What Is Cyclothymia (Cyclothymic Disorder)? Definition, Symptoms, Treatment

Cyclothymia, also known as cyclothymic disorder, is a mental illness that has been defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) since 1980. It continues to be included in the latest version, the fifth edition of the DSM (DSM-5) under the category of bipolar and related disorders. In other words, cyclothymia is a type of bipolar disorder. According to some research, it may actually be the most prevalent form of bipolar disorder. Cyclothymic disorder appears to be more prevalent in youth. Both of these facts may relate to the fact that those with cyclothymia often go on to progress to bipolar disorder type I or II.

The bipolar disorder spectrum of disorders is thought to bridge the gap between schizophrenia spectrum disorders and depressive disorders in terms of symptomology, family history and genetics. Bipolar type I is closest to the schizophrenia spectrum disorders, bipolar disorder type II moves along the spectrum closer to the depressive disorders and cyclothymia is closer still.

Cyclothymic disorder causes aren’t known but it’s thought that cyclothymia is at least partially genetic, as it runs in families, is due to biological brain differences and is also due, in part, to environmental stressors such as traumatic experiences.

Cyclothymic Disorder vs Bipolar Disorder

In order to understand the definition of cyclothymic disorder, one must understand the states of mania, hypomania and depression. These are the states seen in bipolar type I and bipolar type II. The reason these states need to be understood is that it is symptoms from these states that occur in cyclothymia, but in cyclothymia, full-on mood episodes of mania, hypomania or depression are not present.

So, a diagnosis of cyclothymic disorder is given to individuals with periods of both hypomanic and depressive symptoms without meeting the full criteria for a manic, hypomanic or major depressive episode. Those who do meet the criteria for mania, hypomania or depression are diagnosed with other forms of bipolar disorder.

When looking at cyclothymic disorder vs bipolar disorder it’s also important to note that while suicidal thoughts can occur in cyclothymia, they are more likely to occur in bipolar disorder type I or bipolar disorder type II.

Cyclothymia Diagnostic Criteria and Symptoms

According to the DSM-5, a diagnosis of cyclothymia requires the following:

• Having many periods of elevated mood (hypomanic symptoms, see below) and periods of depressive symptoms (see below) for at least two years (one year for children and teenagers) — with these highs and lows occurring during at least half that time.
• Periods of stable moods usually lasting less than two months.
• Symptoms that significantly affect you socially, at work, at school or in other important areas.
• Symptoms that don't meet the criteria for bipolar disorder, major depression or another mental disorder.
• Symptoms that aren't caused by substance use or a medical condition.

According to Medscape, the DSM-5 defines hypomanic episodes as being an elevated, expansive (unrestrained emotional expression, often accompanied with an overvaluation of one’s importance or significance to others) or irritable mood of at least four consecutive days in duration that also includes at least three of the following symptoms:

• Grandiosity (an exaggerated belief in one’s importance) or inflated self-esteem
• Diminished need for sleep
• Pressured speech
• Racing thoughts or flight of ideas
• Clear evidence of distractibility
• Increased level of goal-focused activity at home, at work or sexually
• Engaging in activities with a high potential for painful consequences

The mood disturbance must be observable by others and not be as a result of substance abuse or a medical condition.

Manias have the same symptoms but are more severe and must last at least seven days.

In the case of cyclothymic disorder, then, some of these symptoms would be present, but a full mood episode – either mania or hypomania – as defined above, would not be.

According to Medscape, the DSM-5 defines depressive episodes (depressions; major depressions) as, for the same two weeks, experiencing five or more of the following symptoms, with at least one of the symptoms being either a depressed mood or characterized by a loss of pleasure or interest:

• Depressed mood
• Markedly diminished pleasure or interest in nearly all activities (also known as anhedonia)
• Significant weight loss or gain or significant loss or increase in appetite
• Hypersomnia or insomnia (too much or too little sleep)
• Psychomotor retardation or agitation (physical and psychological slowing or restlessness)
• Loss of energy or fatigue
• Feelings of worthlessness or excessive guilt
• Decreased concentration ability or marked indecisiveness
• Preoccupation with death or suicide; the patient has a plan or has attempted suicide

These symptoms must cause significant impairment and distress and must not be the result of substance abuse or a medical condition.

Again, for cyclothymia, some of the above symptoms would be present during a low mood but not enough of them to meet the criteria for a full, major depressive episode.

Cyclothymic Disorder Treatment

It’s important to know that cyclothymia is unlikely to get better on its own so medical cyclothymic disorder treatment is usually required and the earlier one starts treatment, the better.

If you have cyclothymic disorder, also be aware:

• Not treating cyclothymic disorder can cause problems in every area of life.
• Those with cyclothymia have a high risk of misusing substances.
• Those with cyclothymic disorder commonly also have anxiety disorders.
• Treating cyclothymia (particularly if done early) reduces the risk of progressing to a more severe version of bipolar disorder such as bipolar disorder type I or bipolar disorder type II.

Cyclothymic disorder requires lifelong treatment – even during periods where symptoms aren’t present. The main treatments for cyclothymia are medication and psychotherapy.

No medications are specifically approved by the Food and Drug Administration (FDA) to treat cyclothymic disorder. Medications that are used to treat other forms of bipolar disorder are typically used, however. That means medications like mood stabilizers (lithium), anticonvulsants (such as lamotrigine [Lamictal] or valproate [Depakote]) and antipsychotics (such as quetiapine [Seroquel] and the olanzapine/fluoxetine combination [Symbyax]) are common.

To treat cyclothymia with psychotherapy, the following may be considered:

• Cognitive behavioral therapy (CBT) – This common, time-limited therapy helps identify unhealthy beliefs and behaviors and replace them with healthy ones. Additionally, CBT works to identify what might trigger cyclothymic disorder symptoms. This therapy also teaches skills to help deal with stress.
• Interpersonal and social rhythm therapy – This type of therapy focuses on the creation of routine, particularly in the areas of sleeping, waking and eating.
• Other therapies – Other therapies do have some success in specific cases and your doctor or therapist can help assess which one is right for you.

While cyclothymia can seem like a frightening diagnosis, it’s important to know that with treatment, most people with cyclothymic disorder do go on to live healthy, productive lives.

Cyclothymic Disorder Test

While there is no specific test for cyclothymia, according to the Mayo Clinic, the following are the kinds of questions a healthcare provider would ask in order to determine cyclothymia as a diagnosis:

• How would you describe your symptoms?
• How have the people close to you described your symptoms?
• When did you or your loved ones first notice these symptoms?
• Have your symptoms been getting better or worse over time?
• If you have intense high and low periods, how long do they generally last?
• Do you also have periods where your mood feels relatively stable?
• How would you describe your mental and emotional state during high versus low periods? How would your loved ones answer this question about you?
• How would you say your choices and behaviors change during high versus low periods? How would your loved ones answer this question about you?
• Do your physical needs change during high versus low periods, such as your need for sleep, food or sex?
• How are these cycles affecting your life, including work, school and relationships?
• Have any of your close relatives had similar symptoms?
• Have you been diagnosed with any medical conditions?
• Have you been treated for other mental health disorders in the past? If yes, what type of treatment was most helpful?
• Have you ever thought about harming yourself or others?
• Do you drink alcohol or use recreational drugs? If so, how often?

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