What is Cyclothymic Disorder?

Cyclothymia is a mood disorder that’s often challenging to pinpoint due to its vagueness and potential overlap with several other conditions. It’s marked by highs and lows that don’t reach the severity of bipolar or major depressive disorder. On top of that, people with this disorder often start showing signs early in their lives, such as moodiness and difficulty in managing their emotions. Part of what makes cyclothymia difficult to identify is that it falls within the bipolar mood disorders category according to current diagnosis guidelines, and it’s somewhat similar to some personality disorders in its early onset, chronic progression, and lasting effects on a person’s daily life. This similarity often leads to confusion and misdiagnosis.

The disorder, like many other psychiatric conditions, can cause significant distress and problems in a person’s life. However, the cause-effect relationship is typically one-way, meaning while other disorders can appear alongside cyclothymia, they aren’t induced by it. For example, substance use disorders can occur in the same person with cyclothymia, but addiction issues aren’t the cause of the mood disorder.

While cyclothymia may seem puzzling, a careful evaluation can help healthcare professionals identify this disorder. If a patient is showing signs of emotional instability and they’re struggling to make a diagnosis, it’s important to consider cyclothymia. Doctors should also watch for alternating activity levels, intense sensitivity, heightened emotional reactions, and difficulties in relationships, which could point towards a cyclothymia diagnosis. This simplified explanation is designed to help improve understanding of this frequently misunderstood and incorrectly diagnosed condition.

What Causes Cyclothymic Disorder?

Bipolar disorders, which are thought to include cyclothymia, are believed to be caused by a combination of genetic factors, imbalances in brain chemicals, and triggers in the environment.

Genes appear to play a significant role in cyclothymia, a form of bipolar disorder. This is supported by the fact that identical twins, who share the same DNA, have a 57% chance of both having the condition. Scientists are currently studying several specific areas of our DNA that could be linked to this condition, including sections called 18p11, 13q32, CLOCK genes, and ANK3.

Environment also plays a critical role in the development of bipolar disorders. Negative experiences and ways of thinking can increase the risk of emotional instability and difficulty managing emotions, which are key features of these conditions.

Risk Factors and Frequency for Cyclothymic Disorder

Cyclothymia, a type of mood disorder, affects about 0.4% to 1% of the population over their lifetime. Males and females are equally likely to be affected. However, rates may be higher in certain clinical settings, with some studies showing prevalence rates up to 5%.

Signs and Symptoms of Cyclothymic Disorder

Cyclothymia is a long-term condition that involves persistent changes in mood. People with this condition experience noticeable shifts between periods of feeling low (depressed) and high (elevated). Unlike other disorders within the bipolar spectrum, cyclothymia can cause quick back-and-forth shifts between feelings of extreme happiness and sadness. Potential symptoms of the “low” phase may include feeling down or irritable, feeling hopeless or helpless, having trouble sleeping, feeling tired, losing pleasure in activities, lacking motivation, harboring negative feelings, experiencing headaches, feeling weak, and having thoughts of suicide. Signs of the “high” phase can include acting impulsively, having an inflated sense of self-importance, racing thoughts, being more sociable, engaging in excessive physical activity, and talking excessively.

Feeling down or irritable
Feeling hopeless or helpless
Having trouble sleeping
Feeling tired
Losing pleasure in activities
Lacking motivation
Harboring negative feelings
Experiencing headaches
Feeling weak
Having thoughts of suicide
Acting impulsively
Having an inflated sense of self-importance
Racing thoughts
Being more sociable
Engaging in excessive physical activity
Talking excessively

Looking back at a person’s history, it will often show a continuous and pervasive pattern of emotional instability, extreme sensitivity, frequent interpersonal conflicts, instances of self-harm, episodes of excessive gambling, reckless sexual activity, multiple divorces, legal or financial troubles, and repeated job loss.

In less common cases, some individuals might experience their distress and anxiety as physical pain. Complaints might include chest pain, weakness, weight loss, hair loss, and headaches.

Testing for Cyclothymic Disorder

When performing a psychiatric evaluation, it’s important to first rule out any physical or organic issues. Standard laboratory tests and imaging studies are typically ordered by the clinician. These may include a complete blood count, a comprehensive metabolic profile, a thyroid panel, vitamin B-12, folate, ammonia, urinalysis, and brain imaging. This helps to uncover any underlying physical conditions that could be causing the symptoms.

It’s also important to check for any harmful effects from prescribed medications or illegal substances as these could mimic the symptoms of mental health disorders such as mania and depression. Conducting drug screens and reviewing medication profiles can aid in this process.

Once physical disturbances have been excluded, a thorough psychiatric exam will be performed. This involves investigating the current illness, previous psychiatric history, social history, substance use history, family’s psychiatric history, conducting a psychiatric review of symptoms, and carrying out a mental status exam.

Hagop Akiskal led early research in defining cyclothymia, a type of mood disorder, and created validated questionnaires for its diagnosis. These questionnaires are now used worldwide and have been translated into almost 20 languages.

Cyclothymia symptoms often overlap with manic, hypomanic, and depressive episodes but may not completely meet the criteria for these disorders. According to the DSM-5 psychological manual, a diagnosis of cyclothymia requires that these symptoms have been present for two years or more, with more good days than bad. Also, the mood must not have been stable for longer than two consecutive months. The symptoms must cause significant distress or impairment to the patient’s life, and cannot be a result of another mental or physical illness.

Treatment Options for Cyclothymic Disorder

Treating cyclothymia, which is a mood disorder, involves managing risk factors, noticing symptoms early, and using the right treatments that include education about the disorder, medication, and counseling. The main focus of these treatments is to tackle the constant emotional instability seen in those with the disorder.

Education about the disorder is critically important involving understanding why it’s necessary to take medication regularly, trusting your doctor, recognizing the impact of harmful behavior patterns, and accepting the fact that you have the illness.

Even though there are no officially approved medications by the FDA for treating cyclothymia, there are still effective options. The first step in medication treatment usually involves a mood-stabilizer. If anxiety is the main symptom, valproate may be used; if anxious-depression is more prominent, lamotrigine may be opted for; and for strong emotional intensity, lithium is often the choice.

For some people, a combination of lithium and lamotrigine might be helpful. Atypical antipsychotics (a type of medication) can also be used by themselves or along with a mood stabilizer. Research currently advises not to use antidepressants for cyclothymia as they can actually make symptoms worse.

In addition to medication and education about the disorder, cognitive-behavioral therapy (CBT) has shown promising results as the leading therapy for cyclothymia. Treatment plans should be adjusted according to individual needs, not based on preset guidelines.

As earlier mentioned, certain physical health issues can create symptoms that appear to be like those seen in cyclothymia. These disorders could be related to the endocrine system, immune system, or deficiencies in certain vitamins and electrolytes. Other causes can include infections, traumatic brain injuries, or even issues related to medications like steroids, levodopa, or antibiotics. Misuse or withdrawal from illegal substances can also trigger similar symptoms. Therefore, a detailed medical examination could help separate these physical health issues from primary mental health problems.

Once it’s confirmed that the symptoms are not due to other physical conditions or substances, the next step is for healthcare providers to rule out other mental health disorders. Cyclothymia can share similar symptoms with conditions like major depression, type II bipolar disorder, general anxiety disorder, neurodevelopmental disorders, and personality disorders.

A thorough mental health evaluation can help health professionals differentiate between these disorders when symptoms aren’t clear. There are also certain questionnaires or tools that can be used for a more objective evaluation. Some of these include the Beck Depression Inventory, Beck Anxiety Inventory, Bipolar Spectrum Diagnostic Scale, and the My Mood Monitor checklist.

What to expect with Cyclothymic Disorder

The future outlook for cyclothymia, a mood disorder, can differ from person to person. Due to the nature of this disorder, carrying out everyday tasks can be challenging without the right psychiatric help. It may lead to ongoing issues in personal relationships, work, and mental health due to traits such as over-sensitivity, difficulties in managing emotions, impulsive behavior, emotional reactivity, and low self-efficacy.

Several factors influence the potential outcome of cyclothymia, including a person’s coping mechanisms, personality factors, family support, and how quickly they start medication and therapy. On a more positive note, studies indicate that with adequate support and resources, people with cyclothymia can lead satisfying lives with minimal disruption.

Possible Complications When Diagnosed with Cyclothymic Disorder

This disorder can lead to a wide range of complications, which can vary greatly from person to person. These complications can be mild (like certain side effects of treatments) to severe, even leading to suicide. Common complications include an increase in mood swings brought on by the treatments and problems controlling emotions, which may lead to impulsive behaviour and substance abuse. In rarer cases, youth with this disorder could develop bipolar disorder in adulthood.

Common Complications:

Treatment side effects leading to increased mood swings
Problems with emotional control
Impulsive behaviour
Substance abuse disorders
In severe cases, the possibility of suicide
In rare cases, development into bipolar disorder in adulthood

Preventing Cyclothymic Disorder

Educating patients on their mental health condition, known as cyclothymia, is extremely crucial. It’s important for patients to understand and accept their condition, stick to their treatment plan, avoid harmful substances, and learn how to effectively manage crises. These steps greatly increase their chances of getting better. Additionally, counseling should help them gain a better understanding of their own mental health and develop the ability to think more deeply about their feelings and behaviors. This will enable them to better control their emotions and avoid spur-of-the-moment actions that might be harmful. Simply put, patients should understand that the key issue with cyclothymia lies in their emotional instability.