Cyclothymic disorder is a bipolar spectrum disorder subtype. When left untreated, it can result in comorbid mood disorders or substance abuse problems.
Cyclothymic disorder, also referred to as cyclothymia, is a subtype of bipolar spectrum disorder. This chronic mood disorder is characterized by frequent mood swings between hypomania and depression. Symptoms are not as severe as in bipolar disorder type I or type II; therefore, cyclothymia is considered as a sub-threshold form ofbipolar disorderand is sometimes referred to as bipolar III disorder.
Cyclothymia has an onset in early youth and is often underdiagnosed. Individuals suffering from cyclothymia are at substantial risk of developing full-blown bipolar disorder, other mood disorders and substance abuse disorders.
What Is Cyclothymic Disorder?
Cyclothymic disorder is defined by instability of mood, with regular mood swings fromhypomaniatodepressionand excessive sensitivity to both negative and positive stimuli. The switch between symptoms of hypomania and depression can be abrupt, and symptoms of hypomania may even be present during a depressive period.
Cyclothymic vs. Bipolar Disorder
Cyclothymic disorder differs from bipolar type I and type II disorders, not in terms of the types of symptoms presented but in terms of the severity and frequency of the symptoms. Cyclothymic disorder causes mild to moderate depressive and hypomanic states relative to those observed in bipolar type I and II. These symptoms also tend to be more chronic relative to other types ofbipolar disorder.
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Symptoms of Cyclothymic Disorder
Cyclothymic disorder is characterized by intense and rapid mood fluctuations between hypomanic and depressive states. The rapid changes in mood are irregular and unpredictable, with each episode of hypomania or depression often lasting less than a week. The presentation of cyclothymic symptoms in terms of mood fluctuations varies widely among patients. Some patients mostly show depressive symptoms with occasional periods of hypomania, while others show a shift between extreme highs and lows within the same day.
Hypomanic Symptoms
Hypomanic symptomsare generally characterized by increased irritability and impulsive behaviors, rather than a feeling of elation. Such hypomanic symptoms include:
- Increased restlessness
- Elevated self-esteem
- Impulsive behaviors, like reckless spending or sexual behavior
- Hostility, aggression and explosive rage
- Speech that may be hard to follow
- Increased motivation for various behaviors or goals
Depressive Symptoms
Depressive symptomsof cyclothymic disorder may include:
- Lethargy
- Low self-esteem with feelings of worthlessness and guilt
- High emotional sensitivity
- Sleeping longer than normal
- Feelings of insecurity
- Trouble concentrating
- Suicidal thoughts
Effect on Relationships
The intense moods and emotional reactivity of individuals with cyclothymic disorder can impede the formation of stable work and personal relationships. Cyclothymic patients tend to have low self-esteem and react to any criticism or judgment with excessive sensitivity. This emotional sensitivity may result in lingering feelings of anger and hostility toward the person responsible for the real or imagined offense.
Causes of Cyclothymia
The causes of cyclothymia are not very well understood. Genetic predisposition seems to play a role, with relatives of bipolar disorder patients having a higher likelihood of being affected by cyclothymic disorder. Besides heredity, biological and environmental (including social) factors also influence the expression of bipolar spectrum disorders, including cyclothymia.
Diagnosing Cyclothymic Disorder
Most cyclothymic patients are unlikely to seektreatment for the disorder. Furthermore, there is often considerable overlap between symptoms of cyclothymia and other disorders, making accurate diagnosis difficult.
According to the recently updatedDiagnostic and Statistical Manual of Mental Disorders(DSM-5), individuals are required to meet the following criteria to be diagnosed with cyclothymia:
- Presence of hypomanic and depressive symptoms for at least two years that do not meet the DSM-5 criteria forhypomaniaormajor depressive disorder
- Presence of the above symptoms at least half the time during the previous two years with any absences of symptoms not lasting for more than two months
- Absence of a previous history of diagnosis for a major depressive, manic or hypomanic episode
- The cyclothymic symptoms are not secondary symptoms of a different mental disorder
- Symptoms impair normal functioning in social and professional life and cause significant distress
Cyclothymic Disorder Statistics
Subthreshold forms of bipolar spectrum disorder, including cyclothymic disorder, are more common than bipolar type I (0.8%) or type II (1.1%) disorders. Currently, about 2.4% of adults live with cyclothymic disorder. While more research needs to be conducted, there is thought to be a 15–50% chance that someone with cyclothymic disorder will go on to develop bipolar I or bipolar II disorder.
Cyclothymia and Co-Occurring Disorders
Individuals suffering from cyclothymia tend to show high rates of comorbid or co-occurring disorders. Cyclothymic individuals exhibit mood instability and emotional reactivity that result in an increased risk for mood disorders that share the same temperamental tendencies, including anxiety disorders likepanic disorder,borderline personality disorderandattention-deficit hyperactivity disorder. It must be noted that whether these disorders are actually co-occurring is not clear since they share many of the same symptoms.
Cyclothymic patients are also more likely to have substance abuse problems involving drug and alcohol use. Impulsiveness that occurs during the hypomanic phase in cyclothymic patients may make these individuals more likely to develop impulse control disorders such as sex addiction, pathological gambling and binge eating disorder.
Cyclothymic Disorder Treatment
Cyclothymic disorder is a chronic disorder andlifetime managementof symptoms is necessary, even when symptoms are absent, to avoid relapse.Cyclothymic disorder treatmenttypically involves psychotherapy, lifestyle modifications and careful use of pharmacological drugs.Cognitive behavioral therapyis often used to help individuals cope with and overcome negative patterns of thoughts and behaviors. A cautious approach involving a low dosage of pharmaceutical drugs is also advised due to the rapid mood fluctuations between hypomanic highs and depressive lows. Mood stabilizers, such as lithium and quetiapine, tend to be more effective than antidepressants in the treatment of cyclothymic symptoms.
Because co-occurring substance abuse problemscan worsencyclothymia symptoms or interfere with their treatment, it is essential to address co-occurring substance abuse and cyclothymia symptoms simultaneously.
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