Cyclothymia: The Rare Bipolar Disorder Type We Don't Talk About
When we think about bipolar disorder, we often only think about two types — bipolar I and bipolar II. But did you know there is another bipolar disorder type?
Cyclothymia, also known as cyclothymic disorder, is a relatively mild mood disorder compared to its cousin bipolar disorder, which is characterized by periods of highs (mania) and lows (depression). In cyclothymia, the highs and lows are much shorter and not as intense — known respectively as “hypomania” and “mild depression.” Cyclothymia affects just under 1 percent of the U.S. population, making it a rare mood disorder.
To learn more about cyclothymia, we reached out to J. Allanah Evans, MS, LSCW, who specializes in treating bipolar disorder. Despite cyclothymia’s rarity, Evans said she believes it’s under-diagnosed and misdiagnosed in some people.
What is Cyclothymia?
Cyclothymia is a mild version of bipolar disorder, meaning symptoms don’t last as long as they do in bipolar I or bipolar II disorders.
According to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5), someone can be diagnosed with cyclothymia after experiencing hypomanic and depressive episodes for at least two years. In addition, a person with cyclothymia usually experiences some “stable” mood periods that last about two months at a time. In order to be diagnosed with cyclothymia, your symptoms have had an impact on your daily life, but not to the point where you would qualify for bipolar disorder or another mental illness.
Symptoms of Cyclothymia
Although symptoms of cyclothymia do not last as long as they might in bipolar I or bipolar II, mood changes are still noticeable when compared with your “baseline” mood (your typical mood when you’re not experiencing manic or depressive symptoms).
“[The mood swings] don’t reach the severity of a major depressive episode or a full-on manic episode such as in bipolar disorder,” Evans said. “In cyclothymic disorder, these mood shifts can still significantly disrupt your life if not managed.”
People with cyclothymia can experience symptoms like hypomania, mild depression, mixed episodes and rapid cycling, which we’ve detailed below.
Hypomania is a less intense form of mania, meaning the episodes don’t last as long as full-blown mania.
“Manic episodes in bipolar disorder can manifest into delusions, paranoia and other psychotic symptoms, oftentimes leading to psychiatric hospitalizations,” Evans said. “In cyclothymic disorder, moods will swing between short periods of mild depression and hypomania, an elevated mood absent of psychotic symptoms.”
Symptoms of hypomania can include racing thoughts, feeling impulsive, engaging in risky behavior, feeling irritable or extremely optimistic and having a decreased need for sleep.
Although hypomania can be disruptive to daily life, it rarely requires hospitalization or causes a major disruption. As a result, it can sometimes go unreported or be ignored by the person experiencing the symptoms.
Mild depression is common in people who have cyclothymia. Symptoms aren’t typically severe and can include losing interest in activities and things you would normally enjoy doing, changes in appetite or weight, difficulty concentrating and generally feeling low. In rare cases, some might experience suicidal thoughts.
If you are experiencing suicidal thoughts and need someone to talk to, please call the National Suicide Prevention Lifeline at 1-800-273-8255 or reach the Crisis Text Line by texting “START” to 741-741.
People with cyclothymia may also have mixed episodes, another common experience of bipolar disorder. Mixed episodes occur when you experience hypomania and depression at the same time. These episodes can be confusing because you might have increased energy and self-esteem, but still feel hopeless at the same time. If you experience mixed episodes, know that you’re not alone and it’s OK to have trouble keeping up with your own moods while in a mixed state.
Rapid cycling is when hypomania and depressive cycles occur at a faster rate than normal. Everyone’s experience is different, but it’s typical for someone experiencing rapid cycling to have four or more hypomanic or depressive episodes within a year. In some cases, rapid cycling can be even faster, with some people experiencing mood cycle changes multiple times within the course of a day or two.
If you are experiencing any of the symptoms mentioned above, it’s important to talk to your doctor. Getting a proper diagnosis and correct treatment is vital for recovery from cyclothymia. Evans told The Mighty that if left untreated — especially in times of prolonged stress — cyclothymia can manifest into bipolar I or II disorder.
Diagnosing and Treating Cyclothymia
When diagnosing cyclothymia, your doctor will ask about your family and mood history (which is why it’s helpful to keep a mood log) and may also order a physical exam to rule out other medical causes for the symptoms you’re experiencing. Many doctors treating patients with cyclothymia may prescribe mood stabilizers (medication often used to treat bipolar I and II disorder). Evans told The Mighty this is because there are currently no medications approved by the Food and Drug Administration to treat cyclothymia specifically.
Talk therapy and regularly following up with your doctor are important to lessening cyclothymia symptoms, as well as preventing any relapses.
How to Cope With Cyclothymia
Getting any diagnosis can sometimes feel scary, but you don’t have to go through it alone. If you live with cyclothymia, there are ways to cope. If you are creative, you might find that crocheting or drawing is meditative for you. Maybe spending some time in a park with loved ones helps lift your mood. Or maybe becoming a different person for a couple of hours and playing role-playing games with friends helps you cope with and understand your new diagnosis.
In addition to these self-care coping strategies, Evans recommends the following:
- Engaging in therapy to identify triggers to symptoms
- Mood charting to monitor symptoms
- Refraining from using drugs or alcohol because these can significantly make symptoms worse
- Trying to maintain a healthy diet, an active lifestyle and good sleep hygiene
Aside from discussing your mood with your doctors, it’s important to be open with trusted people in your life. Letting them know what’s going on can help them be there for you and try to understand what you’re going through. You don’t have to go through this alone, and having a support network can help make managing your symptoms a lot easier to deal with.
“Do not be afraid to discuss your symptoms and any mood changes openly and honestly with loved ones and mental health providers,” Evans said. “Recognizing and understanding your own triggers can also help you in knowing what your next step is and knowing that your symptoms will pass.”
How to Support a Loved One With Cyclothymia
If a loved one in your life is struggling, it can sometimes feel challenging to provide support — especially when you aren’t exactly sure what they’re going through. If you don’t live with cyclothymia but you know someone who does, educating yourself is one of the most important things you can do to support your loved one.
Listening and paying attention to hypomania symptoms such as a decreased need for sleep and more energy, or mild depression symptoms like isolation can help not only to provide support, but intervention when necessary. It’s important to remember just being present for your loved one can do a world of good as well.
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