Cyclothymic Disorderhttps://www.psychologytoday.com/us/conditions/cyclothymic-disorderCyclothymic disorder is a milder form of bipolar disorder,
characterized by episodes of hypomanic symptoms (elevated mood and euphoria) and depressive symptoms that last for at least two years.DefinitionCyclothymic disorder, a mild form of bipolar disorder, is characterized by
chronic, fluctuating mood swings—from symptoms of depression to symptoms of hypomania. These symptoms are not sufficient in number, severity, or duration to meet the full criteria for a hypomanic or depressive episode.Hypomania involves periods of elevated mood, euphoria, and excitement but does not disconnect a person from reality. A person with cyclothymia experiences symptoms of hypomania but no full-blown manic episodes.
Hypomania may feel good to the person who experiences it and may lead to enhanced functioning and productivity. Thus, even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that a problem exists. Without proper treatment, however, hypomania can become severe mania or can turn into depression.
For cyclothymic symptoms to be diagnosed, hypomanic symptoms and depressive symptoms must be present at separate times for at least two years. Approximately 0.4 percent to one percent of people will experience cyclothymia in their lifetime. The disorder usually begins in adolescence or early adulthood, and there is a 15 percent to 50 percent risk that a person with cyclothymic disorder will go on to develop bipolar I disorder or bipolar II disorder.
This rate of risk is still too low to justify viewing cyclothymia as merely an early manifestation of bipolar type I disorder, as many people do recover and do not experience future symptoms of hypomania or depression. Cyclothymic disorder is equally common in males and females.
SymptomsFor at least two years (one year for children and adolescents), the individual displays periods of hypomanic symptoms and periods of depressive symptoms that do not meet criteria for a hypomanic or major depressive episode.
Hypomanic symptoms are similar to manic symptoms but are shorter in duration and not as severe.
Signs and symptoms of hypomania include:
Increased energy, restlessness, and activity
Excessively "high," overly good, euphoric mood
IrritabilityRacing thoughts and speech, jumping from one idea to another
Distractibility, inability to concentrateBeing more talkative than usual or feeling pressure to keep talking
Needing little sleepUnrealistic beliefs in one's abilities and powers
Poor judgment
Spending spreesA lasting period of behavior that is different from usual
Increased sex driveAbuse of drugs, particularly cocaine, sleeping medications, and alcohol
Provocative, intrusive, or aggressive behavior
Denial that anything is wrongA hypomanic episode is diagnosed if elevated mood occurs alongside three or more other symptoms most of the day, nearly every day, for four days or longer. If the mood is irritable, four additional symptoms must be present. A manic episode is diagnosed if symptoms continue for one week or longer.
Depressive symptoms include:
Persistent sadness
Fatigue or listlessnessExcessive sleepiness OR inability to sleep
Loss of appetite and weight loss OR overeating and weight gain
Loss of self-esteem
Feelings of worthlessness, hopelessness and, or, guilt
Difficulty concentrating, remembering, or making decisionsWithdrawal from friends
Withdrawal from activities that were once enjoyedPersistent thoughts of death
An individual may 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 any manic or mixed manic episodes.
The disorder does not exist only in the context of a psychotic disorder.
Symptoms are not directly a result of a medical condition or substance usage.
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 with cyclothymic disorder are also more likely to have attention-deficit/hyperactivity disorder than other pediatric patients.
CausesThe cause of cyclothymic disorder is unknown. Although mood swings are irregular and abrupt, the severity of the mood swings is far less extreme than in people with bipolar disorder (manic-depressive illness). Unlike with bipolar disorder, periods of hypomania do not turn into mania, in which the person may lose control over his or her behavior and go on spending binges, engage in risky sexual behavior or drug use, and lose touch with reality.
Hypomanic periods are energizing and can result in productivity for some people, while for others these periods can cause impulsive and callous behavior, which can damage relationships. Because hypomania feels good, people with cyclothymia may not seek treatment.To understand the causes of cyclothymia, it may be useful to explore the causes of bipolar disorder.
Most scientists now agree that there is no single cause of bipolar disorders—rather, many factors act together to produce these conditions. It is known, however, that
major depressive disorder, bipolar I disorder, and bipolar II disorder are more common among close biological relatives of individuals with cyclothymic disorder.
Because
bipolar disorders tend to run in families, researchers search for specific genes that may increase an individual's chance of developing the illness. But genes are not the whole story. Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop it, and this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop it than is another nontwin sibling.
Bipolar disorder, like other mental illnesses, does not occur because of a single gene. It appears likely that many different genes act together, and in combination with other factors of the individual or in the individual's environment. Finding these genes, each of which contributes only a small amount toward the likelihood of bipolar disorder, has been extremely difficult. But scientists expect that advanced research tools currently in use will lead to more effective treatments.