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Cyclothymic Disorder

In 1882, a German psychiatrist presented a lecture and paper on cyclothymia: a new theoretical entity that would contribute to the growing ideas in psychiatry and psychology in manic-depressive illnesses. In 1898, another psychiatrist, Hecker, presented a paper that included clinical features of cyclothymia based on his observations and clinical experience. Hecker observed that cyclothymic individuals had mood swings between moderate exaltation and dysthymic depression.
Later, Emil Kraeplin, would state that:
“ There are two people who constantly oscillate hither and thither between the two opposite poles of mood, sometimes ‘rejoicing of the skies’ sometimes ‘sad as death.’ Today, lively, sparkling, beaming, full of the joy of life, the pleasure of enterprise, and the pressure of activity, after some time they meet us depressed, enervated, ill-humoured, in need of rest, and again a few months later they display the same freshness and elasticity” (Kraeplin, 1896).

So what is this problem that people face?

 

Introduction
Cyclothymic disorder is considered a mood disorder in the Diagnostic and Statistical Manual of Mental Disorders, and its main feature includes persistent instability in mood. Specifically, it involves numerous periods of mild depression and mild elation, without meeting the criteria for bipolar illnesses.

In mental health, people can generally be considered to be suffering from low mood if they have a variety of different symptoms: not able to enjoy things they used to, a persistent low feeling, problems eating, problems sleeping, being close to tears and feeling hopeless. On the other end of the spectrum, we have mania: which is characterized by increases in energy, feelings of elation, impulsivity, feeling on top of the world, having excessive self-esteem and risk-seeking behaviour. Depending on symptoms present, how long they last, how severe they are and how pervasive they are, a person’s diagnosis may be either mania, hypomania, depressive episode, or depressive symptoms.

A diagnosis helps to label different combinations, in order to clarify treatment planning and understand a person’s prognosis.

There are a few different possible diagnoses when someone has these periods of highs and lows. In bipolar I, a person is required to have at least one manic episode, sometimes followed by a hypomanic episode or depressive episode.In bipolar II, there is a current or past hypomanic episode AND a past or current depressive episode.

In cyclothymia, a person must have at least 2 years of numerous hypomanic symptoms and depressive symptoms. The key here is that they do not meet the criteria for a “true” hypomanic, manic, or depressive episode. As well, the symptoms must be present for at least half the time.
In essence, cyclothymic disorder is seen as a chronic, fluctuating mood problem that involves feelings of elation and depression. Symptoms rarely become so severe and pervasive that they are a true manic or depressive episode, but there is enough distress and impairment to cause problems.

What it means to have Cyclothymic disorder
People who struggle with cyclothymia may have problems because of their mood cycling. They might be described as temperamental, unpredictable, moody or unreliable. The ups and downs over a long period of time can become taxing for individuals to maintain relationships, employment, hobbies, and enjoyment in life.

This problem usually starts during adolescence and it affects males and females equally. People tend to develop this disorder “insidiously”, meaning gradually. The course also tends to be persistent and move with people into adulthood. As well, there is a 15-20% risk that cyclothymia may develop into bipolar I or II.

Individuals with cyclothymia may be hesitant to seek treatment because the hypomanic symptoms can feel enjoyable. They are more active, productive, self-confident and social. People tend to present to treatment because of the depressive symptoms or comorbid drug and alcohol use. Stabilizing a person’s mood and understanding any other problems are important for treating this disorder. Fortunately, people diagnosed with bipolar disorders have the potential to return to “normal” functioning when they have access to quality treatment and stay committed to their recovery.

Treatment
Treating cyclothymia typically involves medication and therapy. Medications can be prescribed to stabilize a person’s mood, treat the depressive episodes, or manage the hypomanic symptoms. Overall, stabilizing the mood, coupled with psychoeducation and counselling can be effective in helping people cope with their illness. Psychoeducation is a key component in treating bipolar illnesses, because people generally want to treat the depressive feelings, not the “elated” feelings. Group psychoeducation is one option that involves structured sessions to help individuals experiencing cyclothymia understand their patterns and become experts in their condition. As well, cognitive-behavioural therapy (CBT) may focus on understanding a person’s thoughts, feelings, and behaviours in both low and high mood states and how they impact a person’s overall functioning. A CBT therapist may co-develop a plan to identify early warning signs and a person’s relapse signature, indicating they may be moving towards either a depressive or hypomanic state. A CBT therapist can also help someone understand a person’s repertoire of coping behaviours and come up with new ways of responding to situations.

Conclusion
Cyclothymia is considered a more chronic form of bipolar illness, without any true manic or depressive episodes. Despite not having high highs and low lows, the illness can still cause impairment and distress. Managing bipolar disorders is possible, and people can go on to enjoy a more stable, reliable mental world.

If you’ve been wondering about cycles in your mood, reach out to your GP or meet with a professional at CMAP Health…

 

About the Author

Victoria Howarth is one of our qualifying registered psychotherapists {RP (Q)} and a therapist under supervision at CMAP Health. She has a Master’s Degree in Counselling Psychology at Yorkville University and a Master’s Certificate in Addictions and Mental Health from Durham College. She has experience coaching and counselling adults with substance use disorders with an emphasis on harm reduction. To find out more about Victoria you can view her profile.

 

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