Ever Heard of Cyclothymia?

If you’ve never heard of Cyclothymic Disorder or Cyclothymia, you’re not alone. It’s a mood disorder that doesn’t often make headlines, yet its impact on daily life can be significant. Many people experience intense, repeated fluctuations in mood—shifting from periods of elevated mood and energy to lower mood or depressive symptoms. These episodes can often go unnoticed, making the disorder difficult to diagnose. But what if I told you that Cyclothymia has likely been underreported in national surveys and research studies?

Let’s dive into what Cyclothymia is, how it differs from other mood disorders like Bipolar Disorder, and most importantly, why it’s been systematically overlooked in the prevalence data most cited in mental health research.

What Is Cyclothymia?

Cyclothymia is a mood disorder marked by recurrent episodes of hypomanic symptoms (elevated mood, increased energy, and impulsivity) and depressive symptoms, but without meeting the full criteria for Bipolar Disorder. This means that while these mood shifts are significant, they don’t last long enough to qualify as full-blown episodes of mania or major depression. The mood fluctuations in Cyclothymia often feel less intense than those seen in Bipolar I or II disorders, but the impact on everyday functioning can be considerable.

People with Cyclothymia typically experience mood swings over a period of at least two years, but the key distinguishing factor is that the individual episodes tend to be shorter—lasting a few days to a week or two—without meeting the threshold for either a major depressive episode or hypomania. For many people with Cyclothymia, their emotions fluctuate regularly, and it’s this instability that often disrupts their personal, professional, and social lives.

Why Cyclothymia Has Been Underreported

You might wonder: If Cyclothymia is so impactful, why isn’t it more widely recognized? The answer has a lot to do with how we measure mental health and diagnose mood disorders in large-scale surveys, like those that provide the data for most mental health prevalence studies.

For years, surveys that assess mental health disorders—including the National Comorbidity Survey Replication (NCS-R), the Collaborative Psychiatric Epidemiology Surveys (CPES), and the National Health Interview Survey (NHIS)—have used two primary diagnostic tools: the CIDI (Composite International Diagnostic Interview) and the SCAN (Schedules for Clinical Assessment in Neuropsychiatry). These tools are specifically designed to diagnose a range of psychiatric disorders based on structured interviews, but they have one thing in common: they screen out patients who do not meet the two-week minimum duration for depressive episodes.

What Does This Mean for Cyclothymia?

Cyclothymia is characterized by shorter episodes of both depressive and hypomanic symptoms. But, in both the CIDI and SCAN, the diagnosis of mood disorders (like major depressive disorder or hypomania) is typically contingent upon meeting the two-week minimum for episode duration. If the individual experiences episodes that are shorter than two weeks, they do not meet the diagnostic criteria for a major depressive episode or hypomania.

Because both the CIDI and SCAN prioritize the duration of mood episodes, anyone with mood fluctuations shorter than two weeks (which is a hallmark of Cyclothymia) is systematically excluded from the diagnostic process for mood disorders in these surveys. This results in Cyclothymia being underreported in the prevalence data, as individuals with shorter mood episodes are not captured in the surveys.

Why Does This Matter?

This underreporting of Cyclothymic Disorder has major implications:

1.      Underestimation of Prevalence: Since the CIDI and SCAN are used in the most widely cited surveys of mental health disorders, Cyclothymia’s prevalence is likely underestimated. This means that many people who may be experiencing mood instability (and could benefit from treatment) are being overlooked in national statistics and mental health research.

2.      Missed Diagnoses: Clinicians may also miss diagnosing Cyclothymia in their patients, especially if they rely on the CIDI or SCAN in their own assessments. Without the proper recognition of shorter mood episodes, individuals with Cyclothymia may be misdiagnosed with generalized anxiety disorder, depression, or even Bipolar disorder.

3.      Untreated Symptoms: When Cyclothymia goes undiagnosed, individuals are often left without targeted treatments. These people may struggle with chronic mood fluctuations, but without the right diagnosis, they might not receive effective interventions, such as mood stabilizers or psychotherapy.

What’s the Solution?

The solution to this issue lies in re-evaluating how we assess and diagnose mood disorders like Cyclothymia. We need to move beyond simply looking at duration and instead consider the frequency and impact of mood fluctuations. By using more inclusive diagnostic tools that look at the full range of mood episodes, clinicians and researchers can start recognizing Cyclothymia more consistently.

Incorporating structured interviews that assess frequency and impact of episodes—rather than focusing solely on duration—can lead to better diagnosis and treatment of this often-misunderstood disorder.

Conclusion

The reality is that Cyclothymia is likely more prevalent than current research suggests, and many individuals with this disorder may be going undiagnosed or misdiagnosed. By understanding that traditional diagnostic tools may overlook those with shorter mood episodes, we can begin to shift the focus toward more accurate, comprehensive assessments. This will allow more people to get the treatment they need and finally be recognized for what they are truly experiencing—chronic mood instability that doesn’t fit the typical diagnostic boxes but still has a profound impact.

At Live Well Psychiatry, our structured diagnostic interview probes for the duration of mood episodes after collecting the diagnostic criteria for depression, (hypo)mania, and mixed states, thus properly and correctly identifying Cyclothymia. The first step to effective treatment is accurate diagnosis.

If you or someone you know is experiencing symptoms of mood instability, don’t hesitate to seek an evaluation from a qualified clinician who takes a holistic approach to diagnosis and treatment. It’s time to recognize Cyclothymia for what it is and get people the support they deserve. Contact Live Well Psychiatry today to schedule an appointment and start your journey toward stability and well-being.