Psychic Equivalence: Understanding the Collapse of Internal and External Realities

Psychic equivalence is a psychological phenomenon that has a profound impact on the way we experience the world and our relationships.[1] Rooted in developmental psychology and attachment theory, this concept is central to understanding emotional dysregulation and distorted perceptions of reality. In this mode of functioning, the boundary between internal thoughts and feelings and the external world becomes blurred—what is felt or thought internally is perceived as absolute reality. This mental state, though normal in early childhood, can lead to serious challenges if it persists into adulthood.

Origins of Psychic Equivalence
The term “psychic equivalence” was introduced by Peter Fonagy and colleagues in the context of attachment theory and mentalization-based therapy (MBT)[2]. Mentalization refers to the capacity to understand that one’s thoughts, feelings, and beliefs are just representations of reality, not the reality itself. In young children, psychic equivalence is a natural stage of cognitive development; they are unable to fully differentiate between what they think or feel and the objective world.[3] For instance, when a toddler feels scared of a monster under the bed, the feeling of fear is as real to them as the belief that the monster actually exists.

As children grow and develop mentalization skills, they begin to understand that thoughts are not facts and feelings are not necessarily reflective of the external world. However, when emotional or psychological development is disrupted—through trauma, insecure attachment, or other adverse experiences—this cognitive flexibility may not fully develop, leaving individuals prone to psychic equivalence in adulthood.

Psychic Equivalence in Adults
In adults, psychic equivalence can manifest in various ways, particularly during periods of emotional stress or relational conflict.[4] Individuals in this mode experience their internal world as if it were the external world. This results in emotional rigidity and can lead to intense reactions, as they perceive their subjective feelings as objective truths. For example:

• A person who feels worthless may believe that everyone else sees them as worthless too, as though their feelings of inadequacy are an undeniable reality.
• Someone who is angry may assume their anger is entirely justified by external circumstances, without considering alternative perspectives or the subjective nature of their emotional response.
• A person in psychic equivalence may expect others to know exactly how they feel or what they are thinking, assuming their internal experience is shared or understood without needing to be communicated.

This inability to distinguish between thoughts, emotions, and reality can severely impair relationships, decision-making, and overall mental health.

The Role of Mentalization in Overcoming Psychic Equivalence
Mentalization[5], or the ability to reflect on one’s own mental state and the mental states of others, is the antidote to psychic equivalence. By fostering mentalization, individuals can develop the capacity to see their thoughts and feelings as subjective—just one interpretation of reality among many. This allows for greater flexibility, emotional regulation, and healthier interpersonal relationships.

When someone develops mentalization skills, they can step back and recognize that their emotions or thoughts are not the same as facts. For instance, someone experiencing feelings of worthlessness can acknowledge that while they feel worthless, it doesn’t mean they are worthless, nor does it mean others perceive them that way. This cognitive flexibility leads to more adaptive coping strategies, less emotional reactivity, and better problem-solving abilities.

In psychotherapy, particularly in mentalization-based therapy (MBT), therapists help clients develop these skills by encouraging them to reflect on their own and others’ mental states. This reflective capacity helps individuals break free from the grip of psychic equivalence and move toward a more grounded, reality-based understanding of their thoughts and emotions.

Psychic Equivalence and Mental Health
Psychic equivalence is closely linked to various mental health issues[6], particularly those involving emotional dysregulation and relationship difficulties. Conditions such as borderline personality disorder (BPD), post-traumatic stress disorder (PTSD), and even depression can be marked by periods of psychic equivalence, where the person’s emotional state feels all-encompassing and inescapable.

In BPD, for example, individuals often experience extreme emotional shifts where their feelings are experienced as absolute truths. If they feel abandoned, they perceive the abandonment as real and permanent, even when the objective reality might be different. This leads to volatile relationships and intense emotional suffering.

In trauma survivors, psychic equivalence can be triggered by reminders of past trauma. When overwhelmed by fear or sadness, a person may revert to a state where they perceive these feelings as reflective of their current reality, even when the traumatic event is not actually occurring.

Breaking the Cycle of Psychic Equivalence
Understanding and addressing psychic equivalence is crucial for mental health and personal growth. Here are key strategies for overcoming this cognitive distortion:

1. Develop Mentalization Skills: This can be achieved through therapy or self-reflection.[7] Ask yourself, “Are my feelings and thoughts truly reflecting the external reality, or are they just a product of my current emotional state?”
2. Challenge Cognitive Distortions: Cognitive-behavioral techniques can help individuals challenge their immediate reactions and question whether their emotions and thoughts are necessarily accurate reflections of reality.
3. Improve Emotional Regulation: Mindfulness and emotional regulation techniques can help individuals step back from their emotions and observe them without getting caught up in them. This helps in distinguishing between feeling something and assuming that feeling defines reality.
4. Build Secure Attachments: Attachment theory highlights the importance of secure relationships in fostering mentalization and emotional growth. By cultivating secure, supportive relationships, individuals can experience a sense of stability that makes it easier to reflect on their internal experiences without equating them with external reality.
5. Practice Perspective-Taking: Developing the habit of considering others’ points of view can disrupt psychic equivalence. By recognizing that others may have different thoughts and feelings, individuals can begin to appreciate the subjectivity of their own internal world.

Conclusion
Psychic equivalence is a developmental phenomenon that can persist into adulthood, leading to emotional rigidity and distorted perceptions of reality. By fostering mentalization and self-reflection, individuals can break free from this mode of thinking and develop healthier, more adaptive ways of navigating their internal and external worlds. Understanding the difference between what we feel and what is real is essential for emotional growth, healthier relationships, and overall well-being.[8]

[1] Eekhoff, Judy K. “Psychic equivalency as an aspect of symbiosis.” Psychoanalysis of the Psychoanalytic Frame Revisited. Routledge, 2022. 57-79.

[2] Pedersen, Signe Holm. “Fonagy and Freud. Psychological versus psychic reality.” The Scandinavian Psychoanalytic Review 36.1 (2013): 18-26.

[3] Terradas, Miguel M., Vincent Domon-Archambault, and Didier Drieu. “Clinical assessment of prementalizing modes of psychic functioning in children and their parents in the context of trauma.” Journal of Infant, Child, and Adolescent Psychotherapy 19.1 (2020): 25-41.

[4] Rosbrow, Thomas. “Fear of attachment, ruptured adult relationships, and therapeutic impasse.” Attachment 8.3 (2014): 227-235.

[5] Freeman, Catherine. “What is mentalizing? An overview.” British Journal of Psychotherapy 32.2 (2016): 189-201.

[6] Bateman, Anthony W., and Peter Fonagy, eds. Handbook of mentalizing in mental health practice. American Psychiatric Pub, 2019.

[7] Fonagy, Peter, Chloe Campbell, and Anthony Bateman. “Mentalizing, attachment, and epistemic trust in group therapy.” Attachment in group psychotherapy. Routledge, 2019. 20-45.

[8] Williams, Laurel L. “Core Mentalizing Techniques.” Adolescent Suicide and Self-Injury: Mentalizing Theory and Treatment. Cham: Springer International Publishing, 2020. 17-29.