Cyclothymia: cycle what?

Tiziana
6 min readSep 7, 2023

Getting the right diagnosis for your mental illness, no matter how late, feels like finally finding a perfect outfit, after trying on lots of choices. Since it was such a long journey for me, I want to shed a bit of light on this unrecognized disorder, (even Medium spell-checker suggests it is a typo) and I hope this may help someone still in the middle of their path.

A close up of a graysh branch with small pink flowers. Very moody
Photo tagged as “Fragility” by Amy Spratt on Unsplash.com

I was given official validation to what I knew it was true in my early 50s, by a psychiatrist that began our conversation with: “I don’t believe Cyclothymia exists: it is just bipolar II with frequent cycling”, and then making me take tests to prove that, yes, just like I said, I have some form of bipolar disorder and anxiety.

How about that for gaslighting?

Sure, there is debate among professional on how to classify it or if it is a variation of another disorder, however, maybe it is not the best way to start a relationship with a new patient by telling them they don’t know what they are feeling. Especially if said patient spent many years researching the topic, has a master in psychology, wrote a research paper on it and was unofficially diagnosed by her Pediatric Psychiatrists sister.

It does not really matter, however, how you call it — I prefer bipolar extra-light myself — the symptoms are still the same: very frequent mood cycling (in a matter of days or even hours), with no specific motivation or cause. Some experts even say this condition may be more stressful to handle than other bipolar disorders, because the swings are so rapid and uncontrollable that make you feel completely powerless over how you will be. These patients experience even fewer ‘normal’ days than Bipolar I or II patients: the average is only 77 days a year.

By the way, the DSM-5-TR lists it and define it as such: 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… (1)

I have always felt different: no matter the context, I could never fit in, or at least that what felt like, ne’ carne ne’ pesce (not meat nor fish) as they say in Italian. Since I was little I was extremely sensitive and emotional, and, according to my parents, I would go from crying to laughing and back to crying with no apparent reason. Apparently, I broke down sobbing watching a commercial of a paper boat, sailing on the street and ending in the drain.

What I do remember is noticing my frequent mood swings, and how powerless I felt, because I would never know I what type of emotions I would have that day. This disorder causes intense shifts in mood, energy levels, thinking patterns and behavior and really affects your daily life and motivation. I remember noticing that winter and gloomy days changed my mood. I even remember one day, feeling incredibly down, and telling myself: “you know this happens randomly…you will feel better in a couple of days. Just bear with it and wait”.

Even though this is a very misunderstood disorder, it has been known for more than 100 years: in 1883, a German doctor named Karl Ludwig Kahlbaum, identified a disorder that had cyclic mood swings, but of a lighter variety than Bipolar Disorder. Together with his disciple Edward Hecker, he named it Cyclothymia, from the Greek roots for ‘circle’ and ‘mood/emotion’. He was also the first to recognize that people suffering from this disorder rarely search treatment because of the relatively mild symptoms. This is still the case: many patients will seek help for the secondary issues that derive from it, such as anxiety, depression, or even ADHD. Another reason why most of us don’t seek treatment is because the highs are so pleasant, that we suck it up when we experience the lows.

It also quite difficult to diagnose in children or adolescents, because many of the symptoms could be sign of a different disorder. However, beside fast cycling (1), usually unmotivated, of moods, there are other tell tale signs to look for.

Potential Additional Symptoms
• lingering separation anxiety beyond what it is usually normal for the age
• extreme emotional responses
• creativity
• hyperactivity
• sleeping issues (limited production of melatonin is very common with this disorder)
• extreme approval craving (that can leave to search for unhealthy relationship)
• sensory processing disorders
• extreme sensitivity to all environmental stimuli, including the weather
• thyroid disease

Of course, none of these symptoms alone can make a diagnosis, but when combined to rapid mood cycling, and especially minor mania, well, maybe it is something to consider. In my case, all these symptoms apply, but every person is different. While the symptoms may look not as severe, if left untreated, cyclothymic disorder can devolve in a full Bipolar diagnosis or even in Dysthymic disorder (chronic depression).

I guess I was right in feeling different: cyclothymic disorder is estimated to affect less than 1% of the population, but it also considered to be grossly under-diagnosed and misdiagnosed, so maybe it is more common(2).

Am I cured? Not really, but I can manage my symptoms well, even though, due to a misdiagnosis of anxiety and depression, I was given a “wrong” medication cocktail, as the above-mention doctor told me ( a combination of a SSRI and another type of anti-depressant that lifted the mood). To be fair, mood stabilizers would have probably been a better choice, but when I was given the “right “ medication I felt horrible, and I had to stop, and go back. After all, if it works somewhat, why changing? I still have mood swings, even though I can tolerate them better, and I even have some low level high.

My only regret is ignoring the symptoms for so long, thinking they were not really serious enough to get help and suffering needlessly.

Therapy was also extremely useful, especially CBT, but therapy alone, in my case, was not enough. Only after taking medications I was able to have a much better life, and I can finally feel there is a place for me in the world. I hope you can too.

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NOTES

  1. https://www.theravive.com/therapedia/cyclothymic-disorder-dsm--5-301.13-(f34.0)
  2. https://www.psychologytoday.com/us/conditions/cyclothymic-disorder

From Cleveland Clinic Neurologic Institute https://my.clevelandclinic.org/health/diseases/17788-cyclothymia

Hypomania symptoms in cyclothymia
Hypomania is a condition in which you have a period of abnormally elevated, extreme changes in your mood or emotions, energy level and activity level. This energized level of energy, mood and behavior must be a change from your usual self and be noticeable to others. Hypomania is a less severe form of mania.

  1. Increased energy and less need for sleep.
  2. Rapid speech and racing thoughts.
  3. Being easily distracted.
  4. Having an increased focus on goals, including work, school and social goals.
  5. Participating in risky activities or activities that lack good judgment, such as spending sprees, reckless sexual encounters or impulsive business decisions.
  6. Higher-than-normal level of self-esteem.

Depressive symptoms in cyclothymia
A depressive episode involves feelings of hopelessness and a decreased interest in previously enjoyed activities. The symptoms of depressive episodes in cyclothymia are milder than those of major (clinical) depression.

  1. Feelings of social isolation, low self-worth and guilt.
  2. Changes in eating patterns (eating more or less than usual).
  3. Difficulty falling asleep (insomnia) or trouble staying awake (hypersomnia).
  4. Fatigue or significant loss of energy.
  5. Decreased ability to concentrate.

Academic Resources about Cyclothymia

Akiskal, H. S. (2001). ​Dysthymia and cyclothymia in psychiatric practice a century after Kraepelin. Journal of Affective Disorders, 62(1–2), 17–31. ​https://doi.org/10.1016/s0165-0327(00)00347-5

Balance, B. (n.d.). ​Sensory Processing Disorder (SPD): Signs, Symptoms and Help. Https://Www.Brainbalancecenters.Com. https://www.brainbalancecenters.com/blog/signs-and-symptoms-of-sensory-processing-disorder

Bielecki JE, Gupta V. ​Cyclothymic Disorder.(​ 2020, October 5) [Updated 2023 July 17]. In: StatPearls Treasure Island (FL): StatPearls Publishing; 2021 Jan ​https://www.ncbi.nlm.nih.gov/books/NBK557877/

Brieger, P., & Marneros, A. (1997).​ Dysthymia and cyclothymia: historical origins and contemporary development. ​Journal of Affective Disorders, 45(3), 117–126 https://doi.org/10.1016/s0165-0327(97)00053-0

Perugi, G., Hantouche, E., Vannucchi, G., & Pinto, O. (2015). Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder. J ournal of Affective Disorders, 183, 119–133. https://doi.org/10.1016/j.jad.2015.05.004

Strong, C. M., Nowakowska, C., Santosa, C. M., Wang, P. W., Kraemer, H. C., & Ketter, T. A. (2007).

Temperament–creativity relationships in mood disorder patients, healthy controls and highly creative individuals. Journal of Affective Disorders, 100(1–3), 41–48. https://doi.org/10.1016/j.jad.2006.10.015

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Tiziana

UX Psychologist and ethical interactive designer. Higher ROI without manipulation.