The Introvert-Ambivert-Extrovert Spectrum

Background: Modern psychological theories define introvert-extrovert spectrum as a continuous dimension of personality, rather than simply two personality types. Purpose of this article is to investigate and explain the intro-vert-extrovert spectrum, define and discuss the term ambivert whilst ex-panding the term introvert-extrovert spectrum using the term of ambiversion as an equally important, and finally, discuss the importance of libido in the context of introvert-ambivert-extrovert spectrum. Methods: Using literature review, author’s own experience and reflections about this subject, the theory of introvert-ambivert-extrovert spectrum is explained, expanded and dis-cussed in this article. Conclusion: Libido, which can be defined not only as a sexual drive (narrow meaning), but as an overall life energy (wider meaning), can be directed in the individual’s expression of energy more inward (that is being more introverted) or more outward (that is being more extroverted). Ambiversion is somewhere near the half-way mark between two extremes, and it is characterized by high degree of adaptiveness and a good balance between inward and outward turning of the libido, which is associated with having more mature defense mechanisms in different life situations in comparison with predominantly introverts or extroverts, who might be more susceptible for the development of neurotic defense mechanism when faced with demanding life situations that require personality traits from the opposite side of the introvert-ambivert-extrovert spectrum. Using psychological advice and mental training it is possible to develop some of the personality traits from the opposite side of the spectrum in order to increase the adaptiveness to different life situations and avoid the development of neurotic defense mechanisms and neurotic surrogate life goals.

ties is the source and direction of an individual's expression of energy, defining extraversion as an outward turning of libido and introversion as an inward turning of libido. The interest of the introvert is directed inwards. Introverts think, fell and act in ways that suggest the subject is the prime motivating factor.
Extroverts direct their interest outwards to their surrounding environment. They think, feel and act in relation to external factors rather than the subjective [1].
An ambivert is someone who exhibits qualities of both introversion and extraversion. An ambivert can flip into either of depending on the mood, social context and present goals. Ambiverts have also been called the outgoing introverts (an introvert who can be outgoing in certain situations, or around certain people, or when they absolutely need to), antisocial extroverts (an extrovert who needs time to recharge before socializing or likes to be alone more than a typical extrovert) and social introverts (an introvert who can dial up into extraversion when needed) [2]. The term ambivert was proposed by Edmund S. Conklin in 1923. Davidson J. Ian discusses in his article that the term ambivert largely failed to gain traction, it marginally persisted within the context of Eysenck's integrative view of types and traits, and is now the focus for sales management and popular psychology [3]. The introvert-ambivert-extrovert spectrum might be understood rather as a continuous dimension of personality traits, rather than simply three personality types. Extreme introverts or extroverts are very rare.
Most of the personalities can be measured somewhere between these two extremes. The most psychologically stable persons seem to be ambiverts because they are able to exhibit both extraversion and introversion, depending on the social context. Libido, which can be defined not only as a sexual drive (narrow meaning), but also as an overall life energy (wider meaning), affects and shapes personality traits. Depending on how libido flows through the person, inward or outward or both, defines how introverted, or extroverted a person will be.

Libido
Libido is a person's overall sexual drive or desire for sexual activity. It is influenced by biological (sex hormones and associated neurotransmitters, such as testosterone and dopamine, that act upon the nucleus accumbens, regulate libido in humans), psychological (personality traits, stress, relationship issues), and social factors (work, family) [4].
Sigmund Freud is considered the originator of the modern use of the term libido [5], which can be defined as the instinct energy or force, contained in ID, the strictly unconscious structure of the psyche. Libido is a fundamental instinct that is innate in all humans [6]. Freud developed the idea of a series of developmental phases in which the libido fixates on different erogenous zones: oral stage (exemplified by an infant's pleasure in nursing), anal stage (exemplified by a toddler's pleasure in controlling his or her bowel movements), phallic stage (spanning the ages of three to six years, wherein the infant's libido centers upon his or her genitalia as the erogenous zone), latency stage (libido is dormant) and D. Petric Open Journal of Medical Psychology genital stage (starts in puberty, in which the individual develops a strong sexual interest in people outside of the family) [7]. The libidinal drives can conflict with the conventions of civilized behavior, represented in the psyche by the superego.
Ego uses defense mechanisms in order to solve this conflict. Excessive use of defense mechanisms results in neurosis. Primary goal of psychoanalysis is to bring the drives of the id into consciousness, allowing them to be met directly and thus reducing the patient's reliance on ego defenses [8]. Both Sigmund and Anna Freud studied defense mechanisms, although Anna spent more time and research on five main mechanisms: repression (the feeling is hidden and forced from the consciousness to the unconscious because it is seen as socially unacceptable), regression (falling back into an early stage of mental/physical development because it is seen as less demanding or safer), projection (possessing a feeling that is perceived as socially inacceptable and instead of facing it, the feeling or unconscious urge is seen in the actions of other people), reaction formation (acting the opposite way that the unconscious instructs a person to behave, and this acting is usually exaggerated and obsessive) and sublimation (the most acceptable of the mechanisms, represents an expression of anxiety in socially acceptable ways) [9].
Psychiatrist George Eman Vaillant introduced a four-level classification of defense mechanisms. Level I are pathological defenses: delusional projection (delusion about external reality, usually of a persecutory nature), denial (refusal to accept external reality because it is too threatening, arguing against an anxiety-provoking stimulus by stating it does not exist, resolution of emotional conflict and reduction of anxiety by refusing to perceive or consciously acknowledge the more unpleasant aspects of external reality) and distortion (a gross reshaping of external reality to meet internal needs). Level II are immature defenses: acting out (direct expression of an unconscious wish or impulse in action, without conscious awareness of the emotion that drive the expressive behavior), hypochondriasis (an excessive preoccupation or worry about having a serious illness), passive-aggressive behavior (indirect expression of hostility), projection (primitive form of paranoia which reduces anxiety by allowing the expression of the undesirable impulses or desires without becoming consciously aware of them, attributing one's own unacknowledged, unacceptable, or unwanted thoughts and emotions to another) and schizoid fantasy (the tendency to retreat into fantasy in order to resolve inner and outer conflicts). Level III are neurotic defenses: displacement (shifting sexual or aggressive impulses to a more acceptable or less threatening target, redirecting emotion to a safer outlet, separation of emotion from its real object and redirection of the intense emotion toward someone or something that is less offensive or threatening in order to avoid dealing directly with what is frightening or threatening), dissociation (temporary drastic modification of one's personal identity or character to avoid emotional distress, separation or postponement of a feeling that normally would accompany a situation or a thought), intellectualization (form of isolation, concentration on the Open Journal of Medical Psychology intellectual components of a situation so as to distance oneself from the associated anxiety-provoking emotions, separation of emotion from ideas, thinking about wishes in affectively bland terms and not acting on them, avoiding unacceptable emotions by focusing on the intellectual aspects), reaction formation (converting unconscious wishes or impulses that are perceived to be dangerous or unacceptable into their opposites), and repression (attempting to repel desires towards pleasurable instincts, caused by a threat of suffering if the desire is satisfied, the desire is moved to the unconscious in the attempt to prevent it from entering consciousness). Level IV are mature defenses: altruism (constructive service to others that brings pleasure and personal satisfaction), anticipation (realistic planning for future discomfort), humor (overt expression of ideas and feelings that gives pleasure to others), sublimation (transformation of unhelpful emotions or instincts into healthy actions, behaviors or emotions) and suppression (conscious decision to delay paying attention to a thought, emotion, or need in order to cope with the present reality, making it possible later to access uncomfortable or distressing emotions whilst accepting them) [10] [11].
According to Swiss psychiatrist Carl Gustav Jung, the libido can be defined as the totality of psychic energy, not limited to sexual desire. Jung defines libido as a desire or impulse which is unchecked by any kind of authority, moral or otherwise [12].

Introversion, Extraversion and Ambiversion
Introversion can be defined as a state of being predominantly interested in one's own mental self. Introverts are typically perceived as more reserved or reflective [13]. Introverts usually embrace solitude, they prefer introspection over the expression, are more focused on depth, are less demonstrative emotionally and share personal data with a select few. Introverts usually prefer writing to talking, and occasionally suffer from people exhaustion, which drives them to retreat into aloneness in order to renew energy [14]. People report enjoying momentary extraverted behavior, which does not seem to depend on trait levels of introversion-extraversion. A comparative study was designed in order to explore a novel explanation on why do introverts not act extraverted more often. Authors argued that trait introverts make an affective forecasting error, underpredicting the hedonic benefits of extraverted behavior. It seems that trait introverts forecast less activated positive and pleasant affect and more negative and self-conscious affect (compared to extroverts) when asked to imagine acting extraverted, but not introverted. Introverts tend to be less accurate, particularly by overestimating the negative affect and self-consciousness associated with their extraverted behavior. Authors concluded that taking into account that introverts overestimate hedonic costs that do not actually materialize, this may explain way introverts do not act extraverted more often [15]. Advantages of being predominantly introvert are the increased ability to reflect, to be alone and work independently, in comparison with extroverts. It is considered that introverted persons are more D. Petric Open Journal of Medical Psychology successful as artists, writers, scientists, composers, inventors, and similar professions, in which introversion, reflection, ability to work independently are important. On the other hand, weaknesses of introverted individuals might be inability to work in a team, weaker socialization drive. Introverts might be less successful as public speakers and might not be as successful in professions that demand extraversion, such as politics, show business, teaching, medicine. In the case that an introverted person is talented for medicine, but lacks the ability of extraversion, socialization, and team work, which are all important in clinical medicine, that introverted individual has to engage oneself in mental training and has to learn how to be an extrovert when the situation demands it.
Extraversion can be defined as a state of primarily obtaining gratification from outside oneself. Extroverts tend to enjoy human interactions and to be enthusiastic, talkative, assertive and gregarious. Extroverted individuals are energized and thrive off being around other people. They take pleasure in activities that involve large social gatherings (parties, community activities, public demonstrations, business or political groups). They also tend to work well in groups [13].
The results of a study demonstrated that interpersonal emotional competencies (ECs) act as a moderator in the relationship between extraversion and peer-rated likeability. Extraversion predicted greater likeability among adolescents with high interpersonal ECs, but not among adolescents with low interpersonal ECs. This study demonstrated that adolescents need to be both extrovert and possess high interpersonal ECs in order to be judged highly likeable by their peers. Authors concluded that encouraging rejected adolescents to reach out to others in an extrovert fashion is necessary, but insufficient to increase their likeability. Improving their interpersonal ECs is also necessary. There is also a need to implement school training programs aimed at improving the score ECs (identification, understanding, expression, regulation and use of emotions) [16]. Advantages of being predominantly extrovert are abilities to socialize, to work in team, to better present oneself in public and to be perceived as more likeable in comparison to predominantly introverted individuals. Extroverts might be more successful in show business, politics, medicine, teaching and similar professions, for which team work, extraversion and social skills are very important. Potential weaknesses of extroverts might be inability to work alone, to be alone and reflect, weaker ability to introspect in comparison with introverts. Extroverts usually tend to absorb other people's thoughts and emotions about oneself, and might be more sensitive on insults and defamation of character than introverts do. Whilst introverts might withstand social isolation, such as during COVID-19 pandemic, extroverts might be severely affected by it.
Ambiversion is considered to be near the half-way mark of the introversion-extraversion continuous dimension of personality. According to the OCEAN of human personality theory there are big five traits: Openness to experience, Conscientiousness, Extroversion/introversion, Agreeableness, and Neuroticism. These five traits are considered to be the basic traits under which all other aspects of personality fall. All of these personality traits are observed as a conti-Open Journal of Medical Psychology nuous dimension or a spectrum, not as a single personality trait. Openness to experience refers to the dimension ranging from outgoing, liberal, interested in new things, and imaginative to reserved, conservative, traditional, and conforming. Conscientiousness refers to the continuum ranging from organized, careful, and determined to careless, and weak willed. Agreeableness represents the spectrum from extremes of stubborn versus easy going or suspicious versus trusting. Neuroticism is the dimension of emotional stability ranging from high levels of neuroticism, characterized with high level of emotional instability, to low levels of neuroticism, characterized by higher levels of emotional stability, but sometimes even described as reserved, calm, and unemotional personality [17]. According to Grant M Adam ambiverts achieve greater productivity in sales than extraverts or introverts do because they naturally engage in a flexible pattern of talking and listening, are likely to express sufficient assertiveness and enthusiasm to persuade and close a sale, but are more inclined to listen to customers' interests and less vulnerable to appearing too excited or overconfident [18]. An ambivert is moderately comfortable with groups and social interaction, but also relishes time alone, away from crowd. Ambivert easily adapts to the social context. For example, facing of authority or in the presence of a stranger, the ambivert might be more introverted, but still communicative and capable of socializing, whilst in the presence of family member or a friend, the ambivert might be more extraverted, but never too excited or overconfident. Ambiverts have the ability of adaptation to many different situations. Regarding the personality traits, ambiverts do not have many obstacles in professional life. Ambiversion might be the most adaptive and the most stable personality trait in the introversion-extraversion spectrum.

Neurotic Surrogate Goals
Introverts dealing with situations in which extraversion is necessary, such as large group gatherings, and vice versa, extroverts dealing with situations in which introversion is necessary, such as COVID-19 pandemic-related forced social isolation, might develop neurotic defense mechanisms, such as displacement, dissociation, intellectualization, reaction formation and repression. Ambiverts are less likely to develop neurotic defense mechanisms, especially if they have good emotional competencies as well, and are more likely to handle life difficulties with mature defense mechanisms, such as altruism, anticipation, humor, sublimation and suppression. Healthy mature defense mechanisms are associated with healthy life goals, which can be defined as being based on realistic life context. Contrary to that, neurotic defense mechanisms are associated with the development of neurotic surrogate goals, which are usually not based on realistic competencies and are not placed in the realistic life context. Karen Horney described in her book ten neurotic needs, which are: need for affection and approval, need for a partner who will take over one's life, need to restrict one's life within narrow borders, need for power, need to exploit others, need for prestige, need for personal admiration, need for personal achievement, need for Open Journal of Medical Psychology self-sufficiency and independence, and need for perfection and unassailability [19]. Neurotic surrogate goals might also develop after the life defeat, especially if an individual has neurotic defense mechanisms. In order to set a new healthy life goal, it is important to train and develop healthy mature defense mechanisms during psychotherapy and/or using self-help methods.

Discussion
The introvert-ambivert-extrovert spectrum of personality traits is a continuous dimension of personality, rather than three distinct personality traits. Depending on how libido, which can be defined not only as a sexual drive (narrow meaning), but as an overall life energy (wider meaning), is directed in the individual's expression of energy, person can have more inward turning of libido, that is being more introverted, or can have more outward turning of libido, that is being more extroverted. Ambiversion is somewhere near the half-way mark between two extremes, and it is characterized by high degree of adaptiveness and a good balance between inward and outward turning of the libido. Introversion is associated with the ability to be alone, to work independently, to reflect, to introspect, whilst the extraversion is associated with the ability of working in team, socializing, managing in large group of people, expressing one own's thoughts and emotions more easily. Predominantly introverts might experience discomfort when being in complex social situation or surrounded with many people, when being obliged to speak publicly or being engaged in demanding relationship, whilst predominantly extroverts might be more sensitive to insults, more concerned about other people's opinion about oneself, and are less capable of tolerating social isolation, especially if it is of longer duration. Extraversion when paired with good emotional competencies is associated with a high probability that a person will be perceived as likeable, whilst introversion and poor emotional competencies increase the risk of being socially rejected or isolated. Ambiversion is perceived as the most stable psychological trait and as the most adaptive one. Ambiverts might have more mature defense mechanisms, whilst extreme introverts and extroverts might have more neurotic defense mechanisms when in situation that requires personality traits from the opposite side of a spectrum, but more research on this subject is necessary in order to determine is the ambiversion really the most adaptive personality trait. It could be also very helpful for introverts to train and gain some abilities associated with extraversion, and vice versa, extroverts might benefit from training and learning the ability of introversion, in order to increase their adaptiveness to different life situations and avoid the development of neurotic defense mechanisms and neurotic surrogate life goals, such as need for affection and approval, need for power, need to exploit others… Neurotic surrogate goals may emerge as a consequence of a life defeat or inability to cope. It is very important to recognize and discard the neurotic surrogate goal and set a new healthy life goal, which can be achieved using healthy mature defense mechanisms. If an individual cannot achieve mature defense mechanisms alone, such as altruism, anticipation, hu-Open Journal of Medical Psychology mor, sublimation or suppression, individual or group psychotherapy can be very helpful providing a professional advice and guidance. It is also very important that the society is liberated from stigmatizing individuals seeking psychological help as less worthy because such prejudice might discourage the person in need from seeking psychological help and support. Psychotherapy, various types of psychological support and advice might be also considered as a mean of self-improvement and self-awareness, and as such should be widely available.

Conclusion
Although the term ambivert is only marginally accepted and criticized by some psychologists to be only applicable in sales and popular psychology, I propose that the ambiversion should be more seriously considered as a personality trait in which there is a good balance of inward and outward turning of the libido, making the person more adaptive to different life situations. High level of adaptiveness is associated with more mature defense mechanisms, whilst predominantly introverts or extroverts might be more susceptible for the development of neurotic defense mechanisms when faced in demanding life situations that require personality traits from the opposite side of the spectrum, but using psychological advice and mental training it could be helpful to develop some of the personality traits from the opposite side of the introvert-ambivert-extrovert spectrum, in order to increase the adaptiveness to different life situations, and avoid the development of neurotic defense mechanisms and neurotic surrogate life goals.

Conflicts of Interest
The author states that there are no conflicts of interests.