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When does a "healthy ego" cross the line into unhealthy territory?

Where is the line between confident, positive self-image and grandiose self-importance, which might signal a personality disorder or other psychiatric illness? More fundamentally, what do we mean by ego, from a neural perspective? Is there a brain circuit or neurotransmitter system underlying ego that is different in some people, giving them too much or too little?

What is Ego?

What ego is depends largely on who you ask. Philosophical and psychological definitions abound. Popularly, ego is generally understood as one's sense of self-identity or how we view ourselves. It may encompass self-confidence, self-esteem, pride, and self-worth, and is therefore influenced by many factors, including genes, early upbringing, and stress.

The popular concept of ego is a far cry from what Sigmund Freud elaborated at the turn of the 19th century in his seminal work on psychoanalytical theory. Freud distinguished between primary (id) and secondary (ego) cognitive systems and proposed that the id, or unconscious, was characterized by a free exchange of neural energy and more primitive or animistic thinking. It was the job of the ego, the conscious mind, to minimize that free energy, to "bind" it and thereby regulate the impulses of the unconscious. It was Freud's attempt to "link the workings of the unconscious mind to behavior," says Joseph T. Coyle, M.D., chair of psychiatry and neuroscience at Harvard School of Medicine/McLean Hospital and a Dana Alliance for Brain Initiatives member.

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