Cyclothymic Disorder

Cyclothymic Disorder is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), diagnosis assigned to individuals who experience mood cycling over a two year period, but have not met the diagnostic criteria for Bipolar I, Bipolar II, or Depressive disorder. There are a number of rule-outs to consider, and there is debate among clinician and researchers if cyclothymic disorder is a discrete disease process, a temperamental variation,or a premorbid syndrome for Bipolar I or II (Baldessarini, Vázquez, & Tondo, 2011) as 15% to 50% of individuals with cyclothymic will develop either condition (American Psychiatric Association, 2013). Cyclothymic disorder can be diagnosed in adolescents and children, and can be reliably discriminated between other childhood mental health disorders (Van Meter & Youngstrom, 2012). The diagnosis of cyclothymia, bipolar I or II, or a Depressive disorder should considered with clinical skepticism, increasingly more so with younger children. Adolescents and children are prone to labile mood, emotional dyscontrol, and overreacting to minor stressors and disappoints as they do not yet have adult coping skills. It is a fallacy to project adults behavioral norms on to children and adolescents and pathologize age appropriate and typical behaviors.

Symptoms of Cyclothymic Disorder

According to the DSM-5, there are six diagnostic criterion, with one specifier:

1. For at least a two year period, there have been episodes of hypomanic and depressive experiences which do not meet the full DSM-5 diagnostic criteria for hypomania or major depressive disorder.
2. The above criteria had been present at least half the time during a two year period, with not more than two months of symptom remission.
3. There is no history of diagnoses for manic, hypomanic, or a depressive episode.
4. the symptoms in criterion A are cannot be accounted for by a psychotic disorder, such as schizophrenia, schizoaffective disorder, schizophrenifrom disorder, or delusional disorder.
5. The symptoms cannot be accounted for by substance use or a medical condition.
6. The symptoms cause distress or significant impairment in social or occupational functioning.

A specifier the clinician can add is With anxious distress.

The disorder can also be diagnosed in children or adolescents, but the observational period for symptoms is one year rather than two. (American Psychiatric Association, 2013).

Onset

The DSM-5 notes that the typical onset of Cyclothymic Disorder is in adolescence or early adulthood, though it can appear in children (American Psychiatric Association, 2013).

Prevalence

According to the DSM-5, the lifetime prevalence of Cyclothymic Disorder is .04% to 1%. It's prevalence is roughly equal in males and females. (American Psychiatric Association, 2013).

Risk Factors

The DSM-5 indicates that risk factors for Cyclothymic Disorder are having a first degree relative with bipolar I (American Psychiatric Association, 2013).