What Are Ego-Dystonic Thoughts in OCD?
Originally published July 25th, 2024
Updated July 10th, 2025
7 min read
A guide to ego-dystonic thoughts, why they are upsetting, and how you can manage them.
Written by Simon Spichak
We can’t control the thoughts that pop up in our heads throughout the day. Ego-dystonic thoughts are a type of intrusive thought that many people with obsessive-compulsive disorder (OCD) experience. Ego-dystonic thoughts cause substantial distress because they go against our personal beliefs and values.
This article helps you understand these thoughts, why they occur in OCD, and how to manage them with exposure and response prevention (ERP) therapy.
What Are Ego-Dystonic Thoughts?
An ego-dystonic thought is an unwanted idea, thought, or mental image, that is inconsistent with a person’s self-image, morals, beliefs, preferences, or values. These thoughts are involuntary and not something a person would consciously think about or act on.
Many people may have ego-dystonic thoughts. They might be able to immediately understand they’re untrue and move on with their day. However, in OCD, these ego-dystonic thoughts cause significant distress and anxiety.
The Difference Between Ego-Dystonic and Ego-Syntonic Thoughts
While ego-dystonic thoughts are unwanted and cause distress, ego-syntonic thoughts are more positive. Here’s a comparison:
Ego-Dystonic Thoughts:
Intrusive and unwanted
Cause discomfort
Not in alignment with a person’s beliefs, values, or desires
A common symptom of OCD and other mental health conditions
Ego-Syntonic Thoughts
Don’t feel intrusive
Don’t cause distress
In alignment with a person’s beliefs, values, or desires
Why Are Ego-Dystonic Thoughts Common in OCD?
In OCD, ego-dystonic thoughts can’t easily be tuned out. Thoughts that go against a person’s morals, beliefs, or values are recognized as a potential threat. This leads people with OCD to obsessively ruminate over these thoughts, try to pick them apart, or prove to themselves that they are untrue.
The cycle of analyzing and engaging with these thoughts doesn’t make them go away. Instead, it may make them more frequent and intense.
Common Examples of Ego-Dystonic Thoughts in OCD
Some examples of ego-dystonic thoughts revolve around:
Infidelity or cheating.
Unwanted sexual or violent thoughts.
Breaking tenets of your religion.
Concerns about contamination, cleanliness, or checking.
The thoughts are not reflective of a person’s actual beliefs or intentions. Nonetheless, they lead to the anxiety, fear, and distress of these thoughts becoming reality.
How Do Ego-Dystonic Thoughts Impact Daily Life?
Ego-dystonic thoughts impact a person’s work, social relationships, and overall mental health.
Some people who have thoughts related to their work performance may end up stressed and anxious, and spend extra time double and triple-checking emails and work tasks.
Others may feel isolated and exhausted by social interactions, consistently trying to convince themselves that they aren’t bad people and won’t hurt their friends.
Treating Ego-Dystonic Thoughts
Therapists treat ego-dystonic thoughts through exposure and response prevention (ERP), a first-line therapy for OCD. ERP is a modified form of cognitive behavioural therapy (CBT) that helps you confront fears, intrusive thoughts, and obsessions in a healthy way while also helping you learn to resist compulsions, and helping you avoid engaging with ego-dystonic thoughts.
Getting Started With ERP
The first step of ERP involves learning about the types of thoughts you’re having and how you respond to them. For example, some people with ego-dystonic thoughts may spend hours going over their thoughts to convince themselves that they wouldn’t actually do certain behaviours that hurt themselves or loved ones as the thoughts imply.
During the session, the therapist will acknowledge your beliefs and the risks associated with these thoughts. They will work with you to understand that the risks might be exaggerated and do not require compulsions to prevent bad things from happening.
Exposure and Response Prevention
Next, your therapist will expose you to the thoughts that cause you fear and anxiety to help you learn that nothing bad will happen if you ignore these thoughts and have them pass you by.
This part of the therapy will desensitize you to the thoughts so they don’t stick around in your brain. If there is an annoying constant sound at work – like construction nearby – you might eventually become used to it and start to ignore it. Similarly, ERP will help you get desensitized to the noisiness of ego-dystonic thoughts.
It can take 12 to 16 sessions to complete this treatment.
Frequently Asked Questions (FAQ)
Q: What’s the difference between ego-dystonic and ego-syntonic thoughts?
Ego-dystonic thoughts are unwanted and intrusive thoughts that go against your beliefs, morals, and values. For people with OCD, these thoughts cause substantial distress. Ego-syntonic thoughts are the opposite: They are in line with your beliefs, morals, and values and do not generally cause distress.
Q: Will I act on ego-dystonic thoughts?
While ego-dystonic thoughts are unwanted and cause psychological distress, having the thought does not mean you will act upon it
Q: What kind of therapy can help with ego-dystonic thoughts?
Exposure and response prevention therapy (ERP) is highly effective for many people with ego-dystonic thoughts. Healthcare professionals can help you tailor a treatment plan that includes ERP and mental health medications based on your individual needs.
Q: Will ERP therapy cure my OCD and ego-dystonic thoughts?
ERP therapy does not cure OCD or get rid of ego-dystonic thoughts. Instead, it teaches you the tools you need to cope with these thoughts and diminish the anxiety and distress that they cause.
Further Reading and Resources
Resolvve has a library of free resources about OCD which may be helpful for your mental health journey:
Other organizations have also published resources on ego-dystonic thoughts:
How Resolvve Can Help
Resolvve offers affordable, low-cost therapy with practitioners who have extensive experience treating clients with OCD using ERP. When you’re ready to take the next step, you can book a free consultation.
Please note that this post is written for educational purposes; it is not therapy. If you need to talk to a professional, please book a consultation with a psychotherapist through Resolvve.
