On the Concept of Reality Testing

What has been described in the literature as reality testing includes at least the functions and processes of attention, perception, memory, secondary-process thinking, delay of discharge, judgement and reflective awareness. Freud's early emphasis on the distinction between ideas and perceptions remains central, while later writers have included the acquiring of knowledge of realities through learning, and drawing logical conclusions from perceptions and memories. The relative merits of broadening or narrowing the concept of reality testing and the question of overlap with other ego functions have not been systematically considered. In this paper, we have included, in addition to the inner–outer distinction, the overlapping

components of accuracy of perception and accuracy of inner reality testing. Freud assumed a loss of external reality awareness in psychosis, while the transience and reversibility of reality testing disturbance has been put forth more recently as a basis for distinguishing psychosis from borderline conditions. Viewing disturbances in reality testing as being importantly influenced by defensive operations, the question still remains open as to the likelihood of reality testing impairment beyond given conflict areas, or how general inaccuracy of perception is likely to be in an individual who has manifested delusions and hallucinations. The notion of reflective awareness adds considerable subtlety to the description and understanding of both outer and inner reality testing. A stronger focus on characteristics of the external environment is suggested. Studying such basic processes as attention will likely increase knowledge about reality testing, as will viewing the latter in terms of a given individual's style of reality contact.