Ego-dystonic thoughts refer to thoughts, impulses, or ideas that are inconsistent or in conflict with a person's fundamental beliefs, attitudes, values, and self-image. They are unwanted and when meaning is attached to the occurrence of these thoughts, they cause significant distress and discomfort for the individual and can result in what feels like an internal tug of war. This internal struggle and resultant difficult emotions and distress is exhausting because it's like a battle between your true self, values, intent, desire, and beliefs, and how our very complex thinking machine can be very creative and inventive with the random thoughts it produces. When you really think about it, we need the ability to have spontaneous thoughts in order to be creative and solve problems because this is how we can imagine new ideas and invent. Without this capacity we would have no movies or fiction writing portraying terrifying stories etc. The brain needs to generate thousands of thoughts every day and not all of those thoughts will even come into our awareness or be aligned with our values, intentions, or desires.
Studies have found that unwanted intrusive thoughts occur in 99% of the population and several common themes around these thoughts have been found. They typically concern religion, harm, sexuality, disease, contamination, aggression, mistakes, and dishonesty. The thoughts can just come out of nowhere, although they may be triggered by specific situations such as thoughts about harming people may be triggered by seeing a knife or a horror movie.
Understanding Ego-Dystonic Thoughts
1. Nature of the Ego: In psychoanalytic terms, the "ego" is the self's mental framework dealing with reality, organised thoughts, and identity. Ego-dystonic refers to things that are not aligned with this framework, inducing a sense of inner discord.
2. Contrast with Ego-Syntonic Thoughts: Ego-syntonic thoughts align seamlessly with one's identity and beliefs. For example, a person who highly values honesty and sees themselves as honest will find thoughts of lying ego-dystonic and therefore uncomfortable. On the other hand, thoughts of lying can be ego-syntonic for someone who rationalises dishonesty. This highlights that what is ego-dystonic or ego-syntonic is unique to the individual person's identity, beliefs, and values.
3. Examples of Ego-Dystonic Thoughts: These may include sudden aggressive thoughts of harming someone you love, yourself, or a stranger. Or intrusive images of something bad happening to a loved one, or that one has already caused harm. It can also relate to thoughts and doubts about relationships and doubts over how you feel about your loved ones. Troubling sexual or suicidal ideas can be very distressing because they are so disparate from someone's values, intent, and self-view that they cause significant psychological distress. A common example is an intrusive thought that pops into mind whilst standing on a train platform, that you could push the person next to you onto the track. If this was ego-syntonic the person might feel excited at this thought whilst when it's ego-dystonic it's going to bring discomfort. Some other less commonly discussed ego-dystonic thoughts are ones where a parent thinks they could deliberately harm their baby, which is absolutely terrifying to a new Mum who wants to love and protect their baby, and this is very different from the feelings of someone who actually intends to hurt a baby. It's understandable how a thought like this could become so highly distressing and lead to multiple efforts to neutralise to disprove or escape these thoughts. In most instances people can see these thoughts for what they are, random thoughts that mean nothing, and the thought passes, but with some the discomfort can lead to attaching meaning to having the thought and an obsessive loop can begin that makes it difficult for the thought to pass. These efforts to get rid of the thoughts can then lead to a rebound effect and the compulsions can make the thoughts more frequent! You may have heard of the white bear experiment where you try not to think of a white bear...try it to discover what you are thinking of.
Clinical Impact and Relevance
1. Source of Anxiety: For individuals struggling with Obsessive-Compulsive Disorder (OCD), ego-dystonic thoughts can be a source of immense distress. They often feel these thoughts as alien and distressing, and might engage in compulsions to suppress, cancel out, and avoid the discomfort. While common in OCD, distress experienced from ego-dystonic thoughts can also be present with depression, generalised anxiety disorder, and body dysmorphia. Notably, the awareness of their irrational nature differentiates ego-dystonic from psychosis.
2. Common Therapeutic Approaches: Cognitive-behavioral therapy (CBT) is a common first line approach for supporting understanding of distress provoking ego-dystonic thoughts and what they are. It helps individuals reframe their relationship with these thoughts, to know that they are actually a common occurrence in the general population and that having these thoughts without intent to act on them doesn't actually mean anything about them as a person. There is a huge amount of shame, anxiety and fear surrounding these thoughts for example the fear of losing control and acting on thoughts when there really is no intention, or that having the thought means they want it to happen or will actually make it happen etc. CBT can support with understanding that the exact opposite is true, as it fills the person with terror at the mere thought of it! Understanding thoughts are not facts and it makes us human to experience all sorts of random intrusive creative and sometimes bizarre thoughts can help to begin reducing the distress and any neutralising behaviours that have become compulsions. This reframing information can support with reducing their influence and the disturbance they cause. Acceptance and commitment therapy (ACT) and mindfulness also provide effective strategies by encouraging acceptance of the thoughts without engaging with them or trying to control them. Referred to as the 'gold standard' because it has been the most researched, Exposure Response Prevention involves deliberately thinking of the obsessional thought (exposure) without engaging with any attempts to neutralise. For many this is an extremely difficult process and there tends to be a high drop-out rate so it's important to understand it is only one option, no matter how many people call it the 'gold standard' it doesn't suit everyone. However, it is helpful when approached with the right support, compassionate understanding, and in my opinion best when integrated as part of a strong therapeutic relationship and other therapeutic approaches. When repeated exposure to the thoughts can be achieved the anxiety response to the thought will decrease. Although not the intention of the ERP model, this can also subsequently change the meaning attached to the thought, and the person can experience that the feared outcome does not occur.
3. Self-Compassion and Understanding: It's crucial to approach ego-dystonic thoughts with self-compassion. Recognising they don’t define one’s identity or intentions can empower individuals to accept and manage these intrusive thoughts and begin to let them pass with compassionate understanding and without engaging with them, like any other random intrusive thoughts that just moves and makes space for the next thought. Compassion can be the antidote to shame and many ego-dystonic thoughts appear to link to the underlying feeling of shame. Compassion Focused Therapy also presents a model of three emotion regulation systems, and it can be helpful to understand that the ego-dystonic thought activates the threat system. Rather than there being a healthy engagement of the soothing system to regulate this false alarm of threat, there appears to be an attempt to regulate the threat with the drive system - for example if I do X, Y, Z, behaviour everything will be okay and safe. Therefore increasing the capacity to regulate threat through the soothing system and understand the tricky human mind through the lens of compassion can also support in letting the thoughts pass.
4. EMDR through an attachment lens: The emotions, body sensations, and meaning we make of these ego-dystonic thoughts and why we get stuck on a loop with them can relate to early childhood experiences and belief formation. The foundation of many things we perceive and believe, come from our previous learning experiences and the first five years of life is a crucial developmental stage for a child’s learning and brain development. During this period of a child's early years their interactions with their caregivers create the foundations for their ability to self-regulate emotions, co-regulate as they grow into adults, and learn about themselves, others, and the environment. EMDR is based on the theory of Adaptive Information Processing and that the disturbance that we experience in the present can be connected to past maladaptively stored memories that are activated by something in the present - memories may be implicit or explicit and therefore there can be limited initial awareness of what the thought in the present has activated from the past. An example of this might be that the meaning made of having the 'bad thought' and the feeling of associated shame, actually relates back to earlier experiences of being told your bad, punished for making a mistake, or that there was a general sense of not being wanted, accepted, loved or protected. How does one come to believe what they believe? Why does someone believe they are a bad person because they experience a thought that that is disparate from their actual beliefs? Where does one learn that their thoughts must always be pure, and they must be in control of their thinking? Or that thinking something can make it happen? Or that thinking something is as bad as acting in a harmful way? It can be helpful to understand that what's going on in the present is not actually about the content of the thoughts, but these can be the link to the deeper emotions that felt overwhelming as children...like shame, fear, anger, sadness - sometimes we learn in early experiences that it's not safe to express these emotions. Patterns of behaviour that are learned in childhood such as always pleasing others, or not expressing emotions, or overthinking to predict what comes next can all be relevent to the bigger picture. It may be a protective strategy to keep the mind busy and distract from feeling shame. These are all only examples, as the EMDR case conceptualisation and processing will be very individual in revealing the past memories that need to be updated. EMDR can support you to explore beyond the noise of the present ego-dystonic thoughts, and discover what the root of the attached meaning relates to and understand how it got to be that way.
Final Thoughts
Ego-dystonic thoughts highlight the complex nature of the human mind, the natural generation of creative and spontaneous thinking, and the intricate relationship between thoughts, meaning making, self-identity, emotions, and early developmental experiences of learning. Understanding the nature of these thoughts and being able to let them be thoughts with no meaning, is pivotal to breaking the loop of distress and promoting a balanced self-view irrespective of any ego-dystonic thoughts that occur. Remember, the experience of ego-dystonic distressing thoughts doesn't diminish one's character—they are a part of the broader human experience, manageable once understood as benign. The key to allowing them to pass is to know they have no meaning, to let go of the struggle with them, to let go of your side of the tug of war means the battle is over... but don't get me wrong, I'm not saying this is an easy thing to do, especially if the meaning making, distress, and compulsions have been in a reinforcing cycle for many years, which is often the case with OCD. When the rope attaches to parts of us trying desperately to gain some control or attaches to core early belief formation, it can take time to untangle before letting it go. Remember 99% of the population experience unwanted thoughts so the thoughts can still be there, but we are no longer struggling or attaching meaning...they become thoughts just being there and we are free to turn our attention to what truly matters to us. Once the struggle stops more than likely the frequency of the thoughts also reduces, but that will be down to the thought generator, and not something we need to try to control.
Linda Sunderland
EMDR Accredited Therapist
(EMDR Association UK & Europe)
CBT Accredited Therapist (BABCP)
MA (Hons) Psych., MSc Psych., PGDip CBT,
BPS Graduate Member
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