What is cyclothymia or cyclothymic disorder?
Cyclothymia, also called cyclothymic disorder, is a mood disorder which is a milder and chronic form of bipolar disorder. People with cyclothymia experience cyclic “high” and “low” mood and energy levels that negatively affect their ability to function and are persistent for at least two years or more, but they do not meet the severity criteria for either major depression or hypomania. In between the elevated and depressed moods, you are likely to return to your baseline.
Those suffering from cyclothymia have a 15% to 50% increased risk of being diagnosed with bipolar disorder. Similarly, they have an increased risk of suffering from attention deficit hyperactivity disorder, substance abuse, and sleep disorders.
Cyclothymia or cyclothymic disorder usually appears in adolescence or early adulthood. The onset of cyclothymia is so subtle and gradual that it can be hard to identify. Women and men are equally affected, but more women may seek treatment than men. Its lifetime prevalence ranges from 0.4% to 1% in the general population. Treatment options for cyclothymia include psychotherapy and medications.
Symptoms of Cyclothymia
In cyclothymia, there is an irregular and unpredictable pattern of mood fluctuations from mild depression to mild elation (hypomania) and back again. Mild depression or hypomania can be present for days or weeks. In between these high and low moods, a normal mood may prevail for more than a month—or the person may cycle continuously from hypomania to depression, with no normal period in between. But, these low and high moods are mild and do not meet the criteria for major depression or mania.
Their “high” moods are characterized by:
- Euphoric state – an exaggerated sense of well-being and happiness
- High self-esteem
- Racing thoughts
- Hyperactivity – inability to sit still
- Emotional instability – overreacting to events
- Easy distractibility – they are easily attracted to a new locale, job, or love partner, but they soon lose interest and leave in dissatisfaction
- Increased drive to perform or achieve goals – work, school, social and sexual goals – but uneven performance is common along with repeated romantic breakups or marital failures
- Decreased need for sleep – feeling rested after as few as 3 hours of sleep
- Increased agitation
- Poor judgment leading to risky activities, such as spending sprees, sexual encounters, or unwise business decisions
- Reckless thrill-seeking (e.g., gambling, sports)
Their “low” moods are characterized by:
- Low self-worth
- Social withdrawal and isolation
- Feeling tearful or cry easily
- Loss of interest in activities once considered pleasurable (anhedonia)
- Loss of appetite with weight loss
- Sleep disturbances – sleeping much more or much less than usual
- Fatigue or tiredness
- Inability to concentrate
- Lacking meaning and purpose in life
- Thoughts of self-harm and suicide – suicidality is a public health hazard in adolescents. Many such youth, often labeled “borderline,” may actually suffer from undiagnosed temperamental expression of bipolar disorder
The cyclothymic trait appears to be the temperament involved in poetry, the arts, architecture, and other forms of creative human endeavor. Some people with mild symptoms are highly successful in life, driven by their hypomania to express individual talents.
Causes of Cyclothymia
The exact cause of cyclothymia or cyclothymic disorder is not known. However, the genetic factors play a role because a family history of cyclothymia or some other mood disorder indicates a greater risk of its development and also the risk of developing cyclothymia is 2-3 times more likely if an identical twin is diagnosed with the disorder.
Environmental factors are also likely contributing factors. Certain life events may increase your chances of developing cyclothymia, such as physical or sexual abuse, other traumatic experiences, and prolonged periods of stress.
Diagnosis of Cyclothymia
The following are necessary initially to arrive at a diagnosis of cyclothymia or cyclothymic disorder:
- A general medical history and physical exam
- Blood work to screen for substance abuse and to rule out other illnesses with similar symptoms
- Mental status and psychiatric exam.
Then, as per DSM-V the diagnostic criteria for cyclothymia or cyclothymic disorder are as follows (American Psychiatric Association, 2013):
- Symptoms (alternating “high” and “low” moods) have been present for at least half the time for at least 2 years (1 year in children and adolescents)
- There has not been more than a 2-month period of being symptom-free
- Criteria for a major depressive, manic, or hypomanic episode have never been met.
- These symptoms are not better explained by some psychotic disorder, such as schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, etc.
- Symptoms are not due to substance abuse, a medication or a medical condition (e.g., hyperthyroidism).
- The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Treatment of Cyclothymia
The proper pharmacological treatment for cyclothymic excesses is low doses of lithium (600–900 mg/day) or valproate (500–750 mg/day).
There is evidence that lamotrigine is effective in stabilizing some of the symptoms of cyclothymia. In those with ‘borderline’ features, lamotrigine is particularly promising.
Patients receiving psychotherapy were significantly better at the end of a trial, and the benefits were maintained for at least 2 years of follow-up. Some methods that can be used in the treatment of cyclothymia, include:
- Cognitive Behavioral Therapy (CBT) – changing negative thoughts and beliefs into positive ones; stress management techniques; identification of trigger points
- Dialectical Behavioral Therapy (DBT) – teaches awareness, distress tolerance, and emotional regulation
- Interpersonal and Social Rhythm Therapy (IPSRT) – stabilization of daily rhythms – especially related to sleep, wake, and mealtimes; routines help stabilize moods
The artistically inclined among them should be encouraged to live in those parts of a city inhabited by artists and other intellectuals, where temperamental excesses are better tolerated. Ultimately, the decision to use mood stabilizers in such individuals should balance any benefits from decreased mood instability against the social and creative spurts that the cyclothymic disposition can bring to them.
Parents might benefit from some counseling because the dilettante life of their children is often a source of great sorrow for them. Rarely, parents or spouses are rewarded by great artistic or intellectual achievement, which does not necessarily reduce the pain that the volatile cyclothymes bring to them.
American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Publishing.