'Ego distortion' needs to be distinguished from the ego's reaction in normal, neurotic, and borderline states. Katan conceives of ego distortion as a defect and a fixation, a reaction to an early (pre-superego) conflict; it does not start out as a defense but may secondarily become one. The other ego reactions mentioned are part of a regressive process. The primary identification of the 'as if' personality is an example of ego distortion, an attempt at belated ego formation. The 'pseudo as if' reaction occurs within the framework of a hysterical reaction.