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Egodystonic (or ego alien) is the opposite of egosyntonic and refers to thoughts and behaviors (e.g., dreams, impulses, compulsions, desires, etc.) that are in conflict, or dissonant, with the needs and goals of the ego, or, further, in conflict with a person's ideal self-image.
Many personality disorders are considered to be egosyntonic and are, therefore, difficult to treat. Anorexia nervosa, a difficult-to-treat Axis I disorder, is also considered egosyntonic because many of its sufferers deny that they have a problem.
Obsessive compulsive disorder is considered to be egodystonic as the thoughts and compulsions experienced or expressed are not consistent with the individual's self-perception, meaning the patient realizes the obsessions are not reasonable.
"Ego syntonic" was a taken-for-granted aspect of Freud's conceptual armoury, as in his formulation of 'the aim of psychoanalytic therapy, which is "to replace repressions which are insecure by reliable ego-syntonic controls"'. He saw psychic conflict arising when 'the original lagging instincts...come into conflict with the ego (or ego-syntonic instincts)'.
His daughter, Anna Freud, would point out that 'the defences are harder to get at than the impulses, because...defenses against them are familiar, comfortable, unobjectionable, "ego-syntonic" ways of being, and are thus difficult to see as transference rather than as "real"'.
Otto Fenichel's grand summary of the first psychoanalytic half-century 'differentiated sharply between ego-syntonic morbid impulses and the ego-alien symptoms of compulsion neurotics'. He saw 'impulsive actions, which are ego syntonic' as driven by 'the ego-syntonic impulses'; and conversely regarded neurotic symptoms 'as both painful and ego alien' - while still recognising the possibility of 'a reaction formation against a symptom, namely, the denial of the ego-dystonic character of the symptom'.
Later writers, exploring the gradual emergence of unconscious material, would note how 'the direct, unmitigated expression of a repressed semantic element would be highly "ego-dystonic", and it is considered more "ego-syntonic" for the repressed element to be only indirectly expressed'.
It is disputed whether gambling is egosyntonic or egodystonic. One viewpoint, in 1974, argued that 'at no time is the compulsion egosyntonic, that is, a thing which the gambler wants to do and in which he takes pleasure: it is always ego-alien or dystonic'. Others dispute the universality of the displeasure; and point out that 'the reason that the gambler does not always experience the form of the gambling ritual as an ego-alien action resides partly in the fact that...gambling is not widely regarded as an abnormality'.
'What is egosyntonic and what is ego-dystonic must be determined in a historical, cultural, and social context'.