By David Joel Miller.
Cyclothymia, Bipolar and Substance Abuse.
Cyclothymia is generally seen as a milder, subclinical form of Bipolar disorder. If it is the milder form we would expect to see a lot more Cyclothymia than Bipolar disorder. We don’t. So why and what is Cyclothymia?
A person with Cyclothymia is considered to be “temperamental, moody, unpredictable inconsistent and unreliable” (DSM-4-TR.) Cyclothymia seems to also be related to or overlaps Borderline personality disorder. Genetic risk factors as well as environment and learning may all play a role in creating Cyclothymia.
Cyclothymia, per the DSM, is a disorder characterized by chronic mood swings that do not meet the criteria for Bipolar disorder. Most mental illnesses require that the person to get the disorder experience a specific number of symptoms from a list of symptoms.
To be Bipolar I disorder you must have had a manic episode. For Bipolar Two, there must be a hypomanic (near manic) episode. That means that the person in addition to having an episode of elevated mood for at least 4 days must also have 4 of 7 listed symptoms. What if they only have three symptoms or if they have five “almost” symptoms. The way we count symptoms and who does the counting makes a lot of difference.
Cyclothymia waves the 4 day rule but requires that the mood swings go on over at least two years. (We make that one year in children.) So for over two years the person needs to keep having episodes of depression and episodes of almost hypomania but never reaching the full criteria for depressive or hypomanic episodes.
My experience says that no diagnosis, no treatment, unless you have the money to pay and the motivation to push, like having an overly moody child. So rather than wait the whole year for a child or two years for an adult before treatment is begun, people with these almost hypomanic therefore almost Bipolar diagnoses end up with the label Bipolar NOS or Mood Disorder NOS.
The statistics seem to bear that out. Estimates of the prevalence of Cyclothymia run from 4 to 6 people per 10,000. Bipolar One and Two are in the range of 50 to 150 people per 10,000. Meaning that Cyclothymia despite being thought of as mild Bipolar is much rarer. Mostly Cyclothymia gets diagnosed in people who have suffered for a long time – the full two years before something happened that sent them to treatment.
The criteria say someone with Cyclothymia should be experiencing “almost” depression, mania, or hypomania most of the time over those two years. Those episodes should all be just short of the Bipolar or Major Depressive disorder diagnosis but should cause a lot of distress. There also cannot ever be two months when you don’t have mood swings or we don’t think you meet criteria for Cyclothymia.
To be Cyclothymia you should never have had any psychosis, which includes both hallucinations and severe delusional symptoms. And these symptoms can’t be the result of a medical condition.
Medications and Drugs can cause this.
It is not just street drugs but medications, prescribed and over the counter medications, that can cause Hypomania. Failure to sleep has been reported to cause hypomania and some overlooked products can cause the lack of sleep that induces mania.
Stimulants can interfere with sleep and that includes most of the medications for ADHD. But there is a bigger worry in children.
I feel certain I have seen sleep disruptions, and resulting mood disturbances in kids who take in excessive caffeine. Energy drinks are a problem in teens but the little ones, the preschoolers and the early grade student are also at risk.
Most sodas contain not just obesity causing sugar but massive amounts (relative to body weight) of caffeine. That huge amount of caffeine per pound of body weight causes sleep disruption and sleep disturbances which may be causing mood swings and even inducing Bipolar disorder.
The DSM-5 will tighten up the exclusion for any Drug or medication induced hypomania.
Environmental and learned factors
Some of these symptoms, the swings between depression and hypomania look a lot like what we see in children from abusive, neglectful or deprived backgrounds. Adult children of Alcoholics report that one time they would do something and be praised or rewarded for a behavior, the next time they might get hit.
Inconsistent environment would encourage you to be depressed and anxious at times and when it was safe to possible go overboard at seeking pleasure. So being sort of hypomanic could be adaptive in a dysfunctional environment.
Cognitive Behavioral therapy has been reported as effective in treating people diagnosed with Cyclothymia. This suggests to me that some of these symptoms are learned and that there are core beliefs or schemas supporting this fluctuating mood way-of-being.
There are a host of other factors that influence the expression of Cyclothymia. Sleep changes can trigger changes in mood but so can changes in eating. Social support systems and the level of stress all contribute to mood swings.
Studies of Cyclothymia have the same defects as studies of other mood and anxiety disorders. People who act out and get arrested don’t get included in studies. Neither do people with drug or alcohol problems or those who are suicidal. Psychosis and delusions also get you kicked out of research. So those most likely to really be impaired by Cyclothymia are most likely to be excluded.
Information on Bipolar, Hyperthymia, Cyclothymia, Depression and other Mood disorders is scattered through this blog and I will continue to add to those posts. Check the categories list to the right. To make Bipolar Family posts easier to find there soon will be a separate post devoted to links on this blogs and others places on the subjects of mood disorders.
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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books