What is Cyclothymia?

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

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

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

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Dysthymic Disorder –chronic sadness untreated

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

Depressed person

Depression.
Photo courtesy of Pixabay.com

Dysthymic Disorder, a forgotten Mood Disorder.

Mood disorders are separated into two groups, Depressive Disorders, and Bipolar Disorders.

Major Depressive Disorder gets all the press while it’s craftier and more insidious cousin Dysthymia gets almost none.

In Dysthymia the person feels pessimistic and “down in the dumps” but the condition is not yet severe enough to be recognized as full-fledged Major Depressive Disorder. In children, this disorder is likely to be missed or to be misdiagnosed as a learning disability, attention problem, or poor behavior.

In adults, we call these people pessimists or grumpy old men. People often have been suffering from dysthymia for so long they come to believe this is simply the way they are. They think the sadness is a part of their personality, and don’t know that dysthymia is a treatable condition. They can’t imagine feeling happy as others do.

Diagnosable Dysthymia is a long-term overall sadness that interferes with having a happy life. As a Cognitive Behavioral Therapist, I am sure a faulty belief system either creates or perpetuates this disorder.

Dysthymia is not an occasional “BAD HAIR DAY.’ It involves someone who, while not always depressed, is sad and down more of the days each week than not. It is also not just a rough patch in the road. We may all have weeks or even months of tough times that make us sad. People with Dysthymia have at least two straight years of mostly sad, depressed days but somehow they keep trudging on. If they would just give in and stop trying they might get the diagnosis of Major Depressive Disorder.

For kids, we reduce the two-year requirement to one year, if the child can avoid the “ADHD, heavy meds, hits someone and become a bad kid” trap.  In kids, the mood is more likely to be irritable all the time than obviously sad or depressed. Kids show pain by being irritable. They may also become pessimistic and stop trying to complete their work. Their grades drop and their sad mood leads to missed school days and few friends.

This is a chronic condition and without treatment, it rarely goes away. About half the time Dysthymia deepens and becomes Major Depressive Disorder. The combination of both is sometimes referred to as Double Depression and even when the Major depression lifts the person may still have the overall sad mood of dysthymia. This makes it important that they get treated not just for the Major Depression but for the Dysthymia also.

Just being down, depressed, or irritable for two years is not enough to get you this diagnosis. This disorder will also probably not get you disability, as people with Dysthymia keep trying and are able to go to school or work even when they hate life and are chronically unhappy.

People with Dysthymia will also have features similar to Major Depressive Disorder in being rather Melancholy or having atypical symptoms. They either eat-and-sleep like bears hibernating for the winter or they can’t eat and can’t sleep.

One common characteristic of people who have dysthymia is low self-esteem. They don’t have much self-confidence and they don’t think they can accomplish much; as a result, they give up trying. This can be the result of a difficult childhood, bullying, or simply a lack of having had the experience of succeeding at little things in life.

People with dysthymia are often hypercritical of themselves, others, and the world in general. They may complain a lot and have difficulty having fun. This leads to low productivity and a lack of positive relationships with others.

People who failed a lot or who were never told that what they did was good enough are prone to Dysthymia. Lack of praise was supposed to make for more accomplishment. Some parents ask me why they should praise a child just for doing what they should be doing anyway? The answer is that without praise kids begin to think that no matter what they do, or how hard they try, it will never be good enough. Eventually, they stop trying.

People with Dysthymia don’t get much pleasure out of life. As a result, they avoid doing anything that might be stressful or involve a risk of failure. They become increasingly sad and withdrawn. They find it difficult to make decisions and to start or finish projects. No use in trying if “nothing is going to turn out all right anyway.”

This may be hard to spot, as people with dysthymia avoid social situations and lack of social support is a factor in perpetuating dysthymia. It is hard to make new friends when you are sad, feel bad about yourself, and don’t have a belief in your ability to succeed.

Families tend to share their mental illnesses. If one member of the family has depression, major or minor, then other members of that same family may have dysthymia. This suggests that there is either a hereditary risk factor for Dysthymia or an environmental risk factor. Families provide both.

Dysthymia is extremely common among alcoholics and substance abusers. People who are sad a lot are more likely to abuse substances and people who abuse substances have plenty of reasons to be sad. What brings these people to treatment is an out of control addiction or when the dysthymia becomes Major Depressive Disorder. Many people with Dysthymia have psychical illnesses and conditions also.

Dysthymia frequently starts in childhood and affects both functioning and development. It is important for a child’s healthy development that they know it is possible to succeed and achieve. Having good, positive, and close friends is also an antidote.

The elderly are at increased risk to develop Dysthymia as they lose family and friends, become more isolated, and may have difficulty providing self-care. Changes in appetite, fatigue, sleeping problems, and isolation can all be mistaken for the usual results of aging instead of being recognized as symptoms of Dysthymia or depression in the elderly.

Treatment for Dysthymia is possible and has been shown to be highly effective. Group counseling and support groups are helpful. Individual therapy and medication are useful, though medication appears to be less effective with Dysthymia than with Major Depressive Disorder.

Because of the chronic nature of Dysthymia and the high risk, this will turn into Major Depressive Disorder early treatment is important.

Related articles: Mood Disorders, Depressive Disorders,

Major Depressive Disorder, Bipolar Disorder or Depression?, Bipolar or moody?, Am I Bipolar?, Hyperthymia, Are you hyperthymic? 

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel