Cyclothymia
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Cyclothymia


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 Disorder.

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.

Causes

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 alcohol/drug dependence. 

Symptoms

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" during depression.

Self medication with alcohol or illegal drugs common.

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 Cyclothymia.

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 to expect.

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 him.

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 doctor disagreed.

I wonder if this story has a happy ending?
 
 
 

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