Perceptions of social dominance through facial emotion expressions in
euthymic patients with bipolar I disorder
Sung Hwa Kim, Vin Ryu, Ra Yeon Ha, Su Jin Lee, Hyun-Sang Cho
PII:
DOI:
Reference:

S0010-440X(15)30071-7
doi: 10.1016/j.comppsych.2016.01.012
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Comprehensive Psychiatry

Please cite this article as: Kim Sung Hwa, Ryu Vin, Ha Ra Yeon, Lee Su Jin,
Cho Hyun-Sang, Perceptions of social dominance through facial emotion expressions
in euthymic patients with bipolar I disorder, Comprehensive Psychiatry (2016), doi:
10.1016/j.comppsych.2016.01.012

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Title: Perceptions of social dominance through facial emotion expressions in euthymic

patients with bipolar I disorder

Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea

Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul,

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Sung Hwa Kima,b; Vin Ryuc; Ra Yeon Had; Su Jin Leeb; Hyun-Sang Choa,b*

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Republic of Korea

Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea

Department of Psychiatry, Seoul Bukbu Hospital, Seoul, South Korea

Hyun-Sang Cho, MD, PhD

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*Corresponding author

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Department of Psychiatry, College of Medicine, Yonsei University

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50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea

Tel: +82.2.2228.1587, Fax: +82.2.313.0891

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Email: chs0225@yuhs.ac

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Abstract
The ability to accurately perceive dominance in the social hierarchy is important for

successful social interactions. However, little is known about dominance perception of

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emotional stimuli in bipolar disorder. The aim of this study was to investigate the perception
of social dominance in patients with bipolar I disorder in response to six facial emotional

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expressions. Participants included 35 euthymic patients and 45 healthy controls. Bipolar

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patients showed a lower perception of social dominance based on anger, disgust, fear, and
neutral facial emotional expressions compared to healthy controls. A negative correlation was
observed between motivation to pursue goals or residual manic symptoms and perceived
dominance of negative facial emotions such as anger, disgust, and fear in bipolar patients.

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These results suggest that bipolar patients have an altered perception of social dominance that
might result in poor interpersonal functioning. Training of appropriate dominance perception

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using various emotional stimuli may be helpful in improving social relationships for

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individuals with bipolar disorder.

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Keywords: Social dominance; Facial emotion; Bipolar disorder; Euthymia

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1. Introduction
Interpersonal relationships may be divided into two systems: the social dominance system

and the social inhibition system [1]. The function of the social dominance system is to

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recognize social hierarchy in order to successfully compete with people in a more dominant
position [2]. The social hierarchy is important in interpersonal relationships in that it

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promotes knowledge of ones own place in the hierarchy and eventually it could bring

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appropriate social behavior through behavioral inhibition [3,4]. Recently, comprehensive

studies of social hierarchy across species revealed that recognizing social hierarchy is
associated with a neural network system that is distinct from other social cognition [5].
In interpersonal relationships, social status can be inferred from multiple visual cues, such

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as facial features, posture, gender, age, and facial expressions [6-8]. Facial emotional stimuli
are important because they provide information about the social hierarchy and regulate both

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the affective state and emotional behavior in response to stimuli [9]. For example, an

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individual who expresses approach-related emotions (e.g., anger) may increase perceived
power, whereas an individual who shows inhibition-related emotions (e.g., sadness) may

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decrease perceived power [10]. In addition, facial expressions of happy and angry are seen as
assertive, dominant, and controlling, whereas expressions of fear and sadness are perceived
as submissive, incompetent, and in need of help [8]. In healthy humans, neutral expressions
are considered as high social dominance because neutral faces provide the impression of
having the ability to handle the situation and reacting non-emotionally to the an event [8,10].
Additionally, neutral emotions expressed by males are rated as more dominant than those
expressed by females [8]. Facial features such as a square jaw, low brow position, and male
gender may be perceived as a high social dominance [8,11,12]. When people are faced with
dominant cues, they flexibly adopt either dominant or submissive behavior through
comparing their self-status against other dominance cues [13]. People with a low sense of

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power are more attentive to dominant people and social threats, whereas individuals with a
high sense of power are more attentive to rewarding aspects of social interactions [1,14].

According to reports that examined the perception of social dominance in individuals with a

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social anxiety disorder, facial emotions like anger, contempt, disgust, and fear were
associated with a negative view of dominance (e.g., harsh, threatening) and emotions like

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happiness were associated with a positive view of dominance (e.g., accepting) [15,16].

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Socially anxious individuals perceived themselves as low in the social hierarchy, engaged in
negative social comparisons [17], and were particularly hypersensitive to dominance stimuli
such as angry facial expressions [18]. Depressed people also felt defeated and tended to show
submissive behaviors in response to dominant stimuli [19,20]. Patients with schizophrenia

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have impairments in various social cognitive processes including social perception with
materials generating social cues [21]. Subjects with ventromedial prefrontal cortical lesions

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showed subtle, abnormal judgments of social dominance using static facial stimuli [22]. So

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abnormal dominance perception or recognition can be observed in specific psychiatric

disorders and these impairments of dominance perception may lead to problems in

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interpersonal relationships or social adaptation.

Bipolar disorder is characterized by alternating cycles of manic and depressive episodes,
interspersed with euthymic periods. During a manic episode, patients show approach
behaviors such as excessive goal pursuit with overly confidence and less regard to
consequences. Manic symptoms and impairments of social functioning may be caused, in part,
by underlying deficits in social cognitive functions, such as the perception of potential danger
cues [23]. During the euthymic period, bipolar patients still tend to think highly of themselves
in comparison to others and set ambitious goals [24,25]. As for cognitive vulnerability in
euthymic states, bipolar patients also showed higher levels of dysfunctional attitudes,
particularly related to need for social perfectionism and approval than healthy controls [26].

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Studies on facial emotional processing revealed mixed results, but some studies among them
reported altered recognition of facial emotions [27]. Moreover, altered reactivity in the

prefrontal cortices, including the ventrolateral and ventromedial regions, appears to be

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involved in deficits of emotional processing and regulation in bipolar disorder [28]. Therefore,
these abnormalities in cognitive and emotional processing may lead to the potential alteration

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in the dominance perception in patients with bipolar disorder.

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In this study, we investigated the perception of social dominance in response to emotional

stimuli in patients with bipolar I disorder. Using facial expressions of six different emotions,
including neutral stimuli, we compared the levels of dominance perception in euthymic

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bipolar patients to healthy control subjects.

2. Methods

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2.1. Participants

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Thirty-five euthymic bipolar I patients were recruited from psychiatric clinics at Severance
Mental Health Hospital of the Yonsei University Health System. Bipolar disorder was

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diagnosed by two psychiatrists based on clinical interviews and using the criteria for bipolar
disorder in the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV)
[29].

Patients

diagnoses

were

briefly

confirmed

using

the

Mini-International

Neuropsychiatric Interview (MINI) [30] by two psychiatrists (S.H.K and H.S.C). Patients
with schizoaffective disorder, severe personality disorder, recent substance abuse, history of
head trauma, or any other Axis I disorder were excluded. Forty-five healthy control subjects
were selected from the local community via advertisement and screened by using the MINI to
exclude neurological disease and other major psychiatric disease. This research was approved
by the Institutional Review Board of Severance Mental Health Hospital, and written informed
consent was obtained from all participants.

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Intelligence quotients (IQ) were evaluated based on the short form of the Korean Wechsler
Adult Intelligence Scale (K-WAIS), composed of three subtests: information, digit span,

and picture completions. To assess mood symptoms, the Youngs Mania Rating Scale

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(YMRS) [31] and the Montgomery-sberg Depression Rating Scale (MADRS) [32] were
applied. On the YMRS, the symptom ratings did not reach clinically significant levels (Cut-

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off = 12, Mean = 3.8, SD = 4.8) [33], and there were also no clinically relevant scores on the

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MADRS (Cut-off = 9, Mean = 3.6, SD = 3.0) [34] in the patient group at the experiment day.
Because anxiety could affect the perception of social dominance, participants state and trait
anxiety were measured using the State-Trait Anxiety Inventory (STAI) [35]. Behavior
activation system/Behavior inhibition system (BAS/BIS) [36] are believed to generate

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motivated, approach-related emotion and to hinder ones motivation to move toward goals,
respectively [37]. The BAS/BIS scale consisted of a total of 20 items, each measured using a

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four-point Likert scale. The BAS items were categorized into three subscales: drive (goal

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pursuit), reward responsiveness (response to rewarding outcomes with energy), and funseeking (pursuit of positive experiences) [38]. The BIS had no subscales. Adequate reliability

this study.

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for the BAS (Cronbachs = 0.89) and for the BIS (Cronbachs = 0.70) was established in

Demographic and clinical characteristics of two groups are summarized in Table 1. There
were no significant differences between groups with regard to age, sex, education level, or IQ.
The groups did not show a difference in clinical characteristics as measured by the STAI and
BAS/BIS scale. Both YMRS (p = 0.001) and MADRS (p = 0.005) scores showed a
significant difference between the two groups. The YMRS and MADRS scores of bipolar
patients were higher than those of normal controls.
[INSERT TABLE 1 HERE]

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2.2. Materials
We presented 24 Japanese facial emotional expressions from the JACFEE (Japanese and

Caucasian Facial Expression of Emotion) [39]. Except for surprised facial expressions, the

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facial stimuli consisted of five basic emotions (happy, anger, disgust, fear, and sad) and
neutral faces. Each emotional expression was composed of two male and two female actors.

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Different actors were used for each emotion and did not overlap. Because facial features such

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as hairstyle, jaw form, and facial rounding may influence the perception of social dominance
[11], facial hair and blemishes were removed and all faces were unified into an oval annulus
using Adobe Photoshop. Skin tone was expressed in black and white on a black background
to put the most focus on the emotional expression of the face. Faces were presented centrally

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on a 13-inch laptop computer screen at a size of 275 420 pixels, and at a viewing distance
of approximately 60 cm. Facial emotional expressions were presented in a randomized order.

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Participants were instructed to look carefully at each facial emotional expression and rate

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their perceived dominance for each emotion until they pressed key for next facial stimuli.
To estimate dominance, the translated version of 7-point dominance scale developed by

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Hess [8] (Insecure-Assertive, Placid-Forceful, Non-controlling-Controlling, SubmissiveDominant) was used. The item Placid-Forceful was excluded because the translated
meaning of the Korean words was unclear when the dominance scale was preliminarily
conducted on seven normal persons. The remaining items were combined into an overall
dominance scale (N = 80, Cronbachs = 0.78). Participants rated each face on three 7 pointLikert scales ranging from 3 to 3 with opposite descriptions (i.e., 3 = very insecure; 3 =
very assertive). Thus, higher positive scores were considered to reflect higher levels of
perceived social dominance, and lower negative scores were regarded as greater levels of
perceived social submissiveness.

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2.3. Statistical analysis
The sociodemographic and clinical characteristics of the bipolar patient and healthy control

groups were compared using a Chi-square test and an independent Students t test. Perceived

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dominance scores were analyzed by three-way analysis of variance (ANOVA) to assess

effects of group, gender of the participant, and facial emotional expressions. Post-hoc

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analyses were conducted in 2 ways by using Bonferroni correction method, due to non-

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significant gender of the participant effect: (1) assessing group effects within each facial
emotional expressions and (2) comparing perceived dominance scores for the five emotional
expressions with the neutral expressions (happy vs. neutral, anger vs. neutral, disgust vs.
neutral, fear vs. neutral, and sad vs. neutral) for each group separately. .

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Lastly, Pearsons correlation was used to estimate the correlation between the clinical
characteristics and perceived dominance scores in bipolar patients. All of the above statistical

3. Results

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analyses were conducted with SPSS Statistics, version 19.0.

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For perceived dominance, there were no significant main effect of gender of the participant
(F[1,456] = 0.31, p = 0.575) or significant interactions (group emotion gender of the
participant, F[5,456] = 0.36, p = 0.877; group gender of the participant, F[1,456] = 0.97, p
= 0.326; emotion gender of the participant, F[5, 456]=0.13, p=0.986) when including the
gender of the participants. As a result, this factor (gender of the participant) dropped from
further analysis. A two-way group by emotion ANOVA revealed significant effects of group
(F[1,948] = 20.34, p<0.001) and emotion (F[5,948] = 94.01, p<0.001). There was also a
significant interaction of group by emotion (F[5,948] = 4.75, p<0.001). Post-hoc analyses
were conducted to assess group differences among each emotional expression (Figure 1).
Bipolar patients had significantly lower dominance scores in response to anger (p = 0.046),

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disgust (p<0.001), fear (p = 0.025), and neutral (p = 0.012) facial expressions compared to
healthy controls (Bipolar < Healthy). However, there were no significant differences between

the two groups in response to happy (p = 0.875) and sad (p = 0.563) emotional expressions.

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Additionally, we explored the emotional effects separately for individuals with bipolar
disorder and healthy controls. In bipolar patients, significant differences in dominance scores

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were observed for anger and sad emotional expressions compared with neutral expressions

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(angry > neutral, p<0.001; sad < neutral, p = 0.001). However, there were no statistical
differences in dominance scores for happy, disgust, and fear emotions compared with neutral
ones in bipolar patients (happy vs. neutral, p = 0.125; disgust vs. neutral, p = 0.195; fear vs.
neutral, p = 0.343). In healthy controls, dominance scores differed for anger, disgust, and sad

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expressions compared with neutral expressions (angry > neutral, p<0.001; disgust > neutral, p
= 0.010; sad < neutral, p<0.001). Healthy controls demonstrated no differences in dominance

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neutral, p = 0.055).

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scores for happy and fear emotions with neutral ones (happy vs. neutral, p = 0.465; fear vs.

[INSERT FIGURE 1 HERE]

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When the gender of the actor in the facial stimulus was included as a variable in the analysis,
a significant main effect for gender emerged (F[1,936] = 55.15, p<0.001), in which female
facial expressions were rated as lower in dominance than male expressions. However, no
significant interactions were observed (group emotion gender of the actor, F[5,936] =
0.64, p = 0.667; group gender of the actor, F[1,936] = 3.78, p = 0.052).
Lastly, we investigated the relationship between clinical characteristics and perceived social
dominance in bipolar patients. In relation to BAS subscale scores, drive was correlated
negatively with dominance ratings of anger (r = 0.38, p = 0.023), and a relationship between
drive and dominance ratings of disgust trended towards significance (r = 0.32, p = 0.057). A
positive correlation (r = 0.37, p = 0.030) was observed between BIS and dominance ratings

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of fear. There was a negative correlation (r = 0.34, p = 0.047) between YMRS and
dominance ratings of fear. However, these data did not reveal any significant correlations

when we employed a critical p-value of 0.006 to correct for multiple testing using

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Bonferronis method.

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4. Discussion

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In the present study, bipolar patients showed noticeably lower perceptions of social
dominance based on anger, disgust, fear, and neutral facial emotional expressions compared
to healthy controls. However, there were no significant differences in the dominance
perception of happy and sad emotions between bipolar patients and controls. To our

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knowledge, this is the first study to investigate the social dominance perception using facial
emotional expressions in bipolar I patients.

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This lower dominance perception of negative emotions may be related to impairment of

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emotional processing and regulation that is observed in individuals with bipolar disorder.
Although it was long believed that deficits of facial emotion recognition remit during the

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euthymic status of bipolar disorder, growing evidence suggests that these impairments persist
during the euthymic state [40,41]. A meta-analytic study reported small, but significant effect
sizes for facial emotion recognition in euthymic bipolar disorder [42], in which euthymic
bipolar patients were found to have enhanced or impaired recognition of negative emotions,
especially fear and disgust [43-45]. In another study, several negative facial emotions were
misrecognized as other emotions in remitted bipolar patients in comparison to healthy
controls [46]. Patients with bipolar disorder also exhibited selective impaired with negative,
but not positive, emotional maintenance when compared to healthy controls [47]. Individuals
with bipolar disorder were also more likely to ruminate about a positive affect and engage in
risk-taking behaviors when faced with a negative affect [48]. These difficulties with

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experiencing negative emotions may result in overlooking dominance in negative facial
expressions. Euthymic bipolar patients showed a greater use of suppression and reappraisal,

indicating difficulty with regulating emotions [49]. Another possible explanation is that

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impaired attention in bipolar disorder [50,51] might influence lower dominance perceptions
in response to negative emotional facial expressions. Schizophrenia patients showed a

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significant association between attention processes and facial emotion recognition [52,53].

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Similarly, for bipolar patients, altered dominance perception may be associated with impaired
attention to details of facial expressions. Taken together, altered recognition or maintenance
of negative emotions, difficulties with regulating emotion, and deficits in attention may lead
to a decreased perception of dominance in response to these emotions.

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To the best of our knowledge, there has been no investigation of dominance perception in
response to facial expressions among patients with depression or bipolar depression. Only

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one study directly rated the perceived dominance to anger, neutral, and happy facial

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expressions in individuals who had high or low social anxiety [54]. The results revealed no
differences among groups; however, the participants (i.e., students) only had speech fear, and

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their anxiety was thus not as severe as patients with social anxiety disorder. Studies that
measured dominance indirectly using faces have shown that patients with social anxiety
disorder are hypervigilant to negative facial expressions and that they have an attentional bias
to social threats [55-57]. For example, patients with social anxiety disorder, who view
themselves as less dominant, perceive angry faces as challenges to dominance contest [58].
Patients with social anxiety disorder rated angry faces as more arousing and as more
unpleasant than controls [59]. In addition, participants with anxiety disorder reported elevated
emotional reactivity for facial expressions of anger or contempt [60].
In healthy individuals, the dorsolateral and ventrolateral prefrontal cortices, which are
associated with the regulation of socio-emotional responses and behavioral inhibition,

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respectively, are activated when faced with dominant persons [3,5,61]. Likewise, altered
functioning or connectivity, including ventrolateral prefrontal cortex and amygdala, have

been observed during emotion processing and emotion regulation in individuals with bipolar

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disorder [28]. These altered neural activities may contribute to the emotional dysregulation
and differences in dominance perception in patients with bipolar disorder.

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There were no between-group differences in the dominance perception of happy and sad

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emotions in this study. It has been reported that happy and sad facial emotions have a lower
arousal than do fear, anger, and disgust in healthy people [62,63]. Low arousal faces are more
emotionally ambiguous and appear to be related to an active affective system including
amygdala and prefrontal cortex [63]. So this relatively low arousal might lead to no group

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differences in the dominance perception. Additionally, cultural differences might influence

dominance perception. For example, Westerners perceived happy expressions as higher in

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dominance than neutral expressions [8]. However, no differences in dominance perception

this study.

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were found between happy and neutral faces in either bipolar patients or healthy controls in

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Interestingly, bipolar patients demonstrated not only a significantly lower dominance

perception of neutral facial expressions but also perceived excessive submissiveness of
neutral expressions compared to controls. The neutral facial expressions may be rated as
negative in some circumstances by healthy persons [64], but bipolar patients reported more
fear and showed greater limbic hyperactivation when viewing neutral faces compared with
controls [65]. Bipolar patients also perceived neutral faces as negative when experiencing a
high emotional state [66]. As a result, these altered interpretations of neutral expressions
might contribute to different dominance perceptions in individuals with bipolar disorder.
Although female gender expressions signaled lower dominance than expressions in males,
no significant interactions involving gender were observed in this study. Male expressers

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were perceived as higher dominant than female ones because the morphological cues were
more typical for men than for women in healthy participants [67]. In our study, facial shape

was unified into an oval annulus; therefore, the gender effect on perceived dominance may

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have been attenuated.

Negative correlations between residual manic symptoms (YMRS) or drive subscale and the

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dominance perception of anger, disgust, and fear were found in patients with bipolar disorder.

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Also, low BIS scores were related to lower dominance perception of fear in bipolar patients.
Drive is a subscale of the BAS that regulates approach motivation and goal-directed behavior,
whereas BIS measures the tendency to regulate with anxiety in response to fear stimuli [36].
Individuals with social anxiety disorder view themselves as inferior and incapable of

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adequately competing with others; they also tend to be more hypervigilant or anxious toward
dominant stimuli [17,68]. On the other hand, bipolar patients, who have hypomanic

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symptoms and high drive scores, might view themselves as capable of adequately competing

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with others, exhibiting and fearless responses to facial cues that suggest danger [23,69].
Therefore, bipolar patients who have residual manic symptoms, high goal pursuit, and low

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BIS might have a lower dominance perception of emotions such as anger, disgust, and fear.
However, these results should be interpreted carefully, as the statistically significance did not
appear when applying the conservative threshold.
The ability to accurately perceive and make inferences about the emotions of other people is
critical to interpersonal and social relationships [70]. In individuals with schizophrenia,
improvements in perception of facial emotion were shown in response to a training program
[71], and this has led to improvements in social relationships [72]. Therefore, training of
appropriate dominance perceptions using various emotional stimuli or situation might be
helpful in improving social functioning in individuals with bipolar disorder.
The limitations of this research are the following: First, sample size was relatively small and

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a single site was used for recruitment; therefore, this preliminary study should be replicated
in larger samples. Second, bipolar patients have been taking mood stabilizers and/or

antipsychotics. While we cannot completely exclude the medication effects, we did not find

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any significant correlations between the level of dominance perception of each emotion and
medications (mood stabilizers or neuroleptic doses) in the patient group (all p>0.06). Third,

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our study focused on facial emotions for dominance perception. Although we unified the

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faces, it will be necessary to investigate the contributions of specific facial features and body
postures or gestures to ratings of dominance. Fourth, we did not assess the reasons why the
participants judged the emotional faces as more dominant or more submissive. As a result,
further study will be needed to determine a direct cause of altered dominance perception in

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bipolar disorder. Fifth, the difference in perceived dominance between bipolar patients and
healthy controls was modest. Thus, these effects might have had a subtle influence on real-

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world behavior. Sixth, given that patients with any other Axis I disorder were excluded, our

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bipolar patients constituted a relatively pure sample; Thus, it may not have been
representative of general patients with bipolar disorder who have high rates of comorbid

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substance use or anxiety disorders [73]. In addition, we did not directly measure the
participants self-esteem or their own sense of social dominance. Further study will be needed
to determine the relationship between self-esteem and perceived dominance. Moreover, even
though we measured dominance scores by using Likert scales, future research would consider
using a visual analog scale for increasing sensitivity and decreasing anchoring on specific
values. Lastly, this was a cross-sectional study. Although lower dominance perception may be
a trait factor observed during the euthymic state in those with bipolar disorder, an
investigation into its longitudinal changes during the disease course is needed.
Despite these limitations, this research is the first of our knowledge to study the perception
of social dominance in euthymic bipolar patients. Bipolar patients showed a significantly

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lower perception of social dominance in negative, threatening stimuli compared to normal
participants. This research is important because decreased dominance perception may be

related to impaired social and occupational functioning and potential components of its

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treatment training in patients with bipolar disorder. This study also provides a foundation for
future research, focusing on neurobiological or brain imaging of dominance perception in

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Acknowledgements

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individuals with bipolar disorder.

This study was supported by a faculty research grant (No. 6-2013-0169) of Yonsei

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University College of Medicine.

Conflicts of interest

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All authors declare that they have no conflicts of interest.

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Figure 1. Perceived dominance scores to each emotion for bipolar patients and healthy

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controls, with standard error bars. * : p<0.05, Bonferroni corrected

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Figure 1

Table 1. Demographic and clinical characteristics of subjects

Bipolar
Control

t or 2

p-value

1.37

0.17

ACCEPTED MANUSCRIPT

0.35

(n=35)

(n=45)

Age

35.710.3

32.88.5

Gender (M/F)

20/15

21/24

Education (years)

11.71.7

12.11.4

-1.23

0.22

Estimated IQ
No. admission
Duration of illness (years)
YMRS

107.911.6
3.93.7
9.88.8
3.84.8

111.811.6
0.71.0

-1.46

0.15

3.65

<0.01

MADRS

3.63.0

1.62.8

2.91

0.01

STAI-State

35.57.6

37.510.1

-0.97

0.33

STAI-Trait

39.19.3

38.89.2

0.14

0.89

BAS(total)

30.76.7

32.65.9

-1.32

0.19

RR

12.13.0

13.22.6

-1.83

0.07

9.52.4

10.11.9

-1.44

0.26

FS

9.12.3

9.32.4

-0.31

0.76

16.14.0

17.14.0

-1.13

0.26

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Lithium (mg/day)
Valproic acid (mg/day)

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Antipsychotics
(CPZ eq dose,mg/day)

816.0156.6
(n=25)
839.3361.7
(n=14)
241.4223.2
(n=29)

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BIS

0.87

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IQ : Intelligent Quotient, YMRS : Young Mania Rating Scale, MADRS : Montgomery-sberg

Depression Rating Scale, STAI : State-Trait Anxiety Inventory, BAS : Behavioral activation system,
RR : Reward Responsiveness, D : Drive, FS : Fun Seeking, BIS : Behavioral inhibition system, CPZ
eq dose: Chlorpromazine equivalent dose