Cyclothymia / Cyclothymic Disorder

New Definition in the DSM-5

Cyclothymia - New Definition
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Up until the publication of the DSM-5, Cyclothymic Disorder was defined as having periods of hypomania along with periods of depression that were not serious enough to be called major depressive episodes. Hypomania in itself can cause severe problems (though not as dangerous as in manic episodes), so some people with cyclothymia felt they were being treated as “second-class citizens” when it came to having their illness taken seriously.

The new criteria for cyclothymia may make the picture even more fuzzy.

Criterion A from the DSM-IV-TR is: “For at least 2 years, the presence of numerous periods with hypomanic symptoms … and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode.”  Under “Diagnostic Features,” this edition says it’s not necessary for the hypomanic symptoms to meet the full criteria for a hypomanic episode, but doesn’t rule out the possibility, either.

However, Criterion A from the DSM-5 changes this: “For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode [emphasis mine] and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.

In other words, there is now no diagnosis for people who have true hypomanic episodes along with periods of depression not severe enough to be major depressive episodes.

Additional criteria for cyclothymic disorder in the DSM-5 are:

B. During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.

C. Criteria for a major depressive, manic, or hypomanic episode have never been met. [Note: If such episodes appear later, the diagnosis would be changed to bipolar I or bipolar II disorder, as appropriate.]

D. The symptoms aren’t better explained by another mental disorder.

E. The symptoms aren’t caused by a substance (e.g., medication or drug of abuse) or another medical condition.

F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Other Considerations

  • Cyclothymic disorder usually first appears in adolescents and young adults, and there’s a 15%-50% risk that such an individual will develop full-fledged bipolar I or II disorder later.
  • A genetic component has been found that increases the risk of developing cyclothymia, especially in first-degree relatives of individuals having mood disorders.
  • Substance abuse and sleep disorders may occur in individuals with cyclothymia, and cyclothymic children are more likely than others to have comorbid ADHD.

Sources:

Diagnostic and Statistical Handbook of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). American Psychiatric Association. 2000(398-400). 2 Mar 2015.

Diagnostic and Statistical Handbook of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Association. 2013(139-141). 2 Mar 2015.

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