Academic journal article Journal of Cognitive Psychotherapy

Development of a Measure of Egodystonicity

Academic journal article Journal of Cognitive Psychotherapy

Development of a Measure of Egodystonicity

Article excerpt

The term egodystonicity is a distinguishing feature of obsessional thoughts (American Psychiatric Association, 2000) but has not been consistently nor comprehensively defined. These two studies present the development and initial validation of the Ego-Dystonicity Questionnaire (EDQ). A definition of the term egodystonicity was developed, drawing from existing definitions and theoretical models of obsessive-compulsive disorder (OCD). An item pool was developed and refined through initial testing, the product of which was a 37-item self-report measure. Respondents identify a specific type of thought (e.g., their most upsetting obsession, most upsetting worry) and then answer each item with respect to that thought. In study 1, two nonclinical samples ( N = 278) and one sample of individuals with OCD ( N = 17) were administered the EDQ along with self-report measures of mood, personality, OCD symptoms, and appraisal of obsessional thoughts. A principal components analysis of the nonclinical sample yielded four factors. Scales based on these factors had acceptable internal reliability. The EDQ distinguished between obsessional thoughts and common worries, and individuals in the clinical sample had higher scores than the nonclinical sample. The EDQ showed low to moderate correlations with OCD symptoms, mood, and appraisal of obsessions but was not associated with personality traits such as neuroticism. In study 2, individuals with OCD ( N = 28) completed the EDQ in reference to their most or least upsetting obsession. As predicted, egodystonicity varied according to obsession type. These data indicate that the EDQ is a valid measure with potential for use in understanding and treating obsessional problems.

Keywords: obsessions; OCD; egodystonicity

A defining feature of obsessions is that they are "egodystonic," meaning that the individual senses that the "content of the obsession is alien, not within his or her own control, and not the kind of thought that he or she would expect to have" (American Psychiatric Association, 2000, p. 457). Clark (2004) identifies egodystonicity as a cardinal feature of obsessions. This criterion distinguishes obsessions from negative thoughts that are characteristic of other axis I disorders, such as ruminative thought in depression, repetitive, unwanted traumarelated thoughts in posttraumatic stress disorder, and everyday worries. Indeed, egodystonicity is often viewed as the key distinction between obsessions and worries (Borkovec, 1994; Clark, 2004; Langlois, Freeston, & Ladouceur, 2000; Purdon & Clark, 1999; Rachman, 1973; Turner, Beidel, & Stanley, 1992).

Although egodystonicity is a key feature of obsessions, there exists no standard definition of the term, and there are no instruments that measure it. The term egodystonic was used in psychoanalysis to describe a thought inconsistent with the ego and consistent with the id (Freud, 1973; Rado, 1959). The Penguin Dictionary of Psychology defines the term as "descriptive of wishes, dreams, impulses, behaviors, etc., that are unacceptable to the ego; or, perhaps more accurately, unacceptable to the person's ideal conception of the self," whereas egosyntonic is "descriptive of values, feelings, ideas that are consistent with one's ego, that 'feel' real and acceptable to consciousness" (Reber, 1985, pp. 229-230). Langlois et al. (2000) define egodystonicity as "inconsistency with one's belief system" (p. 159). Clark (2004) defines it as "the degree that the content of the obsession is contrary to or inconsistent with a person's sense of self as reflected in his or her core values, ideals, and moral attributes" (p. 29). Cognitive behavioral models of OCD implicate the inconsistency of the obsession with the self as a key factor in the escalation of normal intrusive thoughts into obsessions. Rachman (1997, 1998, 2006) suggests that repugnant thoughts become problematic when they are recognized as egodystonic that and the individual begins to strive to understand their meaning ("Why would a person like me have a thought like this ? …

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