Tag Archives: ABCD model

Depression : Symptoms and Subtypes

Depression is one of the most common mental illness; as a matter of fact it has been said to be the common cold of mental disorders- almost everyone gets it one time or the other. ~57 million people, in India itself, are estimated to suffer from depression. However, depression thought currently diagnosed and classified as one entity,  is not a homogeneous illness in practice. There are different sub-types of depression.

But first lets recall the symptoms of depression. These I have drafted in ABCD terms for easy recall. Its also useful to think of symptoms as tings that are added to normal experience (the positive symptoms if you may) and things that are missing (the negative symptoms) – although this distinction is usually made in case of schizophrenia. Also important to remember is that at least 5 of the following symptoms need to be present for at least 2 weeks for a clinical diagnosis.

  1. Affective:  Presence of affect : Low mood or prolonged sadness is an affect that is present, and required for diagnosis of depression. The sad emotion is something that has been added.
  2. Affective : absence of affect: Typically one feels pleasure while doing small everyday activities like having a cup of coffee in the morning. A depressed person doe snot feel pleasure form such activities and suffers from Anhedonia – on the inability to experience pleasure. Here something has been taken away from the normal experience.
  3. Behavioral:  presence of behavior: Depression results in abnormalities in sleep, appetite and body weight. When excess sleep (hypersomnia) or excessive appetite or psychomotor agitation or weight gain appears that can be a symptom of depression.
  4. Behavioral:  absence of behavior: Depression results in abnormalities in sleep, appetite and body weight. When loss of sleep (insomnia ) or less appetite or psychomotor retardation or weight loss appears that can be a symptom of depression.
  5.  Cognitive: presence of thoughts/ beliefs: dysfunctional beliefs are present in depressed people including worthlessness and guilt. These thoughts do not make or dominate the normal thought repertoire of most people.
  6. Cognitive: absence of cognitive capacity: Depressed people are not able o think or concentrate; they are also indecisive. All these are cognitive capacities that are lacking or compromised as compared to normal folks.
  7. Drive: presence of motivation : Here I am tempted to put suicidal ideation and attempts: a drive to escape from life and end it. Something again not normally found in normal people, but a motivational force for the depressed person.
  8. Drive: absence of motivation: Anergia (loss of energy) and fatigue go here: one feels drained and unwilling and unable to do anything. Again normal people have decent amount of energy or drive  and this is somewhat deficient in the depressed person.

Now that we know what depression looks like, and how its diagnosed (above is as per DSM-5 criteria), what can we conjecture about the heterogeneous nature of depression?  One useful way to think about depression sub-types is to think of whether it is predominantly Affective in nature, or is it Behavioral or Cognitive or Motivational. Could this differentiate among meaningful sub-types?

For this it may make sense to refer to this paper [pdf] about which I blogged some time back. Please do read my blog or the original paper. The authors identified two dimensions of Anhedonia and Anxiety and identified four neural subtypes of depression. They replicated the four subtypes in Generalized Anxiety Disorder (GAD) too which is closely related to depression.

It is instructive to note that in that paper, that Anhedonia axis is affect related while Anxiety axis is more cognitive.  To me the four subtypes appear as equivalent to whether the predominant symptoms are affective (subtype 3), or whether they are behavioral (subtype 1?) or cognitive (subtype 4?) or motivational (subtype 2).

Irrespective of what the underlying subtypes may refer to, its clear that depression is heterogeneous and the better we identify and start treating the subtypes differently the better it will be for those suffering from depression.

The ABCD’s of CB5T

Today’s post is about the Cybernetic Big Five Theory (CB5T) theory of personality structure [pdf and pdf] as proposed by Colin DeYoung et al.

Colin and colleagues have proposed a structure of personality that is hierarchical and is build around the popular Big Five traits of Neuroticism, Extraversion, Openness/Intellect, Conscientiousness and Agreeableness.

English: A diagram to illustrate the layout of...

English: A diagram to illustrate the layout of a hierarchical organisation. (Photo credit: Wikipedia)

The top level of the hierarchy consists of metatraits of Stability and Plasticity also called Alpha and Beta. Stability is related to the shared variance between Neuroticism, Conscientiousness and Agreeableness while Plasticity consists of Extraversion and Openness/Intellect. Stability refers to the fact that one has consistency of goals, interpretations and strategies; someone with low Stability will easily abandon goals etc due to internal or external disturbances. Plasticity refers to the fact that any dynamical system needs to also explore its environment for new goals, interpretations and strategies. Someone rigid with low Plasticity would lose on opportunities that are present in the uncertain environment out there.

At the intermediate level of hierarchy lie the Big Five each consisting of exactly two aspects. The aspects may be further made up on n number of facets. We will mostly not go beyond the aspects and focus more on the five Big Five traits and the 10 aspects. I have previously too blogged about CB5T and readers may find it interesting to read that post to see how my thoughts have evolved.

Cybernetics thinks in terms of goal driven self-organizing systems and that is the framework that I will be using here. I have blogged previously about there being different types of goals:  approach goals, Avoidance goals, learning goals, performance goals and differences in conceptualizing a goal as either approach or avoidance, learning or performance has different implications that are well established.

I think in terms of underlying Psychological / brain based systems and believe that we can decompose the human systems into these subsystems:

  1.  The Avoidance System: Goals are conceptualized as avoidance goals i.e a reference state that is to be avoided is on top of the mind. This system is sensitive to cues of threats and punishments and uncertainty. Punishment is something that happens when avoidance is not successful and threat is any impending punishment. The variation in parameters of this system lead to variation in Neuroticism trait in humans. Serotonin system is typically found to be associated with his subsystem. Avoidance can be further be of two types:
    1. BIS (behavioral Inhibition System):   Passive avoidance whereby whenever there is a conflict between an avoidance goal and an approach goal, the approach goal/actions are inhibited. This aspect is also called Withdrawal and is associated with depression and Anxiety.
    2. FFFS (Flight-Fight-Freeze-Faint system) : Active avoidance or escape where one exhibits anger or rage or panic but is geared to do something about the situation. This aspect is also called Volatility and is associated with anger disorders.
  2. The Approach system: Goals are conceptualized as approach goals i.e a rewarding stimuli that has to be pursued and achieved.  This system is sensitive to cues of reward and associated with the dopamine system. This is further made up of:
    1. BAS (behavioral activation system) : This is the ‘wanting’ system as opposed to the ‘liking’ system, a difference that was first proposed by Berridge.  This is more directly related to dopamine and is also called Assertiveness aspect and composed of drive etc.
    2. Pleasure system : This pleasure system is related to opioid systems and is related to the ‘liking’ system or the hedonistic pleasure one feels when consummating a goal.  It is related to Enthusiasm aspect and marked by positive emotions, sociability etc.
  3. The Attend (Learning) system: Any dynamic system is sort of torn between whether to learn more about the system to increase it performance in future or to act in such a way as to maximize its performance in present. This system, which is marked by openness/ intellect, is a cognitive exploration system associated with the dopamine system. This is further made up of:
    1.  Imagination System: This is related to the openness aspect and related to apophenia or psychosis proneness. The key mechanisms here is finding patterns and correlations between sensory and perceptual inputs.
    2. Intelligence system: This is related to the Intellect aspect and related to things like working memory capacity. The key mechanisms here are finding causal and logical relations between semantic and abstract information.
  4. The Achievement (Performance) system: This system is focused around achieving long term goals by focusing in the here and now and following rule and procedures. This system, marked by Conscientiousness, is further made up of two parts:
    1. The grit system: This is related to Industriousness aspect whereby one overcomes distractions in the service of non-immediate goals. This is probably a top down process based around inhibiting distracting stimuli.
    2. The discipline system: This is related to Orderliness aspect whereby one wants to tend towards perfectionism and following routines and self made or other made rules to achive efficiency.
  5. The Attachment (Interpersonal) system:  This system is focused around increasing cooperation and ensuring altruism among man, the social animal. The dysfunctions of this system lead to the Dark Tetrad of personality. This system is marked by Agreeableness trait and is made of two parts:
    1. The caring system: This is related to the bottom up processes of compassion and caring built on the foundations of empathy. The Compassion aspect is relevant here with its opposite pole being callousness. The opposite pole would be characterized by sadism and psychopathy.
    2. The social system: This is related to the top down process of curbing anti-social impulses and tendencies etc by reigning in those baser instincts. The Politeness aspect and its opposite pole that of exploitativeness is relevant here.  The opposite pole would be characterized by  Machiavellianism and Narcissism.

Overall, this CB5T layout maps well to the ABCDS framework.

Neuroticism, or its opposite emotional stability is related to Affective stability.

Extraversion is related to Behavioral exploration.

Openness/Intellect is related to Cognitive exploration.

Conscientiousness is related to Motivational/ Dynamic stability.

Agreeableness is related to Social stability.

Together , the ABCD(S) model and the CB5T model make immense sense and provide a good way to characterize the personality structure.

Emotions and Personality: Take 8

I am currently reading ‘Emotions in the practice of psychotherapy‘ by Robert Plutchik and have been finding it a good read. In it Plutchik elaborates on his famous psycho-evolutionary theory of emotions that led to the circumplex and the Plutchik wheel of emotions. Basically, Plutchik argues that emotions can be classified on three dimensions- intensity, similarity and polarity (complementarity) and if one were to focus on similarity and polarity one can find eight basic or primary emotions, with other emotions either being a blend of the primary emotions or differing in intensity.

Cover of "Emotions in the Practice of Psy...

Cover via Amazon

An example will help clarify: if one takes anger as a basic emotion then emotions like rage, fury or irritation, annoyance differ in their intensity from anger; likewise when two emotions like disgust and anger are co-present, then one may feel the emotion of hatred/hostility, which is a secondary emotion.

Long-term readers of this blog will know that I am sympathetic towards the basic emotions concept and also believe that their are eight basic emotions; the eight basic emotions identified by me are same as those by Plutchik though the polarity aspect varies slightly.  For e.g., I believe the right polarity combinations are Fear-Interest; Sadness- Joy; Anger – Love; and Disgust- Surprise. Note that Plutchik considers Anger-Fear to be opposites and believes that Love is not basic but a blend of Joy and Acceptance.

Plutchik believes, and I have been arguing in my series of posts on emotions and personality, that emotions and personality are intimately connected and that regular/ habitual emotional experiences/ states lead to enduring related personality traits. Also having a particular personality trait likewise increases the probability of experiencing a particular emotion predominately. Thus there is a string bidirectional linkages between the emotional states one finds oneself in and personality traits one has.

Emotions evolved because they helped us survive and thrive. They are related to particular contingencies or features of the situation and help prime action tendencies that effectively deal with those situations to restore one towards homeostatic state (in case of negative emotions) or move towards flourishing and growth (in case of positive emotions). Personality or stable differences in emotional, behavioral, cognitive and motivational responding evolved as it enabled different persons to adapt to different niches of the (social) environment. Personality disorders evolved when things were taken to an extreme or their were unresolved conflicts related to the corresponding emotions.

English: Robert Plutchik's Wheel of Emotions

English: Robert Plutchik’s Wheel of Emotions (Photo credit: Wikipedia)

We will look at emotions and corresponding personality disorders to delineate the relationship between personality and emotions.

Examples will make this clear.

Consider Fear. Fear evolved whenever Danger was present and primed the action tendency to Escape/ withdraw/ protect. Or consider Sadness that evolved in relation to a significant Loss and primed the action tendencies towards Reintegrating or gaining social support or renegotiating. Anger evolved in situations where Obstacles impeded progress or goal achievement and primed the action tendencies of Destruction of that obstacle or aggressiveness in social situations. Disgust evolved when faced with Unpalatable or harmful object priming the action tendency to Reject that object, be it physical or social.

Positive emotions have similar situational triggers and similar action tendencies.

Now, Plutchik also looked at personality disorders, their co-morbidity in patients and the similarity ratings by experts for personality disorders, that were factor analyzed, to lead to a circumplex structure of personality disorders. This structure could clearly delineate which personality disorders were similar and clustered together. Remember this clustering is based on actual empirical data and not arbitrary like the clusters defined by DSM.

Plutchik listed three clusters; but I could make out four clusters based on theoretical rationale as well as inspection of the circumplex.

The four clusters of personality disorders are :

  • Cluster A: Avoidant, Self-Defeating and Dependent personality disorders.
  • Cluster B: Dysthemic, Borderline, Histrionic and Hypomanic (this is not there in Plutchik circumplex)
  • Cluster D: Antisocial, Narcissistic, Sadistic and Passive-aggressive
  • Cluster C: Schizoid, Schizotypal, Paranoid and Obsessive-compulsive.

This brings me to my ABCD model, especially as applied to personality. To extend it to above relationship between emotions and personality disorders, I will make a point that Fear-Interest emotional dimension is related to Cluster A (Affect based) personality disorders, Sadness-Joy to cluster B (Behavioral), Anger-Love to cluster D (Dynamic/Social) and Disgust-Surprise to Cluster C (Cognitive).

Consider Avoidant and Self-defeating personality disorders – they are clearly related to (social) withdrawal, escape etc. and thus to Fear;  Dependent can be related to lack of Interest.

Dysthemic and Borderline are clearly related to reintegration/ renegotiation etc and thus to sadness; Histrionic and Hypomanic are clearly related to problems with Joy/ Activity.

Sadistic and Passive-aggressive are related to destructiveness (either overt or covert) and related to anger; Narcissistic (too much self love) and Anti-Social (no love for society)  are problems with Love/compassion.   Taken together the four personality traits related to above like Sadism, Machiavellianism,  Psychopathy and Narcissism make the Dark Tetrad.

Lastly, Paranoid and Obsessive-compulsive are related to getting rid of something undesirable (external conspirators or internal thoughts) and possibly related to disgust.  Schizoid and Schizotypal may on the other hand be related to Surprise.

If one were to continue extending the circumplex and extrapolate from emotions and personality disorders circumplex, one would arrive at the same ABCD structure of personality that I arrived from other considerations.

In essence, Fear is related to Neuroticism personality trait which is related to Avoidant and self-defeating personality disorders. Interest is related to eXtraversion trait and Dependent personality disorder.

Sadness is related to Conscientiousness trait and Dsythemic and Borderline disorders. Joy with Impulsive Sensation Seeking trait and Histrionic and Hypomanic disorder.

Anger is related to Agreeableness trait and Sadistic and Passive-aggressive disorders while Love is related to Honesty/Humility trait and Antisocial and Narcissistic disorders.

Finally, Disgust is related to Imagination trait and Paranoid and obsessive -compulsive disorders; while surprise is related to Openness to Experience trait and Schizoid and Schizotypal disorders.

To me, the above seems conclusive and makes immense sense. The cluster A disorders (as I have defined them, not the DSM ones) are primarily disorders of Affect; Cluster B of Behavior , Cluster C of cognition while cluster D of motives or are interpersonal in nature. This to me is an important theoretical advancement and should be followed up with empirical work.

The Stages of Moral Development

I have alluded to Kohlberg’s stage theory of Moral Development a few times in this blog, but never devoted an entire post exclusively to that; time to rectify that. For those not familiar with the Kohlberg model, I suggest that they read up an excellent description here.

Morality Play (novel)

Morality Play (novel) (Photo credit: Wikipedia)

To recap, Kohlberg argues, that we go through three levels (and two stages within each level) as we advance on our path of moral development. He arrived to this conclusion, among other things, based on a long-term study of 58 young men over a span of two decades. The stage of moral development was assessed by analyzing answers to moral dilemmas like the famous Heinz dilemma. (in which a not-so-well-off person steals from a druggist a drug to save his dying wife).

After presenting people with various moral dilemmas, Kohlberg reviewed people’s responses and placed them in different stages of moral reasoning. According to Kohlberg, an individual progresses from the capacity for pre-conventional morality (before age 9) to the capacity for conventional morality (early adolescence), and toward attaining post-conventional morality (once Piaget’s idea of formal operational thought is attained), which only a few fully achieve. Each level of morality contains two stages, which provide the basis for moral development in various contexts.

The standard stages, as deciphered from say the below responses to Heinz dilemma, are as follows:

From a theoretical point of view, it is not important what the participant thinks that Heinz should do. Kohlberg’s theory holds that the justification the participant offers is what is significant, the form of their response. Below are some of many examples of possible arguments that belong to the six stages:

  • Stage one (obedience): Heinz should not steal the medicine because he will consequently be put in prison which will mean he is a bad person.
Or: Heinz should steal the medicine because it is only worth $200 and not how much the druggist wanted for it; Heinz had even offered to pay for it and was not stealing anything else.
  • Stage two (self-interest): Heinz should steal the medicine because he will be much happier if he saves his wife, even if he will have to serve a prison sentence.
Or: Heinz should not steal the medicine because prison is an awful place, and he would more likely languish in a jail cell than over his wife’s death.
  • Stage three (conformity): Heinz should steal the medicine because his wife expects it; he wants to be a good husband.
Or: Heinz should not steal the drug because stealing is bad and he is not a criminal; he has tried to do everything he can without breaking the law, you cannot blame him.
  • Stage four (law-and-order): Heinz should not steal the medicine because the law prohibits stealing, making it illegal.
Or: Heinz should steal the drug for his wife but also take the prescribed punishment for the crime as well as paying the druggist what he is owed. Criminals cannot just run around without regard for the law; actions have consequences.
  • Stage five (human rights): Heinz should steal the medicine because everyone has a right to choose life, regardless of the law.
Or: Heinz should not steal the medicine because the scientist has a right to fair compensation. Even if his wife is sick, it does not make his actions right.
  • Stage six (universal human ethics): Heinz should steal the medicine, because saving a human life is a more fundamental value than the property rights of another person.

Or: Heinz should not steal the medicine, because others may need the medicine just as badly, and their lives are equally significant.

From the above it should be amply clear what is salient for each stage and level.

Today I came across an old article by William Damon in Scientific American (PDF here) and he does a pretty good job of describing the stages, and levels, using terminology that is easy-to-understand and correlate.



Stage 1:PUNISHMENT “I won’t do it, because I don’t want to get punished.”
Stage 2: REWARD “I won’t do it, because I want the reward.”





Stage 3: INTERPERSONAL RELATIONS “I won’t do it, because I want people to like me.”
Stage 4: SOCIAL ORDER “I won’t do it, because it would break the law.”





Stage 5: SOCIAL CONTRACT “I won’t do it, because I’m obliged not to.”
Stage 6: UNIVERSAL RIGHTS “I won’t do it, because it’s not right, no matter what others say.”

Now, long time readers of this blog will be familiar with my ABCD model of psychology and the eight stage model of development. To recap, the four dimensions important for any psychological model are Affective, Behavioral, Cognitive and Dynamic (motivational/social) – the right order of development is A->B->D->C. There exist two polarities relevant at each dimension. For Affect, it is the polarity of Pain-Pleasure; for Behavior, the polarity of Active (approach/reward)-Passive(avoidance/ punishment) , for dynamics (or social) it is Self vs Others and finally for Cognition, it is Narrow vs Broad. This model is based on the pioneering work of Theodore Millon and combines various other theoretical frameworks.

If one were to see the Kohlberg’s levels/stages from an ABCD lens, it is clear that SELF-INTEREST is a Behavioral level, with the people moving from a passive (punishment avoidance perspective) to an active (reward approaching perspective) way of reasoning and acting as they function and evolve at that level; SOCIAL APPROVAL is a Dynamic /Social level where people move from a primarily Self focus (avoiding social disapproval) to a primarily Others focus (keeping the glue of society intact); and finally The ABSTRACT IDEALS is a Cognitive level with people moving from a narrow view of morality as utilitarian/ social contract based to more broader conceptions like based on universal human rights.

All the above is fine, but what about A or Affect based level/stages in our model? Are there moral reactions and behaviors of children (less than 9 or say even 5 years of age) that cannot be explained solely as a matter of rewards and punishments? Did Kohlberg miss on an important moral foundation on which many of our initial moral acts are based? My contention is yes, Kohlberg did leave out an important moral foundation. I will call that Affect based moral level Level 0.

The Level 0, of moral action and reasoning, is before an infant/ toddler/ child start thinking of, and justifying, their moral actions in terms of self-interests or rewards and punishment. This Level 0 is the Level of EMPATHY. Research in infant and toddler development has shown that the first moral or pro social behaviors develop out of an ability to empathize with others; if an infant or toddler will witness another person crying they will try to soothe the other person even if their means of helping may be inadequate; similarly toddlers, given an opportunity to help another person by saying opening a cabinet, when a stranger has his hands filled with books, will help the stranger, without any regards to any rewards or punishments, but because of the sheer joy of seeing the other person become happy as a result of their actions.

It’s unfortunate that infants cannot speak and many toddlers haven’t developed a good vocabulary, so the verbal responses to dilemma approach cannot be applied as is to them; but clever researchers have developed ingenious protocols to observe and ascertain moral behavior in children of that age group, and probably can develop new techniques to figure out their moral reasoning too. For example, in one of such experiments, children are shown animated clips of figures like squares and triangles that are either helpful or hurtful (pushing around a loved object ) and based on which figures the child prefers, one determines that indeed children like helpful figure/ animation characters over hurtful/ bullying characters; one could modify this paradigm by varying the distress felt by a loved object, that is being pushed around, by increasing the squeaking noise that object makes, to find whether more squeaking leads to more empathy and thus more moral/ pro social action.

The point I am making is that the prediction that there is an earlier moral reasoning/action stage characterized by empathy, is an empirically testable fact and I do hope someone conducts appropriate experiments to modify and add to Kohlberg’s theory.

To reiterate, there does exist a Level 0 of morality based on EMPATHY and the stages here are that based on Avoiding Pain and Enhancing Pleasure; the Avoiding Pain reasoning goes like ” Heinz should not steal the medicine, because it will cause the druggist to become sad (as the druggist has lost something dear to him)” ; the Enhancing Pleasure reasoning goes like ” Heinz should not steal the medicine, so that the druggist can live happily based on profits he earns” .

So the bottom-line, we all start with EMPATHY on our paths to moral development and that provides a solid foundation on which higher stages like those based on abstract ideals are achieved.

The BioPsychoSocioEnvironmental model

Most of us have heard about the BioPsychoSocial model of mental illnesses and have also heard about the stress-diathesis model. Today as I was contemplating the two, taking cue from my ABCD model of psychology, I tried combining the two and find quite some merit in that approach.

Schematic of diathesis–stress model.

Schematic of diathesis–stress model. (Photo credit: Wikipedia)

To recap, BioPsychoSocial model says that any disease is a result of multiple interacting factors- some of them biological in nature while others psychological and social. The mind affects the body and the body affects the mind and together they may lead to health or illness. This model is as opposed to the BioMedical model which considers the disease to be predominantly due to biological factors.

The stress-diathesis model posits that people have underlying biological or psychological vulnerabilities and when exposed to an environmental stressor may develop a mental disease with varying probabilities. The same stressor may be harmless to a person who does not have those many vulnerabilities, but prove detrimental for someone with the right kind of vulnerabilities.

Combining the two models together, one can have biological, psychological or social diathesis or vulnerabilities and when exposed to the right environmental toxin/stressor may lead to the emergence of a mental health issue in the individual.

To  elucidate by way of an example. Consider a person whose serotonin neurotransmitter system is such that he typically has lower levels of baseline serotonin. This would be a biological vulnerability to depression. He also has tendency towards negative automatic thoughts or pessimism.  This would be a psychological vulnerability. Moreover he has limited social support and is unmarried and from a low SES background. This would be the social vulnerability. Strike three. On top of this, lets say he suddenly loses hos job and is laid off. That environmental life event may be enough to drive this person to clinical depression.

The BioPsychSocioEnvironmental model has application not only in psychopathology, but I believe its a powerful framework for normal development too. For e.g., if we replace diathesis-stress model with differential susceptibility thesis  then the diathesis or sensitivity to context can interact with both positive and negative environmental events to lead to positive or negative life outcomes.

To me combining the two models is immensely fruitful; hope you too find it useful.