Cyclothymic disorder or cyclothymia is traditionally conceptualized as a less severe and more chronic form of bipolar disorder.
This article will discuss the diagnosis and treatment of cyclothymic disorder. It is important to understand that the information presented in this article is designed to be used only for educational purposes and cannot be used to diagnose anyone with any form of mental illness. In order to determine if someone is suffering from a formal psychiatric/psychological disorder, it is important to consult a licensed mental health professional.
The term cyclothymia appears to have been introduced in 1882 and was used by early psychiatrists to describe individuals who had a lower-grade manifestation of bipolar disorder that was chronic in nature. In earlier editions of the Diagnostic and Statistical Manual for Mental Disorders (DSM), cyclothymia was listed as a form of personality disorder that presented as alterations between depressive periods and periods of elation. It later became classified as a milder form of bipolar disorder and in the most recent version of the DSM, it retains this recognition.
In the current diagnostic scheme, cyclothymia is listed in the category Bipolar and Related Disorders where it is presented as a milder and more chronic disorder that is related to bipolar disorder but represents an entirely different disorder.
Individuals who have cyclothymic disorder suffer from intermittent episodes of hypomania, which are similar to but not as severe as the manic episodes observed in bipolar disorder.
Hypomania consists of periods of unusually elevated, irritable, or expansive mood accompanied by unusual and persistent levels of activity or energy that last for at least four consecutive days. During these periods, three or more of the following symptoms must occur to a significant level:
- Inflated levels of self-esteem
- Decreased need for sleep
- Being excessively talkative
- The experience of racing or fleeting ideas
- Significant distractibility
- Increased goal-directed activity
- Excessive involvement in potentially hazardous activities.
Hypomanic episodes cannot be due to the use of medications or drugs, the physiological effects of some medical condition, or be better explained by some other psychological/psychiatric disorder. These differ from the manic episodes seen in bipolar disorder in terms of their duration and intensity. Manic episodes last for at least one week, whereas hypomanic episodes can last for four consecutive days. In addition, the intensity of and the presentation of these symptoms are far more severe in manic episodes compared to the presentation observed in hypomanic episodes.
The diagnosis of cyclothymic disorder is given based on a number of specific diagnostic criteria in the DSM-5. These criteria are briefly described here:
- In adults, there is at least a two-year period (one year for children and adolescents) where there have been numerous periods of hypomania that do not meet the criteria for manic episodes, along with numerous periods of depressive symptoms that do not formally meet the diagnosis of a major depressive disorder.
- Over the two-year time period, the episodes of hypomania and depressive symptoms have not been absent for more than two months at a time and have been present for at least half the time.
- The person has never met the criteria for major depressive disorder, mania, or hypomania.
- The symptoms the person experiences result in significant distress or impairment in their functioning.
- The symptoms are not better explained by the presence of another psychiatric/psychological disorder, not due to the effects of medications or drugs, and cannot be better explained by some other medical condition.
Even though the American Psychiatric Association (APA) makes a definite distinction between a formal diagnosis of bipolar disorder and a diagnosis of cyclothymic disorder, about one-third of individuals who are diagnosed with cyclothymic disorder eventually go on to be diagnosed with bipolar disorder. The range of individuals diagnosed with cyclothymic disorder who eventually develop some form of bipolar disorder is often stated as being between 10-50 percent.
Who Develops Cyclothymic Disorder?
According to the APA, cyclothymic disorder is relatively rare, and the lifetime prevalence for the disorder is typically stated at less than 1 percent. It appears equally common in males and females and usually is first diagnosed in adolescence or early adulthood.
There is no identified cause for the development of cyclothymic disorder. Much like its parent disorder, bipolar disorder, it is often more common in individuals who have first-degree biological relatives diagnosed with bipolar disorder or cyclothymic disorder. This suggests that there may be a genetic component that influences the development of the disorder.
According to the APA, individuals diagnosed with cyclothymia are often also diagnosed with substance use disorders; some estimates report that nearly 50 percent of individuals diagnosed with cyclothymia develop a substance use disorder. In addition, cyclothymia often co-occurs with sleep disorders, such as insomnia, and attention deficit hyperactivity disorder in children. Individuals diagnosed with this disorder also appear to be at an increased risk for suicide attempts.
Treatment of Cyclothymic Disorder
Even though there are no medications specifically designed to treat cyclothymic disorder, individuals who are diagnosed with this disorder are often prescribed a number of different types of medications. Mood stabilizers often used in the treatment of the bipolar disorders, such as lithium or Lamictal (lamotrigine), can be used to address hypomania and mood fluctuations, and in some cases, antidepressant medications may be used to address the depressive symptoms in cyclothymia. However, it should be noted that the depressive symptoms in cyclothymia should not be severe enough to warrant a diagnosis of major depressive disorder, and some individuals may develop manic-like symptoms when administered certain types of antidepressant medications. When mood stabilizers are ineffective, individuals may be administered more powerful antipsychotic drugs, such as Seroquel, Zyprexa, or Risperdal.
In some individuals, certain types of therapy – such as Cognitive Behavioral Therapy – can help them adjust and learn to function in the presence of their mood swings. However, these individuals often continue to have various issues in life, such as trouble finding and maintaining a job, severe problems with relationships (which are often exacerbated by co-occurring substance use disorders), and issues with impulsive behavior.