorder clearly resembles obsessive-compulsive disorder. However, the two disorders are ultimately fundamentally different disorders of the psyche. Obsessive-compulsive disorders are characterized by predominantly ego-dystonic symptomatology. The brain metabolism is disturbed in the context of the disorders. Obsessive-compulsive personality disorders are so-called axis II disorders with essential ego syntony. The triggering factor for obsessive-compulsive personality disorders is thought to be an interplay of biological, psychological, and environmental factors. Psychoanalysis considers strict cleanliness education with punishments and the resulting superego as the cause. In cognitive therapy, individual thought processes are held responsible for the maintenance of the personality disorder. Due to thought processes in black and white categories, they assume that possible mistakes on their part will be punished with exaggerated severity. Fearing this, they behave rigidly, perfectionistically, and inhibitedly. Brain damage or other psychiatric disorders are not the cause of obsessive-compulsive personality disorder.
Symptoms, complaints, and signs
People with obsessive-compulsive personality disorder and ego syntonia place work and the pursuit of success above pleasure and, at the same time, above social relationships. Because of ego syntonia, they justify this behavior logically rationally. They often show no tolerance for emotional behavior. They are indecisive and like to postpone decisions. This also manifests their exaggerated fear of making their own mistakes. Because of this fear, they do not carry out certain projects at all. Nevertheless, they are usually extremely conscientious and love to be moralizers. They are extremely scrupulous not only about their own behavior, but also about the behavior of others. They experience authority figures and their criticism as excessively hurtful. Symptoms of other obsessive-compulsive disorders are often present at the same time. People with obsessive-compulsive personality disorder appear rational and cool to their social environment. They show little tolerance for any habits and idiosyncrasies of their fellow human beings. They are loyal to their own principles and norms and demand this loyalty from other people as well. They are extremely preoccupied with rules and details and are inflexible in thought and action. Their lives ultimately seem frozen and lack any dynamism.In ego-syntonia, the affected person feels that all these behaviors are appropriate, correct, and belong to him or her. In delusion, too, the subjective certainty of one’s own delusions is in the foreground for ego syntonia.
Diagnosis and course of the disease
The diagnosis of obsessive-compulsive personality disorder or any other disorder with ego syntonia is made by a professional. The psychotherapist or psychiatrist makes the diagnosis according to ICD-10. Four of eight typical traits must be traceable in the affected person, such as excessive anxiety, caution, rigidity, perfectionism, and lack of tolerance for the habits of others. The prognosis for people with ego-syntonic personality disorders tends to be unfavorable because the individual does not perceive his or her disorder as obsessive and tends to feel it as a compelling part of his or her personality. For a diagnosis of any type of ego-syntonia, evidence of certainty must be provided. In part, as illnesses become chronic, the initial ego-syntonia is lost. Ultimately, however, ego syntonia represents severe treatability.
Complications
Ego syntonia can result not only in physical symptoms but also in physical discomfort and limitations. In most cases, complications arise primarily when treatment cannot take place due to the patient’s lack of insight. It is not uncommon for social exclusion to occur and the affected person withdraws completely from social life. This leads to relatively severe depression and other mental illnesses. Likewise, a great fear of making mistakes develops, so that panic attacks or sweating can occur in many simple situations. These complaints can extremely limit the daily life of the affected person and reduce the quality of life. As a result of ego-syntonia, it is not uncommon for friends and acquaintances to turn away from the affected person, as they cannot understand the behavior. Usually, no complications occur during the treatment of ego-syntonia. However, a long period of time may pass before the patient admits to the disorder and agrees to therapy. In severe cases, treatment in a closed clinic may be necessary. Life expectancy is not usually affected by ego syntonia.
When should you see a doctor?
Anyone who notices signs of ego syntonia in themselves or another person should consult a doctor in any case. Because the condition is often not noticed by the affected person themselves, friends and family members must be alert to any warning signs. If a person who is already suffering from a mental illness shows symptoms of ego syntonia, medical advice must be sought. The medical professional can first perform a physical examination and rule out physical causes. If there is a concrete suspicion of ego-syntonia, a psychiatrist or psychotherapist must be consulted, who can make the diagnosis and, if necessary, initiate treatment with medication. People suffering from a personality disorder or other mental illness are particularly prone to developing ego syntonia. Hormonal disorders and neurological diseases are also possible triggers. Anyone who belongs to these risk groups should consult a doctor when the typical warning signs appear. At the latest, when friends and relatives point out behavioral abnormalities, the help of a doctor and a therapist is necessary.
Treatment and therapy
The treatment of patients with ego-syntonic disorders of the psyche turns out to be much more difficult than the therapy of ego-dystonic patients. Patients with symptomatic ego dystonia often have a subjectively higher level of distress compared with ego syntonia. An insight into one’s own illness and the desire for healing are thus more attainable. As a rule, cognitive behavioral therapy is used to treat disorders with ego syntonia. Cognitive behavioral therapy focuses on cognition and its processes. The attitudes, individual thoughts, evaluations and beliefs of the affected person are thus in focus. In addition to raising awareness of cognitions, therapy ideally involves a review of cognitions and evaluations to determine their appropriateness. Irrational attitudes should thus be recognized and corrected. Patients learn to actively shape their process of perception.The subjective view of things determines behavior and emotional state. By correcting one’s own way of looking at things, reactions to the environment can be permanently changed. For example, compulsive actions can be stopped by changing the causative thought.
Outlook and prognosis
The prognosis of ego syntonia is mostly unfavorable. It depends on the underlying disease present, the overall diagnosis, and the patient’s insight into the disease. If ego syntonia occurs as a symptom of, for example, a schizophrenic or other mental disorder, there is a good possibility of treatment, depending on the form of schizophrenia. Relief of symptoms is possible with comprehensive therapy. However, lifelong medical monitoring and medication are necessary to prevent a relapse of the symptoms. People suffering from ego-syntonic personality disorder do not show insight into the illness in most cases. This is part of the characteristics of the disorder. The lack of awareness of a psychological irregularity means that they typically do not seek adequate treatment as a result. They either do not take advantage of the offer of therapy at all or discontinue it early due to their own decision-making power. This leads to an unfavorable prognosis. If there is an understanding of the disease, there is a good chance of alleviating the existing symptoms. In a comprehensive treatment and therapy plan, a change can be achieved as soon as the patient shows willingness to cooperate. The healing process takes several years and involves coming to terms with the events experienced and restructuring the patient’s lifestyle. If therapy is discontinued, an immediate relapse of symptoms can be expected.
Prevention
Ego syntonia is merely a symptom of superordinate diseases. Thus, the phenomenon can be prevented only to the extent that causative disorders such as obsessive-compulsive or narcissistic personality disorder and delusional disorder can be prevented.
Aftercare
In most cases, no special measures of aftercare are available to the person affected by ego syntonia. In this case, the affected person is primarily dependent on a quick and, above all, an early diagnosis of the disease, so that no further complications or complaints occur. A psychologist should therefore be contacted at the first symptoms and signs of ego-syntonia, and in many cases relatives and outsiders should be made aware of the symptoms of the disease. Patients are dependent on comprehensive psychological treatment, and in severe cases this must take place in a closed clinic. In this context, the support and care of the affected person by his or her own family or friends and acquaintances has a very positive effect on the further course of the disease. Intensive and loving conversations are often necessary. Ego-syntonia can also be treated by taking various medications. The patient should always ensure that the medication is taken regularly and in the correct dosage. If there is any uncertainty or side effects, a doctor should always be consulted first. Ego syntonia usually does not reduce the life expectancy of the affected person.
What you can do yourself
Ego-syntonia can by no means be treated by the affected person on its own. Conditioned by the clinical picture, he neither experiences suffering pressure, nor will he realize that he must change something about his situation. In any case, psychotherapeutic help must be provided that addresses the existing mental illness and the ego-syntonia. Only when the person concerned has reached the understanding that his behavior is abnormal can a combination of psychotherapy and self-help succeed. This includes, for example, attending self-help groups, but can also mean reflecting on one’s own actions and thoughts. For this, a diary or talking to people in the environment can help. The aim is for the person affected to learn to assess his or her own actions as a complement to therapy, and thus also to recognize his or her own behavioral patterns so that he or she is subsequently amenable to behavioral therapy. In order for the affected person to learn to adjust his perception process so that he better recognizes his irrational behavior, it is important that he communicates with his environment.This should therefore be met with reflection. It is questionable if the environment tries to convince the patient of his irrational actions, even though he does not yet feel this way. This is most likely to result in tensions that can lead to incomprehension, isolation, reinforcement of a delusion, or aggression.
