Psychological Disorders: Cyclothymic Disorder
American
Description
A. 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. Note: In children and
adolescents, the duration must be at least 1 year.
B. During the above 2-year period (1 year in children and adolescents),
the person has not been without the symptoms in Criterion A for more
than 2 months at a time.
C. No Major Depressive Episode, Manic Episode, or Mixed Episode has
been present during the first 2 years of the disturbance.
Note: After the initial 2 years (1 year in children and adolescents)
of Cyclothymic Disorder, there may be superimposed Manic or Mixed
Episodes (in which case both Bipolar I Disorder and Cyclothymic Disorder
may be diagnosed) or Major Depressive Episodes (in which case both
Bipolar II Disorder and Cyclothymic Disorder may be diagnosed).
D. The symptoms in Criterion A are not better accounted for by Schizoaffective
Disorder and are not superimposed on Schizophrenia, Schizophreniform
Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise
Specified.
E. The symptoms are not due to the direct physiological effects of
a substance (e.g., a drug of abuse, a medication) or a general medical
condition (e.g., hyperthyroidism).
F. The symptoms cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
Criteria For Mood Episodes
Major Depressive Episode
A. Five (or more) of the following symptoms have been present during
the same 2-week period and represent a change from previous functioning;
at least one of the symptoms is either (1) depressed mood or (2) loss
of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical
condition, or mood-incongruent delusions or hallucinations.
1.
depressed mood most of the day, nearly every day, as indicated by
either subjective report (e.g., feels sad or empty) or observation
made by others (e.g., appears tearful). Note: In children and adolescents,
can be irritable mood.
2.
markedly diminished interest or pleasure in all, or almost all, activities
most of the day, nearly every day (as indicated by either subjective
account or observation made by others)
3.
significant weight loss when not dieting or weight gain (e.g., a change
of more than 5% of body weight in a month), or decrease or increase
in appetite nearly every day. Note: In children, consider failure
to make expected weight gains.
4.
insomnia or hypersomnia nearly every day
5.
psychomotor agitation or retardation nearly every day (observable
by others, not merely subjective feelings of restlessness or being
slowed down)
6.
fatigue or loss of energy nearly every day
7.
feelings of worthlessness or excessive or inappropriate guilt (which
may be delusional) nearly every day (not merely self-reproach or guilt
about being sick)
8.
diminished ability to think or concentrate, or indecisiveness, nearly
every day (either by subjective account or as observed by others)
9.
recurrent thoughts of death (not just fear of dying), recurrent suicidal
ideation without a specific plan, or a suicide attempt or a specific
plan for committing suicide
B. The symptoms do not meet criteria for a Mixed Episode
C. The symptoms cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
D. The symptoms are not due to the direct physiological effects of
a substance (e.g., a drug of abuse, a medication) or a general medical
condition (e.g., hypothyroidism).
E. The symptoms are not better accounted for by Bereavement, i.e.,
after the loss of a loved one, the symptoms persist for longer than
2 months or are characterized by marked functional impairment, morbid
preoccupation with worthlessness, suicidal ideation, psychotic symptoms,
or psychomotor retardation.
Manic
Episode
A. A distinct period of abnormally and persistently elevated, expansive,
or irritable mood, lasting at least 1 week (or any duration if hospitalization
is necessary).
B. During the period of mood disturbance, three (or more) of the following
symptoms have persisted (four if the mood is only irritable) and have
been present to a significant degree:
1. inflated self-esteem or grandiosity
2.
decreased need for sleep (e.g., feels rested after only 3 hours of
sleep)
3.
more talkative than usual or pressure to keep talking
4.
flight of ideas or subjective experience that thoughts are racing
5.
distractibility (i.e., attention too easily drawn to unimportant or
irrelevant external stimuli)
6.
increase in goal-directed activity (either socially, at work or school,
or sexually) or psychomotor agitation
7.
excessive involvement in pleasurable activities that have a high potential
for painful consequences (e.g., engaging in unrestrained buying sprees,
sexual indiscretions, or foolish business investments)
C. The symptoms do not meet criteria for a Mixed Episode
D. The mood disturbance is sufficiently severe to cause marked impairment
in occupational functioning or in usual social activities or relationships
with others, or to necessitate hospitalization to prevent harm to
self or others, or there are psychotic features.
E. The symptoms are not due to the direct physiological effects of
a substance (e.g., a drug of abuse, a medication, or other treatment)
or a general medical condition (e.g., hyperthyroidism).
Mixed
Episode
A. The criteria are met both for a Manic Episode and for a Major Depressive
Episode (except for duration) nearly every day during at least a 1-week
period.
B. The mood disturbance is sufficiently severe to cause marked impairment
in occupational functioning or in usual social activities or relationships
with others, or to necessitate hospitalization to prevent harm to
self or others, or there are psychotic features.
C. The symptoms are not due to the direct physiological effects of
a substance (e.g., a drug of abuse, a medication, or other treatment)
or a general medical condition (e.g., hyperthyroidism).
Hypomanic
Episode
A. A distinct period of persistently elevated, expansive, or irritable
mood, lasting throughout at least 4 days, that is clearly different
from the usual nondepressed mood.
B. During the period of mood disturbance, three (or more) of the following
symptoms have persisted (four if the mood is only irritable) and have
been present to a significant degree:
inflated self-esteem or grandiosity
decreased need for sleep (e.g., feels rested after only 3 hours of
sleep)
more talkative than usual or pressure to keep talking
flight of ideas or subjective experience that thoughts are racing
distractibility (i.e., attention too easily drawn to unimportant or
irrelevant external stimuli)
increase in goal-directed activity (either socially, at work or school,
or sexually) or psychomotor agitation
excessive involvement in pleasurable activities that have a high potential
for painful consequences (e.g., the person engages in unrestrained
buying sprees, sexual indiscretions, or foolish business investments)
C. The episode is associated with an unequivocal change in functioning
that is uncharacteristic of the person when not symptomatic.
D. The disturbance in mood and the change in functioning are observable
by others.
E. The episode is not severe enough to cause marked impairment in
social or occupational functioning, or to necessitate hospitalization,
and there are no psychotic features.
F. The symptoms are not due to the direct physiological effects of
a substance (e.g., a drug of abuse, a medication, or other treatment)
or a general medical condition (e.g., hyperthyroidism).
Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant
treatment (e.g., medication, electroconvulsive therapy, light therapy)
should not count toward a diagnosis of Bipolar II Disorder.
European
Description
A persistent instability of mood, involving numerous periods of mild
depression and mild elation. This instability usually develops early
in adult life and pursues a chronic course, although at times the
mood may be normal and stable for months at a time. The mood swings
are usually perceived by the individual as being unrelated to life
events. The diagnosis is difficult to establish without a prolonged
period of observation or an unusually good account of the individual's
past behaviour. Because the mood swings are relatively mild and the
periods of mood elevation may be enjoyable, cyclothymia frequently
fails to come to medical attention. In some cases this may be because
the mood change, although present, is less prominent than cyclical
changes in activity, self-confidence, sociability, or appetitive behaviour.
If required, age of onset may be specified as early (in late teenage
or the twenties) or late.
Diagnostic
Guidelines
The essential feature is a persistent instability of mood, involving
numerous periods of mild depression and mild elation, none of which
has been sufficiently severe or prolonged to fulfil the criteria for
bipolar affective disorder or recurrent depressive disorder. This
implies that individual episodes of mood swings do not fulfil the
criteria for any of the categories described under manic episode or
depressive episode.
Includes:
* affective personality disorder
* cycloid personality
* cyclothymic personality