The main feature of cyclothymic disorder is a chronic and fluctuating alteration of the mood. We all know someone who we say often changes mood, going from sadness to joy within a few days.
Well, these people could be suffering from cyclothymic disorder. Although, of course, this is not necessarily the case. The mood of a person with cyclothymic disorder oscillates between states of exaggerated “happiness” and states of depression. That is, there is a noticeable mood swings that most people do not consider “normal”.
It is important to distinguish cyclothymic disorder from bipolar disorder. Bipolar disorder is more severe because its symptoms are more serious. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), criteria for a major depressive, manic, or hypomanic episode were never met in cyclothymic disorder.
What criteria must be met in order to be able to diagnose a cyclothymic disorder?
According to the DSM-V, the diagnostic criteria are as follows:
A. Presence for at least 2 years of numerous periods of hypomanic symptoms and of numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode.
Note: In children and adolescents the duration must be at least 1 year.
B. During the period of more than 2 years (1 year in children and adolescents) the person has not stopped showing symptoms of criterion A for more than 2 months.
C. No major depressive episode, manic episode, or mixed episode occurred during the first 2 years of the disorder.
Note: After the first 2 years of cyclothymic disorder (1 year in children and adolescents), there may be manic or mixed episodes superimposed on cyclothymic disorder (in this case both disorders, cyclothymic and bipolar disorder are diagnosed) or episodes of depression major (in this case both disorders, cyclothymic disorder and bipolar II are diagnosed).
D. The symptoms of Criterion A are not better justified by the presence of a schizoaffective disorder and are not superimposed on schizophrenia, a schizophreniform disorder, a delusional disorder, or an unspecified psychotic disorder.
E. Symptoms are not due to the direct physiological effects of administering or consuming a substance (for example, a drug or a medicament) or to a general medical condition (for example, hyperthyroidism).
F. Symptoms cause significant clinical or social, occupational or other important areas of activity of the individual.
As previously stated, cyclothymic disorder presupposes a chronic and fluctuating alteration of the mood. It involves numerous periods with hypomanic symptoms and periods with depressive symptoms, differentiated from each other. Hypomania is a term that defines exalted moods that do not come to be manic, but that cause mild irritability and compulsive attitudes.
Symptoms of hypomania go unnoticed most of the time, primarily because the patient feels stable (he also believes he is having a “great day” and is in “possession of reason”); secondly, because it does not always cause a significant deterioration in work, family or society.
For further difficulties in detection, hypomania is sometimes confused with simple “joy” or with a slight isolated hyperactivity. Mania, on the other hand, is defined as opposed to depression. The patient is elated and elated, with excessive mood.
Furthermore, depressive symptoms in cyclothymic disorder are insufficient in number, severity, generalization, or duration to meet the criteria for a major depressive episode. A diagnosis of cyclothymic disorder is made only if the criteria for a major depressive, manic, or hypomanic episode are not met. This is very important, because it distinguishes it from bipolar disorder.
Development and course of cyclothymic disorder
Cyclothymic disorder usually begins in adolescence or early adulthood. It is sometimes considered a temperamental predisposition to other bipolar disorders. The onset of cyclothymic disorder is usually gradual, and the course is persistent. There is a 15-50% risk that a patient with cyclothymic disorder will eventually develop bipolar disorder.
If the onset of hypomanic or depressive symptoms occurs in late adulthood, it will need to be clearly distinguished from bipolar disorder and disorders due to another medical condition (e.g. multiple sclerosis) before diagnosing it as cyclothymic disorder.
In children with cyclothymic disorder, the mean age of onset is 6.5 years. As we have seen, cyclothymic disorder is like the little brother of bipolar disorder. There is a clear change in mood, which is not considered normal, but which does not even become as drastic as in bipolar disorder.
American Psychiatric Association (2014). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) .