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How to diagnose cyclothymic disorder

Affiliations

  • 1 Mclaren Greater Lansing
  • 2 South Carolina Department of Mental Health
  • PMID: 32491800
  • Bookshelf ID: NBK557877

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Authors

Affiliations

  • 1 Mclaren Greater Lansing
  • 2 South Carolina Department of Mental Health
  • PMID: 32491800
  • Bookshelf ID: NBK557877

Excerpt

Cyclothymia is a primary mood disorder that is connotated with great ambiguity and controversy. The primacy of the disorder is inherently nebulous as it shares diagnostic features with a multiplicity of disorders. Cyclothymia is characterized by episodes consisting of hypomanic and depressive symptoms that do not meet the full criteria for bipolar or major depressive disorder. Furthermore, its manifestations onset early in life, demonstrable via temperamental mood reactivity and dysregulation. The complexity of the disorder makes it difficult to identify in clinical practice. In DSM-5, it is subsumed under the category of bipolar mood disorders. Cyclothymia is somewhat analogous to personality disorders as its onset is early and its course is chronic and pervasive. In fact, cyclothymia is often misconstrued with cluster-B personality disorders. Because of overlapping diagnostic criteria, it can be easily misdiagnosed. As with other psychiatric disorders, it leads to dysfunction and distress. While many psychiatric disorders may precipitate in the setting of cyclothymic disorder, the reciprocal is not valid. For example, although often comorbid with substance use disorders, by definition, cyclothymia is not induced by substance use.

Although equivocal in nature, a detailed and careful evaluation can enable clinicians to uncover this sometimes subtle disorder. In the event, clinicians find themselves pulled in varying directions regarding the correct diagnosis of an emotionally dysregulated patient, consideration of cyclothymia should be paramount. In addition to emotional dysregulation, identification of oscillating levels of psychomotor activity, hypersensitivity, hyper-reactivity, and interpersonal dysfunction should hint towards a diagnosis of cyclothymia. This article will shed light on this misunderstood and often misdiagnosed disorder.

What Is Cyclothymia?

How to diagnose cyclothymic disorder

Cyclothymia, or cyclothymic disorder, is a rare condition that causes mood swings. Doctors consider it a milder form of bipolar disorder, meaning the highs and lows aren’t as extreme.

Cyclothymia isn’t common. Researchers say that fewer than 1% of people have it. But it’s hard to know exact numbers because it’s easy to miss the diagnosis. It has many of the same symptoms as depression and other mood disorders.

What Triggers Cyclothymia?

Experts aren’t sure what causes cyclothymia. It may be several factors together, including:

  • Genetics (Mood disorders like depression and bipolar disorder tend to run in families.)
  • The unique makeup of your brain
  • Your environment (Stress and trauma can trigger it.)

What Are Common Cyclothymia Symptoms?

You can usually go about your daily life when you have cyclothymia. However, you might cycle through moods quickly and without warning. You can’t know when you’ll feel one way or the other.

The name for the “high” in cyclothymia is hypomania. Symptoms include:

  • Extreme happiness
  • Overconfidence, overdrive to reach goals
  • Poor judgment and risky behavior
  • Racing thoughts, talking a lot
  • Irritation and agitation
  • Too much physical activity
  • Less need for sleep
  • Being easily distracted

The low side is mild depression. When you’re in this state, your symptoms include:

  • Feeling sad, empty, or hopeless
  • Crying easily
  • Irritability
  • Lack of interest in your usual activities
  • Weight changes
  • Feeling like you don’t matter
  • Feeling guilty
  • Trouble sleeping
  • Trouble sitting still or concentrating
  • Sluggishness
  • Thoughts of your death or suicide

How Do Doctors Make a Cyclothymia Diagnosis?

Diagnosing the disorder can take time. You may not seek help for it, especially since the depression is mild and the highs can feel good. To tell if you have it, your doctor will want to know how long and how regularly you’ve had mood swings. You may need to track your moods on paper so your doctor can get a better idea of what’s going on. Your doctor may give you a psychological test and talk to your friends and family to learn more about your behavior patterns.

It’s likely you have this disorder if:

  • It’s been happening for two years or more (or one year for kids or teens).
  • You haven’t had a steady mood for longer than two months.
  • Doctors have ruled out bipolar disorder, major depression, and other mental disorders.
  • You don’t have another condition or addiction that could explain your symptoms.
  • Your symptoms affect your job, social life, or relationships.

What Are Cyclothymia Treatment Options?

There’s no cure for cyclothymia. You’ll need to treat the symptoms for the rest of your life. Typical treatment involves:

  • Talk therapy with a trained therapist
  • Cognitive behavioral therapy (CBT), a type of talk therapy that involves changing your thought patterns and learning to respond differently to events and emotions
  • Interpersonal and social rhythm therapy (IPSRT), which focuses on making the patterns of your sleep, waking hours, diet, and exercise as steady as possible

The FDA hasn’t approved any medication just for cyclothymia. Your doctor may suggest you try medications for other disorders, such as:

  • Mood stabilizers
  • Depression medications
  • Medications for epilepsy
  • Bipolar disorder medications

Not treating your disorder can cause emotional problems down the road. It also raises your chances of:

If you find yourself thinking about suicide, call 911, go to a hospital to have a professional help you, or call the National Suicide Prevention Lifeline at 1-800-273-TALK.

(c)2019 WebMD, LLC. All rights reserved.

Cleveland Clinic: “Cyclothymia.” Mayo Clinic: “Cyclothymia (cyclothymic disorder).” NHS: “Cyclothymia.” American Psychiatric Association: “What Are Bipolar Disorders?”

Cyclothymia, or cyclothymic disorder, causes mood changes – from feeling low to emotional highs.

Cyclothymia has many similarities to bipolar disorder.

Most people’s symptoms are mild enough that they do not seek mental health treatment, or the emotional highs feel nice, so they do not realise there’s anything wrong or want to seek help.

This means cyclothymia often goes undiagnosed and untreated.

But the mood swings can affect daily life, and cause problems with personal and work relationships.

If you think you have cyclothymia, it’s important to seek help from a GP.

People with cyclothymia are at risk of developing bipolar disorder, so it’s important to get help before reaching this stage.

Men and women of any age can get cyclothymia, but it’s more common in women.

Symptoms of cyclothymia

If you have cyclothymia, you’ll have periods of feeling low followed by periods of extreme happiness and excitement (called hypomania) when you do not need much sleep and feel that you have a lot of energy.

The periods of low mood do not last long enough and are not severe enough to be diagnosed as clinical depression.

You might feel sluggish and lose interest in things during these periods, but this should not stop you going about your day-to-day life.

Mood swings will be fairly frequent – you will not go for longer than 2 months without experiencing low mood or an emotional high.

Symptoms of cyclothymia are not severe enough for you to be diagnosed with bipolar disorder, and your mood swings will be broken up by periods of normal mood.

Treatment for cyclothymia

Treatment usually involves medicine and some kind of talking therapy (psychotherapy).

  • stop the cyclothymia developing into bipolar disorder
  • reduce your symptoms
  • stop your symptoms coming back

You’ll probably need to continue this treatment for the rest of your life.

Medicines

You may be prescribed:

  • medicines to level out your mood (mood stabilisers)
  • antidepressants

Mood stabilisers include:

  • lithium – commonly used to treat bipolar disorder
  • anti-epileptic drugs – such as carbamazepine, oxcarbazepine or sodium valproate

Antidepressants may help improve your low moods, but they may cause you to switch to the other extreme of hypomania.

Recently, some antipsychotics such as quetiapine have also been used as mood stabilisers.

But not all people with cyclothymia respond to medicine.

The charity Mind has more information on lithium and other mood stabilisers.

Psychotherapy

Psychotherapy, such as cognitive behavioural therapy (CBT), can help with cyclothymia.

CBT involves talking to a trained therapist to find ways to help you manage your symptoms by changing the way you think and behave.

You’ll be given practical ways to improve your state of mind on a daily basis.

Further support for cyclothymia

You may also find it helpful to join a support group so you can talk to others who share your experiences and problems.

You can ask your mental health service or GP if there’s a local group you can join.

Other organisations that can help include:

Living with cyclothymia

It’s not known how many people with cyclothymia will go on to develop bipolar disorder.

But some people with cyclothymia see their elevated or depressed moods become more severe.

Other people will find their cyclothymia continues and they need to manage this as a lifelong condition.

Causes of cyclothymia

The causes of cyclothymia are not known, but there’s probably a genetic link because cyclothymia, depression and bipolar disorder all tend to run in families.

In some people, traumatic events or experiences may act as a trigger for the condition, such as severe illness or long periods of stress.

Page last reviewed: 10 December 2020
Next review due: 10 December 2023