The primary characteristic of cyclothymic disorder is a chronically fluctuating state of mind. We all know someone who has drastic mood swings, going from sadness to joy in a matter of days. Well, these people may be suffering from cyclothymic disorder.
The mood of a person with cyclothymic disorder fluctuates between states of dramatic “happiness” and depressive states. That is, there is a marked change of mood that most people would not consider “normal.”
Now, it’s important to distinguish cyclothymic disorder from bipolar disorder. Bipolar disorder is more serious because its symptoms are more severe. In cyclothymic disorder, the patient won’t have any episodes which meet the criteria for a major depressive, manic, or hypomanic episode (DSM-V).
Criteria for cyclothymic disorder
According to the DSM-V, the diagnostic criteria for this condition are the following:
A. Presence of numerous periods of hypomanic symptoms and depressive symptoms that do not meet the criteria for a major depressive episode over the period of at least two years.
Note: In children and adolescents, the duration is at least one year.
B. During a period of two years or more (1 year for children or adolescents), the person has not stopped presenting symptoms for more than two months at a time.
C. No major depressive episode, manic episode, or mixed episode occurred during the first two years.
Note: After the initial two years of cyclothymic disorder, there may be manic or mixed episodes superimposed on the cyclothymic disorder. In this case, both cyclothymic and bipolar I disorder are the diagnosis. Or, the individual could experience major depressive episodes (in which case cyclothymic disorder and bipolar II disorder are diagnosed).
D. The symptoms of criterion A are not explained by the presence of a schizo-affective disorder. Nor are they superimposed on schizophrenia, a schizophreniform disorder, a delusional disorder, or an unspecified psychotic disorder.
E. Symptoms are not due to the direct physiological effects of a substance (i.e. a drug or medication), or a medical illness (i.e. hyperthyroidism).
F. Symptoms cause clinically significant discomfort or impairment in social, occupational, or other important areas of the individual’s activity.
As we said at the beginning, cyclothymic disorder consists of a chronically fluctuating alteration of an individual’s state of mind. It involves numerous periods of hypomanic symptoms and periods of depressive symptoms, differentiated from each other. Hypomania means exalted moods that do not reach the level of manic, but do cause irritability and mild compulsive attitudes.
The symptoms of hypomania go unnoticed most of the time. First, because the patient himself feels stable. Second, because it doesn’t always cause a significant deterioration in their work, family, or social environment.
Complicating the diagnosis even more, it is easy to confuse hypomania with just “happiness” or slight hyperactivity. Mania, on the other hand, is defined as a counterpoint to depression. The patient is euphoric and exalted.
Also, in cyclothymic disorder, depressive symptoms are insufficient in number, severity, generalization, or duration to meet the criteria of a major depressive episode. Cyclothymic disorder is only diagnosed if the criteria of major depressive, manic, or hypomanic episodes are not met. This is very important, because it is what distinguishes it from bipolar disorder.
Development and course of cyclothymic disorder
Cyclothymic disorder usually begins in adolescence or early adulthood. Scientists sometimes consider it to reflect a temperamental predisposition towards other bipolar disorders. The onset of cyclothymic disorder is usually gradual, and the course is persistent. There is a 15-50% risk that a patient with cyclothymic disorder will subsequently develop bipolar disorder.
If the onset of hypomanic or depressive symptoms occurs in late adulthood, in order for a cyclothymic disorder diagnosis to be appropriate, one must clearly distinguish it from bipolar disorder and related disorders due to another medical condition (i.e. multiple sclerosis). In children with cyclothymic disorder, the average age of onset is six and a half years.
To sum up, cyclothymic disorder is like the younger brother of bipolar disorder. There is a marked change in mood, to an extent that it isn’t considered normal but not as drastic as in bipolar disorder.
American Psychiatry Association (2014). Manual diagnóstico y estadístico de los trastornos mentales (DSM-5), 5ª Ed. Madrid: Editorial Médica Panamericana.