Euphoric vs. Expansive?

[prominence]

How would you describe/contrast these affects?

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[worriedwell]

Expansive speaks to the range of one's affect, in that it is overly expressive and unrestrained. It is a less severe than labile affective range in that it is a bit more predictable and with less extreme or rapid shifting. In general, it doesn't feel dangerous to be in a room with someone with expansive affect per se, but it could feel that way with someone who is labile.

Euphoric speaks to the type of one's affect, and specifically in that it is overly happy. In fact, one's affect can be constricted in range (ie the opposite of expansive) but euphoric at the same time if they cannot express any other type of affect in the interview including sadness or anger.

That's the way I conceptualize it. I think people tend to use expansive loosely whenever someone seems manic, but I think it really represents a mild form of emotional incontinence, where someone expresses greater range of affect than would normally be expected in an interview.

 

[prominence]

hey worriedwell,

thanks for the helpful reply. i really appreciate it.

 

[CaMD]

I think it really represents a mild form of emotional incontinence,

Thank you for this phrase.

 

[Encephalopathy]

Good answer, worriedwell. How about restricted vs constricted?

 

[worriedwell]

I consider restricted and constricted to essentially be interchangeable. I used constricted above, and ironically, I don't like to use that term as much as I like restricted.

 

[kugel]

Good answer, worriedwell. How about restricted vs constricted?

I was taught that "restricted" referred to restriction of the affect to one end of the spectrum, i.e. normal amount of amplitude but all in the happy end of the spectrum or all in the sad end of the spectrum. For instance, "normal" affect might be thought of as -3 to +3 on a scale of -10 to +10.

I was taught that "constricted" is essentially synonymous with "blunted", i.e. the amplitude is significantly less than normal, almost no change in affect. But not quite "flat."

Therefore, a person can have normal "range" but be restricted to the happy/elated end of the spectrum, or a person can have "neutral" affect (centered around zero) that is constricted to the point of almost being flat, or any combination of the above.

A very depressed person might have normal "range" (5-6 points), but be restricted to the sad end of the scale (-5 to +1). But it is probably worse if he is restricted to the sad end of the scale AND the range is "constricted" to -5 to -4, i.e. comes across as just as sad even when talking about good/happy things.

So I always try to get a person to talk briefly about something at the other end of the scale, to determine if they are "constricted" as well as "restricted." For a depressed or angry person, I try to lighten the mood temporarily and see if the person can follow me. For a manic, elated person, I try to identify something sad or depressing to see if the person can show those emotions.

A little bit of self-deprecating humor lets me see a few things:
a) abstract thought: required to see the humor
b) ability to understand the mood in the room and mirror the smile/chuckle from me and the nurse, (if the nurse thinks it was as funny as I did)
c) constriction: shows changed affect, but only a tiny difference and very fleeting
d) self-centeredness. Not narcissism, but so caught up in internal problems (depression, psychosis, etc) that one cannot even recognize that I was talking about me - not him.

 

[worriedwell]

Kugel, I believe I quite like that way of looking at it and will use that moving forward. Thanks.

 

[Encephalopathy]

Thanks Kugel, very helpful!