Cyclothymia

Cyclothymia (or cyclothymic disorder) is a bipolar disorder. The etymology of the word is Greek, derived from kyklos “circle” and thymos “mood. The word cyclothymia is used to describe the emotional swings that characterize this mood disorder. It is characterized by alternating periods of hypomania and periods of mild depression. During hypomanic periods, the person has a euphoric mood, excessive optimism, and the feeling that anything is possible.

Thoughts follow one another rapidly, the person feels full of energy and increased activity, which may become disorganized and inconclusive. In some cases, the hypomanic episode is not characterized by euphoric mood, but by dysphoria, i.e., irritability, intolerance, anger.

In cyclothymia, these periods are interspersed with periods of depressed mood that do not represent a true depressive episode, but in which the person feels a loss of interest or pleasure in his or her activities, feels sad and tired, the ability to concentrate is diminished, and feelings of devaluation and guilt may be present.

In cyclothymia, symptoms of both types are rarely absent, and sufferers face daily problems resulting from their unpredictable mood swings and resulting difficulty in making plans.

Cyclothymia is a disorder that often lasts for many years, begins early in life, and is often considered a predisposition to other mood disorders. In fact, about 15-25% of cyclothymic patients go on to develop bipolar disorder.

It should be noted, however, that the diagnosis of cyclothymia is often made out of hand to justify the sudden and frequent mood swings that are very common symptoms of other psychological problems, especially personality disorders.

Borderline patients, in particular, have frequent mood changes in response to even trivial events, but often psychiatrists, in order to justify the need for drug therapy with mood stabilizers, misunderstand the personological diagnosis and medicalize symptoms that have an exquisitely psychological basis.

Scientific research has shown the importance of psychotherapy in achieving better mood stability in cases of cyclothymia. Cognitive-behavioral psychotherapy has been shown to be particularly effective in helping people quickly recognize the early symptoms of its stages and learn how to modify dysfunctional thinking styles and cope with related issues. Psychotropic medications are relatively easy to prescribe for the treatment of cyclothymia, but it is usually possible and recommended to avoid them with good psychotherapeutic intervention.

Symptoms of cyclothymia

The main symptoms of cyclothymia can vary and are related to the depressive and hypomanic phases.

The main symptoms that can be found in a cyclothymic individual are

  • aggression
  • distress
  • anhedonia
  • impulsive behavior
  • depression
  • logorrhea
  • euphoria
  • hypomania.

Cyclothymic disorders can also affect the sleep-wake cycle, with moments of insomnia and great nervousness.

Hypomanic episodes: typical symptoms

During hypomanic episodes, the person with cyclothymia typically exhibits:

  • An exaggerated sense of happiness and well-being (euphoria)
  • Extreme optimism
  • Extreme self-esteem
  • Extreme talkativeness (talking more than usual)
  • Poor judgment, which may even lead him or her to make dangerous gestures or choices that jeopardize his or her safety
  • Rapid thinking
  • Agitated or irritable behavior
  • A particular tendency to engage in excessive physical activity
  • A particular desire to achieve certain results
  • Little need for sleep
  • A particular tendency to be distracted
  • A particular inability to concentrate properly

Depressive episodes: typical symptoms

Typical symptoms characterize the depressive episodes of cyclothymia:

  • Sadness, hopelessness, and feelings of emptiness
  • Crying
  • Irritability (especially in young people)
  • Loss of interest in all those activities that are usually fun or cherished pastimes
  • Weight fluctuations
  • Sleep disturbances at night
  • Feelings of worthlessness or guilt
  • Restlessness
  • Feeling tired and slow in getting things done
  • Problems concentrating
  • Thoughts of suicide

Causes of cyclothymia

The causes of cyclothymic disorder are still an element of study and scientific research by professionals, who confirm the existence of interaction between neurobiological, genetic and environmental factors.

In most cases, the first clinical manifestations of thymic instability appear during adolescence and are often misinterpreted as age-related “problems” or changes in character and personality.

Depressive symptoms are often attributed to concurrent stressful life events or more or less “self-perceived” as traumatic, while hypomanic and related subexcitatory symptoms go unrecognized or are considered part of “normal adolescent agitation”.

Cyclothymia and relationships

For the person with cyclothymic personality disorder, it is not always easy to recognize the symptoms and understand what is going on. Suffice it to say that during a hypomanic episode he or she may feel invincible, full of energy, and socially appear tireless, exuberant, with many innovative projects.

The cyclothymic character can, in some people, promote success at work, the acquisition of leadership roles, and great creativity. However, while this may appear to be a positive aspect, it is not uncommon for harmful consequences to occur in interpersonal relationships.

For example, when analyzing cyclothymia and emotional relationships, it is not uncommon to find that the latter may be affected by the effects of cyclothymia: friendship or family relationships, for example, may have difficulty moving in the same direction.

The mind of a person with cyclothymia may be overflowing with thoughts, so that he or she lives in an almost constant state of tension and anxiety, as if time were running out. In addition, episodic alcohol and drug abuse may occur in cyclothymics.

All of these difficulties have a negative impact on the individual’s social, work, and relationship spheres, so much so that we speak of cyclothymic disorder and disability, which is recognized at a rate of 31 to 40 percent and is designed for those suffering from cyclothymic disorders with repercussions on social life.

Cyclothymic mood can affect the love relationship, which can be labeled as a “toxic relationship,” causing possible couple crises, repeated romantic or marital breakups.

Finally, it may not be easy to know how to behave with a person who is depressed, and as we have seen about the causes and symptoms of cyclothymia, a cyclothymic partner may have behaviors characterized by strong ambivalence, alternating moments of love and gentleness with others characterized by aggression and lack of empathy.

Listening to the testimonies of those who suffer from cyclothymia or live with a cyclothymic person, we can see that even when it comes to cyclothymia and sexuality, there are some difficulties that can affect the quality of a relationship.

In fact, hypersexuality can manifest itself as one of the secondary symptoms of a mood disorder such as cyclothymia, and it can occur especially when a cyclothymic person is prone to bipolarism.

Cyclothymic disorder: treatment and cures

According to the clinical picture described above, failure to treat cyclothymic disorder can lead to significant emotional problems that affect all areas of life. In fact, untreated cyclothymia can:

  • over time, lead to a high risk of developing type I or II bipolar disorder
  • lead to an associated anxiety disorder
  • lead to an increased risk of suicidal ideation
  • lead to substance abuse and the risk of addiction.

As much as there are cures and treatments for this type of disorder, the person with cyclothymic mood will need them throughout his or her life, even during periods when everything seems to be going well.

Therefore, it is important to find an appropriate treatment as soon as possible that can significantly reduce symptoms and possible complications. For this reason, there is no natural cure for cyclothymia.

So what is the treatment for cyclothymic disorder? At the stage of psychological diagnosis, the specialist can use useful tests to assess the possible presence of cyclothymia.

The most popular psychological tests used to diagnose cyclothymia are

  • Internal State Scale (ISS): which assesses different types of bipolar disorder, cyclothymia and mixed states, focusing on detecting any symptoms of depression and manic episodes.
  • Beck Depression Inventory (BDI): diagnoses depressive states and is an international standard reference.
  • Mania Rating Scale (MRS): a rating scale that examines symptoms of manic episodes of varying intensity.

Cyclothymia: psychological and pharmacological therapy

Therapy is based on the use of psychotherapeutic methods and techniques, sometimes combined with the administration of specific drugs for mood disorders and depression, which act on the regulation of serotonin and dopamine. Strongly recommended psychotherapies are:

  • cognitive behavioral therapy
  • interpersonal therapy
  • group therapy.

The latter can also be of great help to partners and family members, as they can help to identify and manage the possible difficulties and emotional aspects of living with a cyclothymic person.

As for medication (lamotrigine or lithium are often prescribed to treat cyclothymia), this must be tailored to the individual patient and case, which is why it may take a longer process, as some medications take weeks or months to take full effect.

Consultation with qualified and specialized professionals, such as psychotherapists experienced in mood disorders (including those who conduct online psychotherapy sessions), is paramount in the management of this disorder. Therapeutic support for recovery from cyclothymia aims to reduce symptoms and prevent the possibility of each cyclothymic episode leading to the development of manic and depressive episodes.

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