It’s a disorder that leaves you at the mercy of your moods, but tends to be subtle enough that you may not even understand you’re struggling with diagnosable symptoms. It’s not particularly common, and there’s not much information available.
Cyclothymia affects up to 1 percent of the population. However, at a hospital’s psychiatric department, it’s anywhere from 3 to 5 percent, according to Dr. Stephen B. Stokl, MD, Chief of Psychiatry at Southlake Regional Health Centre in Ontario.
Cyclothymia is marked by bouts of low-grade depression and hypomania, which includes elevated or irritable mood, decreased need for sleep and racing thoughts for at least four days. Adults are diagnosed after symptoms persist for two years. (Kids and teens are diagnosed after one year.) “Cyclothymia has an insidious onset that starts in late adolescence or early adulthood, and has a chronic nature,” Stokl said. It’s milder than bipolar I and bipolar II.
Most people never get treatment, according to John Preston, PsyD, professor at Alliant International University and author of three books on bipolar disorder, including Taking Charge of Bipolar Disorder. That’s because the depressions typically aren’t incapacitating, and people do feel OK for periods of time, he said. (But these periods don’t last longer than two months, which DSM-IV stipulates for the diagnosis.)
In other words, because symptoms tend to be less debilitating, people just don’t realize they have an illness, said Sheri Van Dijk, MSW, a psychotherapist and author of The DBT Skills Workbook for Bipolar Disorder. It’s usually loved ones who notice a problem, finding it hard to live with someone who has unstable moods, Preston said.
In fact, the toll on relationships can be dramatic. “Cyclothymia usually comes with a high morbidity in terms of breakdown in relationships both personal and at work,” Stokl said.
Also, if untreated, cyclothymia can get worse. “At least half of the people with cyclothymia, over a period of time, will start developing increasingly severe mood episodes,” and will be diagnosed with bipolar disorder, Preston said.
Diagnosing cyclothymia can be tricky. It may be misdiagnosed as bipolar NOS, bipolar II or borderline personality disorder, Van Dijk said. But individuals with bipolar II tend to struggle with more severe depression.
As Preston explained, there also are important differences between cyclothymia and borderline personality disorder. A person with borderline personality disorder may appear to be experiencing a hypomanic episode by acting upbeat and animated. But their elevated mood doesn’t last long and it always happens after becoming infatuated with someone new, he said. (Once the infatuation fades, they’re back to feeling dejected.)
The hallmark sign of hypomania is a decreased need for sleep, Preston said. People with hypomania only sleep for four or five hours. But they feel no fatigue, while those with borderline personality disorder become exhausted, he said.
Also, “People with borderline personality disorder are exquisitely sensitive to feeling rejected and abandoned,” he added.
The best way to diagnose cyclothymia – and bipolar disorders in general – is to get a comprehensive history of the person’s mood, which requires talking to both the person and a loved one who knows them very well, Preston said. Loved ones are usually better able to spot the mood changes, he said.