Cyclothymic Disorder is a chronic bipolar
disorder consisting of short periods of mild depression and short periods
of hypomania (lasting a few days to a few weeks), separated by short periods
of normal mood. Individuals with Cyclothymia (thymia: from the Greek
word for the mind) are never free of symptoms of either depression or hypomania
for more than two months at a time. In 1980 the classification of
Cyclothymia was changed in the DSMV-IV from Personality Disorder to Mood
Though the above description portrays Cyclothymia
as a mild disorder, it is so only relative to the severity of Bipolar I
and Bipolar II disorders. Cyclothymia can completely disrupt the
life of an individual and create personal chaos. In their continual
oscillation of mood, they never know from one day to the next what to expect.
Incidence of Cyclothymia
Equally common in men and women, cyclothymia
affects 0.4 to 1 percent of the population. Most commonly the disorder
begins in the teens or early twenties. Eventually approx 30 percent
of individuals with cyclothymia experience a full-blown manic episode or
major depression, and their diagnosis is changed to Bipolar I or II.
Genetic factors appear to be causative in
Cyclothymia as they do in the Bipolar Disorders. Many of those affected
have a family history of major depression, bipolar disorder, suicide or
Zigzagging from periods of elation to gloom
Unable to maintain enthusiasm for new projects
due to mood changes
Personal Relationship Problems due to influence
of moods causing a constant "pulling close and pushing away" of emotions
Abrupt changes in personality from cheerful,
confident and energetic to sad, blue or "mean"
Sleep difficulties are prominent, with affected
persons sleeping little during hypomania, and "unable to get out of bed"
Self medication with alcohol or illegal drugs
In a word cyclothymia seems to sabotage a
person's opportunity for a stable life.
According to DSMV-IV a diagnosis of Cyclothymia
is based on the following:
1. Individual has had many periods of both
hypomania and depression, for a period of at least 2 years.
2. Individual has experienced no periods
of normal mood lasting longer than two months.
3. Individual has experienced no major
depression, manic or mixed episode during the first two years of symptoms
4. Symptoms are not attributable to either
Schizophrenia or Psychotic Disorder
5. Symptoms are not due to effects of medication,
illicit drugs or medical condition.
6. Individual experiences significant distress
or impairment in daily living.
Treatment of Cyclothymia
In some cases individuals may prefer no treatment
or supportive psychotherapy alone. Couples or Family therapy is often
sought to help with the problems in relationships brought on by the disorder.
In addition, lithium, a mood stabilizer used
commonly in the treatment of Bipolar Disorder, has been proven to help
a substantial number of people with Cyclothymia.
Imagine if You Will
I am going to create a small story to illustrate
the impact of Cyclothymia, both on an individual and on those close to
him. This is a fictional story about Mark and Diane. Mark has
Mark and Diane met at a time when Mark was
in a hypomanic mood. He was charming and attentive, constantly surprising
Diane with small gifts and tokens of his love. His courtship of her
was a whirlwind of phone calls, dates and promises of love everlasting.
Diane found him irresistible and soon found herself deeply in love with
him. Both were working at good jobs making decent money and in a
short few weeks decided to marry, and a honeymoon cruise was planned.
During this time Mark's mood had shifted to normal, but he loved Diane
and the marriage took place.
Though Mark struggled hard to hide it, he
became depressed while on the cruise ship, withdrawn and indifferent not
only to the events taking place on the cruise, but to Diane. It seemed
all he wanted to do was sleep, and made excuses to her that he was exhausted
after the events of the past two months. Diane tried to understand,
but she was hurt, especially when he would say things like "Please just
leave me alone. Go have some fun."
The morning before the cruise was to end
Mark woke up a totally different person. Exuberant and full of excitement
about making their last days special and memorable ones. Diane was
thrilled - she had "her Mark" back (or did she?)
Diane would soon learn that this was just
a taste of things to come. Twice in the next months Mark lost excellent
jobs, once because he was unable to get out of bed for several days and
failed to call in and once because he decided he knew better than his boss.
When he was depressed he was disinterested in working and gave no thought
to finances. Diane worried about the bills and he would be angry
if she tried to talk to him. Then before she knew it he was on top
of the world. At such times he was wonderful with her, but Diane
felt she was a ship at sea without an anchor. She never knew what
Neither did Mark. He was as much at
mercy to his moods as Diane was. Yet, he couldn't truly understand
why she was so upset. Mark didn't see anything aberrant about his mood swings
- he had had them for years and thought it was normal for people
to go through them.
Things came to a head one night when Mark
arrived home, escorted by two police officers and charged with DUI.
Diane gave him an ultimatum. Either they seek help or she was leaving
At the first appointment with the doctor
Mark informed him that he was there at the insistence of his wife - that
there was nothing wrong with him - and that he needed no help. The
I wonder if this story has a happy ending?