Cyclothymic disorder, also known as 'cyclothymia', is a rare mood disorder on the bipolar spectrum, in which a person experiences alternating symptoms of depression or hypomania.
Cyclothymia is often described as a 'mild' form of bipolar disorder, 'baby bipolar', 'bipolar light', or even 'bipolar-ish' – but these terms and descriptions can feel frustrating for people like me who suffer from this mental illness ...
this is because they undermine the experience of living with a destructive and disorientating chronic mental health condition, and they do nothing to help other people understand and empathise with what we truly live with on a daily basis. There's so much more to a mood disorder than just a high and a low mood. So in this post, I want to do my best to explain what cyclothymic disorder is and how it relates to bipolar disorder, so that hopefully people can start seeing it as more than just bipolar's underrated baby sister.
Please keep in mind that I'm not a health professional. I'm speaking mainly from my own 'lived experience' and personal perspective suffering from the condition myself.
I also share what I've discovered during my research and self-study. You should do your own research to develop your own understanding, but my blog is definitely a good starting point!
Is cyclothymia a mild form of bipolar?
I don't think it's fair to say that cyclothymia is just a mild form of bipolar. Many people who suffer from this disorder feel like the word "mild" invalidates their suffering and experience of a mental illness.
Cyclothymic symptoms can indeed be extremely subtle, often passed off as personality quirks. For example, 'he's in hermit-mode' or 'she's in work-mode' when the truth is that he's experiencing symptoms of depression and she's experiencing symptoms of hypomania.
Symptoms can also go unnoticed by both the sufferer and the people around them because they've developed effective coping strategies that disguise the problem.
For example:
Taking time off work or staying at home to preserve energy and ensure a depressed mood state isn't visible to friends and family.
Self-medicating (knowingly or naively) by using alcohol to relax or caffeine, sugary foods, and even sex to 'take the edge off' and make you temporarily feel good.
Staying up late to focus on 'projects' because your brain is so wired that you can't sleep.
Pacing while on the phone because hypomania is making you restless and you can't sit still or keep your inner monologue and racing thoughts quiet.
The truth is that cyclothymia is in its own right a serious mental illness that can dramatically affect the quality of a person's life.
Therefore, in my opinion, it's not a mild form of anything. It's just as dangerous and destructive as bipolar disorder. It still ruins lives and it can still lead to suicide.
A more accurate description might be that cyclothymia is a different form of bipolar disorder.
Did you know that there are in fact three main different types of bipolar disorder? There's bipolar type 1, bipolar type 2, and then there is cyclothymia. I often wonder why they didn't just call it bipolar type 3!
The different variations of bipolar disorder are not just milder or stronger forms of each other, they are separate diagnoses, and separate manifestations of a mood disorder.
So let's take a look at what makes each one unique.
What is bipolar type 1?
With 'bipolar 1' there's an emphasis on the mania.
People diagnosed with bipolar 1 have suffered from at least one full-blown episode of mania. Full-blown mania can be a catastrophic event in a person's life and often leads to hospitalisation.
Only people suffering from bipolar 1 suffer from full-blown manic episodes, and you only need to have ever experienced one of these episodes to be diagnosed with it.
Simply put, mania is a severely and noticeably elevated mood, which completely disrupts a person's life. The episode has to last for at least a week, and include consistent symptoms according to the criteria for diagnosis.
According to the NHS the manic phase of bipolar disorder may include:
feeling very happy, elated or overjoyed
talking very quickly
feeling full of energy
feeling self-important
feeling full of great new ideas and having important plans
being easily distracted
being easily irritated or agitated
being delusional, having hallucinations and disturbed or illogical thinking
not feeling like sleeping
not eating
doing things that often have disastrous consequences – such as spending large sums of money on expensive and sometimes unaffordable items
making decisions or saying things that are out of character and that others see as being risky or harmful
You need to have experienced several severe symptoms consistently for longer than a week for it to qualify as a full manic episode, and usually longer. According to Mind the severity of the symptoms disrupt and often completely prevent a person's ability to do daily activities.
Mania can basically look like a person is living life to excess with much overindulgence and often inappropriate behaviour – but it also describes an extended period of time where a person loses touch with themselves and with reality, in an often dangerous and self-destructive manner.
This can go as far as to include psychotic symptoms, such as delusions and hallucinations, although these aren't present in every case.
The rest of the time the person experiences long periods of normal mood, and sometimes, but not in every case, depression and hypomania, which we'll cover next.
What is bipolar type 2?
With 'bipolar 2' there is an emphasis on depression.
People who suffer from bipolar 2 never reach full-blown mania. Instead, they experience hypomanic episodes, which consist of several milder symptoms of mania that consistently last for at least 4 days, but can also go on for much longer.
The difference between mania and hypomania is in the severity of the symptoms. People experiencing hypomania, despite their symptoms causing disruption, will usually still feel able to continue working or socialising, according to Mind.
Another key distinction between a diagnosis of bipolar 1 and 2 is that at least one depressive episode is required for a diagnosis of bipolar 2.
According to the NHS, during a period of depression, symptoms may include:
feeling sad, hopeless or irritable most of the time
lacking energy
difficulty concentrating and remembering things
loss of interest in everyday activities
feelings of emptiness or worthlessness
feelings of guilt and despair
feeling pessimistic about everything
self-doubt
being delusional, having hallucinations and disturbed or illogical thinking
lack of appetite
difficulty sleeping
waking up early
suicidal thoughts
A depressive episode consists of several consistent severe symptoms of depression that last for at least two weeks, but often much longer.
Each episode is distinct and recognisable. This means that medication or treatment can be adjusted to control the episodes.
Medication can then be readjusted and continued in order to maintain a more balanced mood after the episode is over. This is the case with bipolar 1 as well.
The NHS also recognises that patterns are not always the same and some people may experience:
rapid cycling – where a person with bipolar disorder repeatedly swings from a high to a low phase quickly without having a "normal" period in between
mixed state – where a person with bipolar disorder experiences symptoms of depression and mania together; for example, overactivity with a depressed mood.
Mind offers the following examples of a mixed state; 'you may feel very energised and impulsive, while feeling upset or tearful. Or maybe you feel very agitated or irritable. You may also experience highs and lows very quickly after the other, within the same day or hour.'
What is cyclothymia?
With cyclothymia, there's an emphasis on unpredictable mood cycling. I'm talking relentless cycling up and down with very little relief in between.
In fact, the mood swings can be so frequent and unpredictable that it can be almost impossible for some people to determine where the normal mood phase begins and ends. Others may experience a period of normal mood, but it'll last no longer than two months at a time.
Rather than call the individual mood states 'episodes', they're described as 'mood swings', or the sufferer is described as experiencing 'symptoms of... (depression or hypomania)'.
The symptoms are said to be milder in nature than those experienced by people diagnosed with bipolar 2 but many people beg to differ ...
The key difference however, is that symptoms don't persist long enough to neatly fit the medical criteria for an 'episode'. If they did, then the diagnosis would switch over to one of the bipolar classifications.
My experience of cyclothymia
My own switches in mood are generally fairly mild when I consider myself to be well. They're always there but I can manage them easily.
When I'm not well though, it's a different story. My symptoms can become more severe and my mood swings rapid, and this is exacerbated by stressful situations and people who trigger me.
When I'm not well, my symptoms start to feel more severe to me. But because they swing back and forth too frequently to be considered episodes I'm diagnosed with cyclothymia and not bipolar 2. I often lose track of how I'm feeling due to the frequency of change.
It's not uncommon for me to feel like I've been balanced for a longer period of time, when in fact I was in a depressed state just three days previously. Once my mood becomes normal or starts to climb higher again, or vice versa, I seem to lose my awareness of the previous mood state.
There are never any full-blown manic symptoms with cyclothymia. This means the person still has, to a certain extent, a grasp on reality. In my own experience though, spiralling negative or obsessive thoughts and anxiety can lead to paranoid thinking and an inaccurate perception of other people's intentions.
If you can bring yourself to imagine just how disorientating it is to constantly swing from one mood to another, back and forth, then you might be able to appreciate why I say that cyclothymia is not a milder form of anything ...
It's just a different form of a mood disorder on the bipolar spectrum – just like bipolar 1 and bipolar 2 are both different forms of the same mood disorder.
In my opinion, it's the way in which the disorder manifests itself in a person's life that determines how destructive it has the potential to be, not whether symptoms are described as 'mild' or 'severe'.
Each variation of this mood disorder is serious and destructive in its own way.
Why is cyclothymia sometimes described as bipolar light?
As we've seen, the symptoms of cyclothymia may be considered milder than those that define bipolar 1 and 2 because they don't have the time to develop into something more visible that's obviously out-of-the-ordinary to onlookers ...
But that doesn't mean the condition isn't causing havoc in a person's life.
One of the most frustrating things about cyclothymia is that symptoms are often attributed to the person's 'personality' rather than the fact that they're unwell.
In fact, this is one of the main reasons that so many sufferers of cyclothymia go undiagnosed or are misdiagnosed with something else.
It could be argued that this has resulted in cyclothymia being a 'rare' mood disorder due to inaccurate statistical representation.
I may be biased in saying this, but because cyclothymia offers very little relief period – which makes it incredibly difficult to treat effectively because you're not able to treat the individual episodes like you would with bipolar 1 and 2 – then cyclothymia is perhaps the worst type to live with on an day-to-day basis.
Cyclothymia destroys your sense of self. Most of the time I have no idea who I am, what I think or believe or want, or what I am doing with my life because everything I perceive changes from one mood to the next.
I find it difficult now to trust myself to make big decisions about my life, become passionate about new projects, or even to fall in love.
My Mood Disorder Metaphor
In order to try and illustrate my understanding of the core differences between bipolar 1, bipolar 2, and cyclothymia, I've come up with these visual metaphors.
(These are based on my own understanding, research and experience, so please don't be offended if your own experiences feel different. They are just my thoughts.)
Bipolar 1...
...is like having a truly gruesome and terrifying manic monster hiding in your closet. It could stay hiding for years before you even know it's in there.
Then one dark night it reveals itself, and until it retreats back into the shadows of the closet, you'll find yourself completely immersed and living in its nightmare world, unable to wake up and get on with your life.
If the bipolar 1 sufferer experiences episodes of depression and hypomania too then they will also relate to the following metaphor I've created for bipolar 2.
Bipolar 2...
...is like having a smaller hypomanic monster and also a dark demon of depression living underneath your bed. You always know they're there because they like to kick up your mattress while you sleep, plaguing and tormenting you.
Occasionally, in turn, they come out from underneath the bed and trap you in their dark worlds for a while, with the hypomanic manic monster leading you on a merry dance all around your bedroom, knocking over and destroying everything that lies in your way (this is hypomania), or the demon of depression laying on top of you completely so that you cannot function at all (this is depression).
Then the monsters retreat back under the bed, letting you escape their nightmare world, and you're free to go back into the reality and daylight of your everyday life for a while.
Cyclothymia...
...is more like having mini mood gremlins that inhabit not just space under your bed and inside of your closet, but every nook and cranny of your life.
They don't just stay confined in the bedroom either, pulling you into their nightmare worlds when they have the opportunity – no no, they cross boundaries into your everyday life and follow you about wherever you go.
They make it their mission every single day to sabotage you.
Sometimes they sit on your shoulders all day wittering on in your ear about all sorts of nonsense so that you can't focus on anything at all. You believe everything they say because it's all you can hear.
Other days they hang off your body, weighing you down and making everything feel ten times harder.
Sometimes they mess with the lights and volume so that everything feels too bright and too loud and you just want to get into bed and hide under the duvet.
And then there are those times when they sneak happy-pills into your food and drink, grab you by the hands and entice you into doing all of the things that you really shouldn't be doing - like partying, flirting, spending all of your money on new obsessions and working on all-consuming projects when you should be sleeping or doing something productive or responsible with your adult life.
A life inhabited by mood gremlins is never your own, even when you think it is. Trust me. Those pesky gremlins stay hidden from your friends and family, and they play tricks with your mind to turn everyone against you, including yourself.
Want to know more about cyclothymia? Read about what depression and hypomania look like in people diagnosed with cyclothymic disorder.
How would you describe your own disorder?
The interesting thing about mental illness is how different the same disorder can look in different people. My experience of cyclothymia is likely to look and perhaps even feel at times very different to yours.
So why not join me in starting a conversation in the comments below this post about how your mental illness manifests itself in your life?
If you suffer from depression, anxiety, or any other mental health problem, feel free to get involved in the conversation and tell your own stories. I'll look forward to reading them.
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