The cyclothymic disorder , also known as cyclothymia, is a relatively mild form of bipolar II disorder characterized by mood swings that may seem almost within the normal range of emotions , these mood swings ranging from mild depression or dysthymia mania low intensity or hypomania.
It may go undiagnosed, and people with the disorder may not know they have a treatable disease. People can experience episodes of low-level depression, known as dysthymia; periods of intense energy, creativity and / or irritability, known as hypomania or can alternate between the two moods.
Like other bipolar disorders, cyclothymia is a chronic illness characterized by mood swings that can occur as frequently as every day and last for several days, weeks, months, or up to two years. People with this disorder are never symptom-free for more than two months at a time.
People with cyclothymic disorder differ in the relative proportion of depressive versus hypomanic episodes they experience. Some individuals have more frequent depressive episodes, while others are more likely to feel hypomanic. Most people seeking help for the disorder alternate between feelings of mild depression and intense irritability, those who feel energized and creative when hypomanic, and who find their low emotional periods tolerable, may never seek treatment.
History of cyclothymic disorder
In 1882, Karl Ludwig Kahlbaum identified a disorder characterized by recurring mood cycles, the disorder contained both melancholic and manic episodes that occurred in a milder form than in bipolar disorder . This condition was coined as “cyclothymia” by Kahlbaum and his student Ewald Hecker, developed his theory of cyclothymia through his work with people presenting with symptoms at the Kahlbaum Sanitarium in Goerlitz, Silesia (Germany).
He was recognized as a prominent hypnotherapist and psychotherapist of his time, he was a progressive in the field of mental health, believing that mental illness should not have a stigma and that people who face mental health problems should be treated humanely. Kalhbaum was the first to recognize that people with cyclothymia often do not seek help for the disorder due to their mild symptoms.
The disorder has been conceptualized in various ways, including as a subtype of bipolar disorder, a temperament, a personality trait, and a personality disorder, there is also the argument that cyclothymia should be considered a neurodevelopmental disorder. In the past, cyclothymia has been conceptualized to include features other than the flow between depression and hypomania, such as mood reactivity, impulsivity, and anxiety .
Symptoms of cyclothymic disorder
For at least two years (one year for children and adolescents), the individual exhibits periods of hypomanic symptoms and periods of depressive symptoms that do not meet the criteria for a hypomanic or major depressive episode.
Hypomanic symptoms are similar to manic symptoms but are shorter in duration and not as severe, these include:
- Increased energy, restlessness, and activity.
- Excessively “high” euphoric mood.
- Strange thoughts.
- Distraction, inability to concentrate.
- More communicative than usual.
- Unrealistic beliefs in abilities.
- Lack of criteria.
- A lasting period of behavior that is different than usual.
- Increased sexual desire.
- Drug abuse, particularly cocaine, sleeping pills, and alcohol.
- Provocative, intrusive, or aggressive behavior.
- Denial that something is wrong.
A hypomanic episode is diagnosed if elevated mood occurs along with three or other symptoms most of the day, almost every day, for four days or more. If the mood is irritable, four additional symptoms should be present. A manic episode is diagnosed if symptoms continue for a week or more.
Depressive symptoms include:
- Persistent sadness
- Fatigue or apathy
- Excessive drowsiness or inability to sleep.
- Loss of appetite and weight loss or overeating and gaining weight.
- Loss of self-esteem.
- Feelings of worthlessness, hopelessness and / or guilt.
- Difficulty concentrating, remembering, or making decisions.
- Retreat from activities once enjoyed.
- Persistent thoughts of death.
An individual can be diagnosed with cyclothymic disorder if:
- During the two-year period (one year for younger patients), symptoms are not absent for more than two consecutive months.
- The patient has never had a major depressive episode or manic or mixed mania episodes.
- The disorder does not exist only in the context of a psychotic disorder.
- The symptoms are not directly the result of a medical condition or substance use.
- Symptoms result in significant distress or impaired functioning in social, work, or personal areas.
It is not uncommon for people with cyclothymic disorder to also have diagnoses of substance-related disorders and sleep disorders . Children are also more likely to have attention deficit / hyperactivity disorder than other pediatric patients.
Causes of cyclothymic disorder
Controversy exists as to whether it is really a mood disorder in biological or psychological terms, or whether it belongs to the class of disorders known as personality disorders . Despite this controversy, most of the biological and genetic research evidence supports the placement of cyclothymia within the category of mood disorders.
Genetic data provide strong support that it is indeed a mood disorder, around 30% of all cyclothymia patients have a family history of bipolar I disorder, which involves full-blown manic episodes alternating with periods of relative emotional stability .
Complete depressive episodes are often, but not always, part of the picture in bipolar I disorder . Reviews of family histories of patients with bipolar I disorder show a trend toward illnesses that alternate from generation to generation: bipolar I in a generation, followed by cyclothymia in the next, followed again by bipolar I in the third generation.
The overall prevalence of cyclothymia in families with bipolar diagnoses is much higher than in families with other mental disorders or in the general population, it has been reported that about a third of patients with cyclothymic disorder subsequently develop a major mood disorder .
Most psychodynamic theorists believe that the psychosocial origins of cyclothymia lie in early trauma and unmet needs dating back to the early stages of childhood development. Hypomania has been described as a deficiency of self-criticism and an absence of inhibitions, it is believed that the patient uses denial to avoid external problems and internal feelings of depression and that hypomania is frequently triggered by a deep interpersonal loss.
The false sense of euphoria (giddy or intense happiness) that arises in such cases serves as a protection against painful feelings of sadness, and possibly even anger against the lost loved one.
What are the treatments for cyclothymic disorder?
Cyclothymia is a chronic disease that will require lifelong treatment, if you stop taking medications, even during periods of remission, your symptoms will return. Because cyclothymia can turn into bipolar disorder, it is crucial that you receive proper treatments, alcohol and drug use can also increase your symptoms.
The main types of medications used to treat cyclothymia include:
- Mood stabilizers such as lithium.
- Anti-seizure medications, include divalproex sodium (Depakote), lamotrigine (Lamictal), and valproic acid (Depakene)
- Atypical antipsychotic medications such as olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal) can help patients who do not respond to antiseizure medications.
- Anti-anxiety medications such as benzodiazepine.
Antidepressants should only be used in conjunction with a mood stabilizer as they can cause potentially harmful manic episodes when taken on their own.
The behavioral therapy cognitive focuses on identifying negative beliefs and behaviors or unhealthy and replace them with positive or healthy, can also help you manage stress and develop coping techniques.
Wellness therapy focuses on improving overall quality of life rather than correcting specific psychological symptoms. A recent clinical study found that a combination of cognitive behavioral therapy and wellness therapy brings significant improvements in the lives of cyclothymia patients.
Other types of therapy that can benefit patients include talk, family, or group therapy.
Cyclothymic disorder vs. Bipolar Disorder: What’s the Difference?
Only a doctor can accurately make the clinical distinction between cyclothymia and bipolar disorder, but in general, the symptoms of major bipolar depression are debilitating and can include the inability to get out of bed, feeling overwhelmed or unable to make even simple decisions, and having obsessive thoughts, especially about loss, personal failure, or guilt. These symptoms, which can be long-lasting, affect your ability to function and can dramatically reduce your quality of life.
The same types of symptoms can be present in cyclothymic depression, but they are less severe in degree (although they can have a significant impact on quality of life and social functioning). Cyclothymic symptoms can last no more than two weeks and can cause fewer disruptions to your daily routine.
The true mania of bipolar disorder, essentially the opposite of major depression , can also be debilitating and can be accompanied by feelings of euphoria and indestructibility, a feeling of being on top of the world, which can include reckless behaviors, such as driving too fast. or abusing drugs or alcohol.
A manic person can go a day or two without sleep, they can talk quickly, going from one topic to another without making much sense. The symptoms of hypomania seen with cyclothymia are less dramatic and do not last as long, they can be so mild that they appear normal: mild insomnia , for example, or shyness and increased energy.
While some people living with cyclothymia are happy not to be treated, it may be important for others to recognize and monitor the condition – there is an estimated 15 to 50 percent risk that people with cyclothymic disorder may develop bipolar disorder full. This escalation is especially common if bipolar disorders run in the family.
Although preventive treatment has yet to be identified, there is some hope among researchers that early treatment of cyclothymia may prevent the development of full-blown bipolar disorder.
How to live with cyclothymic disorder?
Less than half of the people living with cyclothymia develop bipolar disorder, in most cases, it is a chronic disorder that continues to be prevalent throughout life and in others, it seems to dissipate and resolve over time.
The effects of cyclothymia can be detrimental to social, family, work and romantic relationships. Additionally, the impulsivity associated with hypomanic symptoms can lead to poor life choices, legal problems, and financial difficulties. Research has also shown that if you have a cyclothymic disorder, you are more likely to abuse drugs and alcohol.
To lessen the negative effects of cyclothymia in your daily life, take your medications as directed, do not use alcohol or take recreational drugs, track your mood to provide helpful information to your mental health provider on the effectiveness of the treatment, getting enough sleep, and exercising regularly.
Hello, how are you? My name is Georgia Tarrant, and I am a clinical psychologist. In everyday life, professional obligations seem to predominate over our personal life. It's as if work takes up more and more of the time we'd love to devote to our love life, our family, or even a moment of leisure.