Psychiatric Diagnosis and Classification - ResearchGate

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Table 4.2 Matrix of levels and sublevels of thought illustrating transcendence of temperament and sublimation of character: sublimation is lightening from level 1 to level 5, and transcendence is elevation within each level, going from sublevel A to sublevel E. There is increasing order or maturity in personality as thought rises from 1A to 5E Sublevels of transcendence of thought 1 Sexuality 2 Consumption Levels of sublimation of thought 3 Emotion 4 Intellect 5 Integrity E integration aspects) D intellectual aspects) C emotional aspects) B consummatory aspects) A sexual aspects) discretion generosity humor morality integrity unity) moderation curiosity sympathy insight selftranscendence) wisdom non-local) validation satisfaction security community serenity coherence) eroticism safety sex libido vs. harm avoidance) consumption satiety aggression novelty seeking) attachment aloofness insecurity reward dependence) altruism egoism cooperation) Self-direction persistence) love free will) creativity non-causal)
90 PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION emotional, intellectual, and integrative aspects of sexuality. This progression involves an elevation or transcendence of the level. The forces from the body associated with each of the first four non-integrated levels are called temperaments. Each temperament dimension involves information processing in partly overlapping subdivisions of the limbic system, which are centrally integrated in the hypothalamus and supervised by neocortical association cortex according to extensive work on comparative neuroanatomy [54] and more recent brain imaging and neurophysiological research [28, 55]. The hypothalamus centrally integrates input from the limbic subdivisions and regulates the tonic opposition of sympathetic and parasympathetic branches of the autonomic nervous system. The autonomic nervous system maintains homeostasis by the opposition of its parasympathetic functions such as sexual arousal, feeding, digestion and storage of nutrients, elimination, and sleep) and its sympathetic functions such as sexual orgasm, preparation for fighting or flight, wakefulness). Accordingly, it is not surprising that each of the limbic subdivisions also regulates the tonic opposition of pairs of such psychodynamic drives, each of which has advantages and disadvantages depending on the context. In terms of functional neuroanatomy, there are opposing drives for sexuality vs. preservation of safety in the septal subdivision, feeding and aggression vs. satiety and satisfaction in the amygdaloid subdivision, social attachment vs. aloofness in the thalamo-cingulate subdivision, and industriousness vs. impersistence in the striato-thalamic subdivision. In psychodynamic terms [56], the first level of sexuality involves the opposition of the outpouring of libidinal energy vs. preservation from harm libido vs. harm avoidance). Harm avoidance is manifest as shyness and fatigability whereas libido is manifest as outgoing vigor and daring. When libido is not satisfied, anxiety develops, whereas sexual orgasm reduces anxiety. The second level of consumption involves the opposition of the drive for feeding vs. satiety novelty seeking). When the drive for feeding is not satisfied, aggression develops, whereas feeding reduces irritability. Novelty seeking is manifest as impulsive aggression and consumption vs. stoicism and frugality with material possessions. The third level of emotionality involves the opposition of social aloofness and attachment reward dependence). This reward dependence is manifest as strong social attachment, loyalty, and sympathy vs. social aloofness and distance. Separation or loss of attachments provokes insecurity, whereas inseparability facilitates sympathy and humor. The level of intellect initially involves the strengthening of ego-directedness or self-directedness by persistence. As intellect matures, there is reconciliation of the opposition of egoism with altruism, leading to increasing integration of character with increases in cooperativeness and self-transcendence. Unbridled egoism leads to conflict and delusion, whereas altruism leads to the insight and judgement
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PREFACE xi world who are interested
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MULTIAXIAL DIAGNOSIS IN PSYCHIATRY
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282 INDEX AsociacioÂn PsiquiaÂtri
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