What is Cyclothymia?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

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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, in order to get the disorder must 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 the 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 bodyweight 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.

An inconsistent environment would encourage you to be depressed and anxious at times and when it was safe to possibly 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 blog and other places on the subjects of mood disorders.

Staying connected with David Joel Miller

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5 thoughts on “What is Cyclothymia?

  1. I doubt this is going to get any response since the post was made so many years ago now, but I have to ask just in case.

    I found out today that the diagnosis the psychiatrist gave me a long while ago (but never told me, just pushed drugs and nothing else really) is for cyclothymia, however I am very confused about why I have been given that diagnosis. I was of the understanding that it is a milder condition than Bipolar Disorder and that most people with it lead relatively normal lives and are able to function relatively normal (in comparison to someone with a “worse” diagnosis of BP1 or BP2) and that it does not include hallucinations, nor actual full blown manic or depressive symptoms.
    But I have had plenty of hallucinations (both visual, auditory and physical e.g. feeling something brushing up against me which isn’t there as I’m the only one in the room) and have had psychoses too. Both of these things were mentioned to the psychiatrist. I have also had full blown manic symptoms (I’ve met practically every criteria in BP1 for the symptoms) its just that the length of the symptoms may not be consistent. I’ve also had several suicide attempts and have suffered with suicidal thoughts on a near constant basis since young childhood. The first suicide attempt was actually me trying to throw myself out of a moving car whilst I was still using a booster seat. And I had to be younger than 6-7 years old as my Mum was not pregnant at the time and my brother had not been born either. So yeah…. Not quite sure how that can’t be full blown depression or full blown mania.
    My problem seems to be that I do experience several episodes of mania and depression per year. So maybe that is why they didn’t want to diagnose me with either form of bipolar? The first psychiatrist I saw wouldn’t listen to me when I tried to describe my manic symptoms. She just said that since I had never had a credit card, I couldn’t possibly have mania. She ignored the fact that I had been a student with thousands of pounds worth of student loan debt and was at the bottom of a £1600 student overdraft. Nowhere would give me a credit card and I had tried!

    I just don’t see how I can be cyclothymic and yet experience hallucinations and delusions. I thought I could fly on more than one occasion. One time I was believing it so much that I tried to fly out of a window. Luckily the window was shut so all I got was a very sore head from running head first into it, but had it been open, I’d have fallen from the second floor of the house, which could have done quite a bit of damage even if it wasn’t quite high enough to lead to death. If I had got up enough speed from running towards the window, I could even have ended up falling further out and ended up landing on a busy main road. As it is, I ended up with the sore head and spent the next 4 hrs laughing hysterically to myself about the whole situation.
    I did tell this to the psychiatrist. So maybe its not reason for concern? I don’t know. I’m just not sure cyclothymia fits me that well.


    • Thanks for writing. Even though the posts were from some time back, yes I try to monitor them and respond. Just sometimes it takes me longer than others as counselorssoapbox.com is a one man operation. As your comment indicates diagnosis has been and continues to be a subjective endeavor. Professionals sometimes have to make “judgment calls” when a clients presentation does not exactly fit the official list of symptoms. One thing that may influence the diagnosis is the “indications” a medication is listed for. If you are prescribed a medication the doctor is included to diagnose you with the disorder that med is supposed to treat. Number of symptoms can change from visit to visit and that may change the clinicians assessment. Not knowing you and just looking at the things you put in your email I would think Cyclothymia is a lot too mild a diagnosis for the symptoms you have described. Remember it is possible to have more than one diagnosis. Most clients meet criteria for from 3 to 4 disorders. My suggestion to you is to get another opinion and then follow the treatment program that most seems to help. Whatever treatment you are on, medication and or therapy, stick with it. Constantly changing can do more harm than good. Hope you find a treatment that works for you.


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