Fig. 8.1
The AIS2C (Activation-Inhibition-Sensitivity-Coping-Control) matrix. Activation and Inhibition are the main vectors, which are regulated by control. Combinations of Activation and Inhibition levels produce the main synthetic results of expansion, stagnation, ambivalence, indifference, and moderation. Sensitivity and Coping refer to how the system responds to environmental adversity. Stability and Harmony are general properties that result from the other features of the system
The AIS-2C principles can be applied to systems by simply adapting the terms. In the case of temperament (Fig. 8.2), the AIS-2C was translated as emotional traits, which putatively reflect relevant neurobiological and behaviors subsystems. Activation refers to the dimensions of Energy/Volition, Desire, and Anger. This separation became necessary and useful to enrich the understanding of how behavior is motivated and initiated. Volition (a more adequate term for languages of Latin origin) is the basic Energy (better term for Anglo-Saxon languages) to drive action, has an inbuilt positive bias, and is not focused on immediate reward. This energy allows processes to be carried on and underlies activities such as getting up from bed, doing routine actions, interacting with others, working, and so on. In contrast, Desire is the instinctive attraction to reward, originally to food and sex, but expanded during civilization to drugs of abuse, power, games/gambling, vanity, and other “objects.” Anger arises when the Desire is not satisfied and may be adaptive to overcome the barriers to reach the desired object. Inhibition reflects Fear (the reverse of audacity) and Caution (the reverse of impulsivity), which are important for avoidance and protection, respectively. Emotional Sensitivity is how the system reacts to straining events, frustration, and interpersonal stress. Control is the ability to monitor the environment (attention) and to regulate the expression of Activation and Inhibition, thereby including characteristics of duty and discipline. Coping also reflects cognitive features such as the ability to face and solve problems and to learn with experience. Finally, Anxiety is the reverse of Harmony, and Stability is how the system “flows” along time in terms of rhythm and predictability. These dimensions are called the Emotional traits for simplicity, although cognitive and motivational aspects are also covered. The examination of these traits has the advantage of providing an in-depth personalized and specific profile at the cost of easy communication.
Fig. 8.2
Temperament matrix producing affective temperaments (in italics), mood/energy disorders (M, D, md, ADHD) and other psychiatric disorders (numbers). Higher Control is represented as “C”. Low Sensitivity and Anxiety and high Coping and Stability are represented by the white shade. 1 configuration prone to externalized disorders, such as mania; bipolar I disorder; antisocial, narcissistic, and histrionic personality disorders; intermittent explosive disorder; excessive and compulsive behaviors associated with high desire, such as drug abuse and dependence (including cigarette smoking), buying, and sex; 2 configuration prone to externalized/internalized disorders, such as mixed mood states, bipolar II disorder, bulimia, PTSD, panic, borderline (BPD) and paranoid personality disorders, mixed types of OCD, some attention deficit disorder, drug abuse to decrease sensitivity, such as alcohol and benzodiazepines; 3 configuration prone to internalized disorders, such as depression, generalized anxiety, social phobia, panic, inhibited types of OCD, cluster C personality disorders; 4 configuration prone to ADHD, learning disorders (towards the bottom), oppositional defiant disorder (towards the top); 5 configuration prone to good mental health, with low risk for development of psychiatric disorders, and high chance of recovery if a psychiatric disorder develops, e.g., due to acute stress
The major patterns of “relationships between the parts” (emotional traits) are expressed as the Affective Temperaments. This global perspective derived from the five affective temperaments proposed by Akiskal based on Kraepelin’s fundamental states [8]. However, we realized that there should be other common configurations, starting with the euthymic predisposition. Conceiving an orthogonal matrix of two major independent axes (Activation and Inhibition), each divided in high, medium, and low, the 3 × 3 possible combinations suggested the existence of nine types. We later realized that still other types were necessary to cover adequately the area of the matrix, for example, to differentiate the more extrovert but mostly stable hyperthymic type from the externalized and less adaptive euphoric type. The final classification of affective temperaments is as follows:
Internalized or Introvert Types
Depressive or melancholic: tendency towards melancholy and sadness, takes little fun and joy in things, tends to put oneself down, quiet
Anxious or avoidant: worrier, careful, often feels insecure and apprehensive, afraid that bad things will happen, avoids risky situations, always alert and vigilant
Apathetic: has little initiative, often drifts away from what others are saying or doing, often fails to finish what has started, tends to be passive and slow
Unstable Types
Cyclothymic: unpredictable and unstable mood, quick and disproportionate reactions, periods of high energy and enthusiasm alternate with other phases of sluggishness and loss of interest
Dysphoric: tense and uneasy, with a strong tendency to feel agitated, anxious, and irritated at the same time
Volatile: restless, disorganized, and easily distracted; sometimes hasty or inconvenient, quickly loses interest; often fails to do duties and to finish what has started
Stable Types
Obsessive: dedicated, demanding, detail oriented, inflexible, and a perfectionist; needs to be in control of things; does not deal well with uncertainty and mistakes
Euthymic: balanced and predictable, with mood changes only when there is a clear reason; usually in good spirits and feeling good about oneself
Hyperthymic: always in good spirits, very confident, and has fun easily; loves novelties; active, obstinate, and with a tendency to leadership
Externalized or Extrovert Types
Irritable: very frank, direct, and determined, but also angry, explosive, and suspicious
Disinhibited: restless, active, spontaneous, and distracted; often rushes and acts carelessly; leave things to the last minute; when irritated, gets over it quickly
Euphoric: expansive, fast, talkative, and intense; has many ideas and is easily distracted; hasty, explosive, and impatient; takes risks when overconfident or excited; overindulges in pleasurable things; does not like routines and rules
The AFECT Model, Mood Spectrum Disorders, and Borderline Personality Disorder
Mood is usually conceived as one dimension from sad/apathetic to happy/euphoric, and bipolar disorder is often described as the alternation between these states. These are simplistic and equivocal definitions that fail to address more complex presentations related to mood such as irritable, dysphoric, agitated, anxious, and worried states, which are indeed very common mixed features in subjects with bipolarity, in addition to euthymia.
The concept of mood spectrum has regained considerable attention in recent years, particularly due to the works of Akiskal and Angst. Angst has proposed a model that combines Major and minor mania (M and m) and depression (D and d) as independent from each other. The range of mood states from elevated to low mood goes in the following order: M, m, MD, Md, md, mD, d, D. This is a considerable conceptual advance compared to the previous lack of models or to the dichotomy of prototypical manic-depressive illness and major depression. However, Angst’s model fails to explain (1) euthymia and how it can be “in between” mania and depression without being a mixed state; (2) how depression and mania can occur separately but also combined; (3) why some aspects cancel each other, e.g., being elated and depressed does not happen exactly at the same time, while other aspects do not cancel each other and acquire a different presentation (mixed states); (4) how mood oscillates between these states or tends to remain stable; and (5) other “energetic dysfunction” such as recklessness and hyperactivity without elation.
First, it is important to differentiate mood states (short-term presentations) from temperament traits (long-term tendencies), but to understand that temperament is the basis upon which mood is expressed according to internal and external stimuli. Both mood and traits can be understood using the same system principles. To gain insight into how various mood states and patterns emerge, we suggest that mood should be regarded as the result of the interaction between the emotional and cognitive traits within a context. This is depicted in Fig. 8.2, which shows the bidimensional matrix with euthymia in the center and altered mood states in the periphery (including attention deficit and hyperactivity). Also, Table 8.1 displays the general emotional/cognitive configurations of the 12 affective temperaments.
Table 8.1
Emotional trait profiles of affected temperaments
Volition | Desire | Anger | Fear | Caution | Sensitivity | Anxiety | Control | Coping | Stability | |
|---|---|---|---|---|---|---|---|---|---|---|
Depressive | ↓↓ | ↓ | ↔ | ↑↑ | ↑↑ | ↑↑ | ↑↑ | ↓ | ↓↓ | ↓ |
Anxious | ↔ | ↓ | ↔ | ↑↑ | ↑↑ | ↑ | ↑ | ↑ | ↓ | ↔ |
Apathetic | ↓ | ↓ | ↓ | ↑ | ↑ | ↑ | ↔ | ↓↓ | ↓↓ | ↔ |
Cyclothymic | ↔ | ↑↑ | ↑↑ | ↔ | ↓ | ↑↑ | ↑↑ | ↔ | ↓ | ↓↓ |
Dysphoric | ↔ | ↑ | ↑↑ | ↔ | ↔ | ↑ | ↑↑ | ↔ | ↓ | ↓↓ |
Volatile | ↓ | ↑ | ↑ | ↔ | ↓ | ↑ | ↑ | ↓↓ | ↓↓ | ↓↓ |
Obsessive | ↑ | ↔ | ↑ | ↔ | ↑↑ | ↔ | ↔ | ↑↑ | ↑ | ↔ |
Euthymic | ↑↑ | ↓↓ | ↓↓ | ↓ | ↑↑ | ↓↓ | ↓↓ | ↑↑ | ↑↑ | ↑↑ |
Hyperthymic | ↑↑ | ↔ | ↓ | ↓↓ | ↑ | ↓↓ | ↓↓ | ↑↑ | ↑↑ | ↑ |
Irritable | ↑ | ↑ | ↑↑ | ↓ | ↔ | ↔ | ↔ | ↑ | ↑ | ↓ |
Disinhibited | ↑ | ↑↑ | ↔ | ↓ | ↓ | ↔ | ↔ | ↓ | ↔ | ↓ |
Euphoric | ↑ | ↑↑ | ↑↑ | ↓↓ | ↓↓ | ↔ | ↑ | ↔ | ↑ | ↓↓ |
Euthymia (euthymic mood) results from a balanced expression of Activation as high Energy/Volition with low Desire and Anger, moderate Inhibition (more Caution than Fear), high Control and Coping, and low Sensitivity and Anxiety. This tends to high (mood) Stability and positive affectivity. Euthymic temperament is the predisposition to this configuration of emotions and cognitive functioning over time. Hyperthymic mood and temperament are similar, but with somewhat higher Activation and lower Inhibition, whereas the obsessive profile is slightly more inhibited, anxious, and angry, but still relatively stable over time. These three configurations are the stable types. The euthymic and hyperthymic types are protective against mental disorders.
The internalized types and moods (depression) have a dysregulation of Activation characterized by lower Volition/Energy and low to moderate Anger and Desire, along with high Inhibition. Control and Coping are low to moderate, and Anxiety and Sensitivity are moderate to high. The apathetic type tends towards particularly low Control and Coping, and the anxious type stands out for high Inhibition. The depressive mood and temperament has oversensitivity and low Volition as its hallmark features. All are relatively unstable overtime due to these dysfunctional emotional and cognitive expressions. These profiles commonly underlie internalized behaviors and disorders such as social avoidance and generalized anxiety.
The externalized types and moods (mania) also have some deficiencies in Coping and Control, but their excesses arise from increased Anger and Desire associated with low Inhibition. This mixture results in more Anxiety and low Stability. The disinhibited type particularly lacks Control and Caution, the irritable type displays excessive anger, and the euphoric type shares these two tendencies. These configurations also give rise to externalized behaviors such as drug abuse and excessive buying.
Finally, the unstable types and moods (dysphoria) are characterized by a combination of moderate to low Control and Coping along with high Sensitivity and Anxiety, Activation expressed mostly as Anger and Desire and Inhibition as more Fear than Caution. These features result in emotional reactivity and low Stability overtime. The volatile types have particularly low Control and Coping, whereas cyclothymics are more sensitive, angry, and impulsive (low Caution and high Desire).
The unstable temperaments predispose to behaviors and disorders of externalization, internalization, and executive function (such as ADHD). Also, the co-occurrence of emotional excesses and deficiencies along with poor Control and Coping leads to high tension and desperation, which may manifest as psychosomatic disorders, panic, compensatory behaviors to frustration (e.g., binge eating or drinking), and inward aggression (e.g., self-mutilation). This configuration reflects the phenotype described as a borderline personality disorder (BPD) or borderline traits.
The symptoms of BPD can be interpreted in the light of the emotional and cognitive traits. The overall picture is that emotional traits (Anger, Desire, Fear, Sensitivity) overwhelm the self-regulatory abilities of cognitive traits (Control, Coping, and Caution). Specific features of BPD related to traits are interpreted in Table 8.2.
Table 8.2
BPD features related to traits of the AFECT model
BPD features | AFECT model traits |
|---|---|
Idealization and devaluation | ↑ Desire (expectations), ↑ Anger (“all or nothing” pattern) |
Interpersonal sensitivity | ↑ Sensitivity, ↓ Coping |
Impulsive and reckless behaviors | ↓ Caution, ↓ Control, ↑ Desire |
Self-harm and suicidal attempts | ↑ Anger, ↑ Sensitivity, ↓ Volition |
Difficulty maintaining actions with no immediate reward | ↓ Volition, ↓ Control, ↑Desire |
Attention deficits | ↓ Control |
Emptiness | ↓ Volition |
Victimization | ↓ Coping |
Unstable self-image, relationships, and sense of identity | Linked to ↓ Stability resulting from interaction between other traits |
Typical emergence in adolescence | When Desire and Anger ↑, but self-regulatory traits (Coping, Control, and Caution) not yet mature |
Long-term improvement during adulthood | Self-regulatory traits mature and “hot emotions” (Desire and Anger) attenuate |
AFECTS: A Short Self-Report Scale to Assess Emotional Traits and Affective Temperaments
Using the Internet to provide good sampling (the Brazilian Internet Study on Temperament and Psychopathology – BRAINSTEP) [9], we developed the AFECTS (see the full revised version in the Appendix), which evolved from a preliminary version called the Combined Emotional and Affective Temperaments Scale (CEATS) [10]. The AFECTS emotional section was composed of bipolar items, 5 of them with 8 items and 5 with 4 items (when the dimension of Inhibition is split into Fear and Caution, which “behave” differently depending on the kind of analysis performed). The original version [1] and the revised version [11] showed good or very good internal consistency in all dimensions and worked well in confirmatory analysis.
The Affective Section is composed of 12 short descriptions rated in a 5-point Likert scale (scored 1–5 from “nothing like me” to “exactly like with me.”) followed by a question to choose the most precise description of the subject’s temperament. This allows both a dimensional and a categorical evaluation of affective temperaments. Importantly, 99 % of subjects rated at least one affective temperament as a score 4 or 5, suggesting that all major patterns were covered [1]. However, ~30 % of subjects considered that only one description was a perfect match (score 5), and about 80 % considered that 1–3 descriptions of affective temperaments were compatible with their profile, usually with types within the same group (e.g., someone who chooses the cyclothymic temperament could also have a high score in dysphoric and volatile) or in “neighbor” types (e.g., volatile and apathetic, hyperthymic and euphoric) according to the matrix (Fig. 8.2).
Related posts:
Is Borderline Personality Disorder Underdiagnosed and Bipolar Disorder Overdiagnosed?
Mood Disorders and Personality Disorders: Simplicity and Complexity
Depressive Disorders in Borderline Personality Disorder: Phenomenology and Biological Markers
Cognitive Behavioral Therapy-Based Interventions for Borderline Personality Disorder and Mood Disorders
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