Diagnostic Criteria for Cyclothymic Disorder

Distressed man with hands over his face
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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 DSM-5 criteria for cyclothymia may make the picture even fuzzier.

How Cyclothymic Disorder Is Diagnosed

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.

As a result of the DSM-5 changes, 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.

The specifier “with anxious distress” may be added to a diagnosis of cyclothymic disorder where anxiety is a significant factor.

Other Considerations

Cyclothymic disorder usually first appears in adolescents and young adults, and there’s a 15 percent to 50 percent 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.

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Article Sources

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

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