Cyclothymia- A Milder Form of Bipolar Disorder

“I am bipolar, and I am a full manifestation of it in terms of my speech, in terms of my energy.” -Mauro Ranallo

After several years of being called, “bipolar” by endearing family members, I set aside my judgment of them and often wondered if there was some validity in the criticisms.

The depression persisted from my teens up until now, however, the mania wasn’t fully manifested until later in life. I can recall one friend telling me that I was the only person they’ve known that exhibited both a melancholic and hyper disposition simultaneously.

As a female, my moods have always been further compounded by the fluctuations in my hormones (i.e., “pms”, and postpartum).

About 7 years ago, I went to my doctor who diagnosed me with depression and PMDD. Every visit since then, the depression notes remain on my summary. Once, when I tried to contact one of my doctor’s, she stated that none of my conditions weren’t applicable because I wasn’t re-evaluated for them- I had missed an appointment and she seemed harsh and unhelpful.

When I went back for a yearly appointment in 2017, the doctor assumed I was there specifically for a prescription. I told her I wanted to have a thorough diagnosis- that meant I had to get blood tests to rule out physical conditions. It also meant she would refer me to a psychiatrist for the full evaluation.

I met with two psychiatrists- the first might have had a different certification because he made my second appointment with the doctor who conducts evaluations. Again, I think I was scheduled with him first because the staff thought I just wanted counseling or pills.

When I had my evaluation, she told me I was, “a little bipolar.” I told her I didn’t want pills, just a diagnosis so I could manage my disorder on my own. She prescribed something that I never took. Weeks later, I requested my records and discovered the notes about my mood disorder- which didn’t explicitly state that I had bipolar disorder.

This diagnosis leads me to research more about bipolar disorder. More specifically, I wish to learn more about cyclothymia- or, as some people refer to it- “mild” bipolar (a “little” bipolar!).

Cyclothymia is a somewhat rare mental disorder, affecting about 0.4-1% of the population, with women being more frequently diagnosed than men by a ratio of 3:2.

“Cyclothymic disorder is characterized by hypomanic and mini-depressive periods that last a few days, follow an irregular course, and are less severe than those in bipolar disorder; these symptom periods must occur for more than half the days during a period of ≥ 2 yr. Diagnosis is clinical and based on history. Management consists primarily of education, although some patients with functional impairment require drug therapy.” (Merck Manuals)

Many people, such as myself, enjoy the hypomania component of the disorder allows me to be “high-functioning”.

It helps those who are achievers, leaders, or those with an artistic bent, to be productive and creative, even influential and admired by their peers. On the other side of the coin- the “depressed” element of cyclothymia, wreaks havoc on relationships and can create conflict due to erratic behavior in the workplace and otherwise.

Many people afflicted by cyclothymia (or other forms of mood disorders) often turn to drugs and alcohol to a feeble attempt to quell their moods.

How can somebody get help if they think they may have cyclothymia? There is no test for cyclothymia. A doctor usually refers to your medical history and sometimes will refer you to a psychiatrist. Since the symptoms of cyclothymia are similar to bipolar 1 and bipolar 2, it is important to seek an evaluation from a psychiatrist.

Since cyclothymia is less severe than other forms of bipolar disorder, you may decide to examine various methods of treatment, with or without medications.

What works well for one individual isn’t always ideal for everybody else.

You can choose to see a therapist at regular intervals, join a support group, etc. Still, many psychiatrists prescribe medication.

Medications Often Prescribed

Lithium– a mood stabilizer

Lamictal– an anticonvulsant

Tegretol– used to treat seizures and bipolar disorder (anticonvulsant)

In conjunction with working with your doctor and psychiatrist, you can find online resources to provide you with information. The ADA has a screening tool to help guide you.

References:

  1. https://ada.com/conditions/cyclothymic-disorder/
  2. https://www.merckmanuals.com/professional/psychiatric-disorders/mood-disorders/cyclothymic-disorder
  3. https://www.psycom.net/depression.central.lamotrigine.html
  4. https://www.psycom.net/depression.central.cyclothymia.html
  5. https://www.drugbank.ca/drugs/DB01356
  6. https://www.everydayhealth.com/drugs/tegretol

How to Channel Anxiety in a Positive Way

Where Are You On Maslow’s Pyramid?

“We may define therapy as a search for value.”

-Abraham Maslow

Abraham Harold Maslow (1908-1970), an American psychologist best known for “Maslow’s Hierarchy of Needs”- a theory that employs the notion that in order to achieve one’s highest potential, one must not be lacking in any of the four essential needs of the pyramid. Of these four needs that precede the self-actualization level of the pyramid, the following must be satisfied:

  • Esteem- The desire to be valued and accepted, power, recognition.
  • Love/Belonging- Family, friends, intimacy, inclusion.
  • Safety- Money, health, stability, and a sense of personal and family safety, property, employment.
  • Physiological- Air, clothing, food, water, shelter, rest.
Maslow's Hierarchy of Needs

Maslow’s hierarchy of needs helps outline the components needed to ensure happiness and self-actualization.

Maslow, who referenced his own work as, “positive psychology”, called the four bottom levels of his five-level model, the “deficiency needs.” These needs are called deficiency needs because, without them, we feel uncomfortable and anxious. However, when these needs are met, we are not likely to notice, or feel any different, simply because they are innate needs.

The highest of Maslow’s “Hierarchy of Needs” is self-actualization. This tier includes things such as morality, creativity, problem-solving, and spontaneity. Self-Actualization is the ability and desire to meet one’s fullest potential or to accomplish as much as one’s ability allows. Self-actualization is achieved when we are equipped and ready to “level up.” In other words, when we don’t have to worry about the basics, we have more resources available to consider our growth and development.

What Things Hinder An Individual’s Personal Growth?

When a person is living with constant fear, it is more difficult to get their needs met. For instance, when an individual feels threatened, their brain prompts the fight-or-flight response. At that state, it is unlikely that the person who is plagued by fear will have to ability to effectively utilize problem-solving skills. Additionally, that person will be so focused on meeting their safety needs, as well as the need for love/belonging and esteem.

In an effort to subdue distress and anxiety, people often use what Freud called, “defense mechanisms.” Furthermore, many individuals who suffer from anxiety may also substitute their deficiencies. Instead of adopting healthy habits that will help us achieve our needs (and thus, self-actualization), we may feel compelled to feel a sense of love/belonging by controlling our appearance or employing unhealthy eating habits. Another example would be family dysfunction or a dysfunctional household. The teenager who lives in an alcoholic family may undertake the role of the nurturing parent. Another person may take a different route- perhaps by running away or seeking solace by withdrawing from the family.

The How And What Of Defense Mechanisms

While Maslow focused his work on the study of what makes humans happy, the Austrian neurologist, and founder of psychoanalysis, Sigmund Freud explored other elements of the human psyche, such as sexual energy being the driving force behind our unconscious behaviors. Freud noted several defense mechanisms people use to protect themselves from anxiety.

  • Repression
  • Denial
  • Projection
  • Displacement
  • Regression
  • Sublimation

Freud's Defense Mechanisms

Sublimation: A “Mature” Defense Mechanism

Psychiatrist and professor at Harvard Medical School, George Vaillant, contends that many of the aforementioned defense mechanisms can be harmful to us, but concluded that more “mature defenses”, like sublimation, can be productive. Vaillant proposed four layers of defense mechanisms:

  • Narcissistic
  • Immature
  • Neurotic
  • Mature

Some common examples of sublimation include channeling aggression into a sports activity, or painting when one wishes to express, in a socially-acceptable behavior, the pain they feel from a broken relationship.

Sublimation can be used to control negative impulses associated with anger, jealousy, disappointment, sadness, and mistrust.

Many notable creative and literary work have been bestowed upon humanity, most likely, as a result of the use of the sublimation defense mechanism. Van Gogh is reported to have painted one of his most prominent paintings, The Starry Night, while hospitalized at Saint-Remy. The painter Jackson Pollock, employed “action painting” into his creations. The use of movement and expression involved in this type of pursuit likely utilized the sublimation defense mechanism to deal with his own internal conflicts and anxieties.

While both artists had personal struggles- Van Gogh had mental health issues and Pollack had a tendency to become violent when drinking, it can be surmised that their ability to express themselves artistically may have helped them channel at least some of their negativity into more positive ways of dealing with their problems. Possibly, life could have been better for these artists, but we can truly never know the depths of their psyches.

Maslow’s pyramid indicates that one characteristic of self-actualization as the ability to be creative and spontaneous, independent, and honest. Pollock was widely regarded for his authenticity in his painting style. Was he true to himself? Could he have been even more successful as an artist, or even, as a husband to fellow artist Lee Krasner?

Other psychologists theorize that self-actualization involves fulfilling an altruistic need, that is, the ability to serve humanity. Perhaps by using sublimation defense mechanisms (sports, art, science, etc.), we can manage our anxieties until all our hierarchical needs are fully met. We can “fake it ‘til we make it.” Although it is challenging at times to consider altruistic endeavors, once we can find a way to overcome ourselves, we can be equipped to use our gifts to serve others.

References:

  1. https://outre-monde.com/2015/10/01/a-philosophical-cure-for-anxiety/
  2. http://www.pursuit-of-happiness.org/history-of-happiness/abraham-maslow/
  3. https://courses.lumenlearning.com/suny-monroecc-hed110/chapter/theory/
  4. https://www.simplypsychology.org/defense-mechanisms.html#why
  5. https://www.verywellmind.com/biography-of-abraham-maslow-1908-1970-2795524
  6. https://www.psychologistworld.com/freud/defense-mechanisms
  7. https://psychologenie.com/understanding-concept-of-sublimation-in-psychology
  8. https://www.britannica.com/biography/Jackson-Pollock

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A natural-looking woman rests her face in her hands while smiling.

The Importance of Following-up After a Diagnosis

I had hoped for clarity when I requested my paperwork from the psychiatrist’s office. Instead, I am more confused. All day today I have experienced “mixed episodes” with my moods. Mixed moods, ranging from happiness and mischievous to sadness and despair, to obsessional thoughts of the darkness in the world. Now I am obsessed with records and details again. It has only been a week or so since the clinic mailed me my paperwork- I haven’t had time to ruminate until now.

When I was a kid, I recall my mom commenting on how sensitive I was, and now I read the doctor’s notes and find he made this same observation. It’s not all the time that I feel sensitive. Sometimes I can feel quite apathetic, or envious and bitter. The clinic offered me the paperwork from both doctor’s that I met to discuss my mental health issues.

The first doctor (the one that observed that I was sensitive) gave me a primary diagnosis of Anxiety Disorder, NOS (Not Otherwise Specified).

The second doctor noted on my mental status “Excessive elaboration on insignificant issues.”

She observed my speech to be “circumstantial.”

My thoughts were logical, my grooming and eye contact were average. My insight was deemed to be “fair.”

Affect (Mood): Constricted/Blunted. I believe that means a restriction in my display of emotions, but not so much that my expression of emotions would be considered “flat.”

The second doctor’s primary diagnosis: Persistent Mood (affective) Disorder, Unspecified. She had told me that I was a “little bipolar.”

I found some information on this disorder at http://www.gpnotebook.co.uk

Persistent affective disorders are a lifetime diagnosis in patients with recurrent mild symptoms. The main persistent affective disorders are:

  • cyclothymia: (resembles a mild form of the bipolar affective disorder, with cycling between hypomania and mild depression).
  • dysthymia: (chronic low-grade depression, the symptomatology does not meet the full criteria for major depression and is not the consequence of a partially resolved major depression).

There is no resolution of the information contained in this paperwork. My mood disorder does not fit neatly into any specified category. It was noted that I was a sensitive person. It was also indicated that the previous medications caused me much distress. Yet, I was prescribed Lamictal for management of my moods. Lamictal is used to treat neuro-patients. My sensitivity and a low threshold for any nuances of chemical restructuring and balancing hinder me from taking medications.

Oppression

Sorrow and pity often accompany my thoughts when I do not have the answers. It seems I lack answers and help of “natural” man and anything temporal- I have a rudimentary existence, no true social support system (i.e., family and friends) in place for myself or kids. We have, for the most part, only each other. This may be a bit suspicious or presumptuous of me to conclude, but when people are poor, they are less inclined to have very many friends. My obvious barrier to having strong relationships is my mood disorder. When you are dealing with a myriad of emotions, it makes it difficult for others to accept you. Also, it makes it hard for you to sustain the energy and desire to handle some people.

Despair and Obsessive Thoughts

Focus on others- I think my family would be fine without me. In fact, maybe they would benefit more without me, but then I realize that being a parent means you do not back out, even if your kids would be better off without you! It means that you need to quit devaluing yourself. When I am mulling over such thoughts of hopelessness, I try to pinpoint where such negative thoughts originated in my thought pattern.

Guilt

As a parent, you feel sometimes that your kids expect too much. Too much money, too much energy. When these expectations are not met, some of us less-hearty moms feel guilty. Mothers with less emotional reserves have less to give at times. I was easily manipulated by my own guilt and insecurities. More often than I’d like to admit, I purchased things on my credit card just to “feel” better. Although the amount I spent wasn’t astronomical, it most certainly wasn’t a wise choice.

Not Otherwise Specified

The doctor said my speech was circumstantial. I discovered that means that the individual elaborates on insignificant or unrelated issues, but always returns to the primary issue.

Circumstantiality (also circumstantial thinking, or circumstantial speech) – An inability to answer a question without giving excessive, unnecessary detail.[9] This differs from tangential thinking, in that the person does eventually return to the original point. Wiki

My primary issue with this subject is “Not Otherwise Specified”. Knowing whether or not I have a particular anxiety disorder or mood disorder is a SIGNIFICANT detail towards my healing. I only wish they could have elaborated on the details. In fact, the psychiatrist who authorized the record’s release advised me to talk to her about the diagnosis. I haven’t given proper attention to prioritizing follow-up visits, mostly because I don’t want to be prescribed medication again, or I will be judged- by others and even myself.

A woman wearing dark clothes and hat walks in a field of daisies.

When People Pretend to Understand Bipolar Disorder

Don’t assume anything about Bipolar Disorder.

It is much easier for me to tell people I have been diagnosed with bipolar disorder now that I have had an actual psychiatric evaluation. It has taken me years to be led in the right direction for such a diagnosis. Five years ago, I believed I suffered from PMDD (premenstrual dysphoric disorder). A few times a year, when I would become so distraught over my moods, I would schedule a doctor’s appointment. I believed my periods were causing me such psychological problems that they were the major culprit in any interpersonal relationship conflict I had with family, friends or co-workers.
In 2016, I penned an email to my family doctor:

“I am no longer taking Lexapro. I tried for 3 weeks and had some nightmares and discovered I grew a tolerance for it. I felt really hostile on it the final week. I was seemingly fine until my period this week.”

She gingerly replied:

“Unfortunately you did not follow-up at your scheduled appointment where we would typically re-evaluate symptoms of anxiety, depression, PMDD, and any side effects. Therefore none of this is actually documented.”

I had been to the same office for “mood” problems since 2012 when the doctor tried to put me on birth control pills. The “pill” was not effective in treating my mood disorder. Each time I visited the doctor, they tried to give me another antidepressant. Mostly, I was given medication in the SSRI class of antidepressants. Then, I was prescribed Wellbutrin, a medication in the NDRI class (norepinephrine-dopamine reuptake inhibitor). My doctor determined that I was “sensitive” to medications, which is why she tried me on Wellbutrin.

I was afraid to mess with the new prescription she recommended. Then, my mood would improve, I’d get a euphoric feeling. I felt creative and happy about half of my life, then I descend into depression. It was always with that period of depression that I sought help. My doctor’s office replaced the previous physician with a new doctor. I explained that I was not there for “meds” as the nurse remarked on my intake form. She reviewed my symptoms and gave me a referral to their partner clinic- the clinic that deals with mental illness, therapy and psychiatry. A wave of embarrassment and shame poured over me. The psychiatrist asked me many questions. As I spoke to her, my speech became more rapid. “Do you realize how fast you are talking?” I said I was moderately aware of how my speech changes but nobody else has ever remarked about it.

We talked about my family history, specifically, how members of my family used alcohol to mask what was possibly their own mood disorders. In the past, there was more stigma against mental illness. People kept problems hidden from others, or at least they tried. The alcoholism simply created additional problems. My grandfather was a WWII survivor (USS Indianapolis). He was quiet and held his liquor well. It was socially acceptable to throw down a few beers. He was dealing with traumatic memories that he wanted to suppress. Grandma, on the other hand, was a talker. She was also a drinker, as was my mother. As a child, I witnessed interesting discussions when they all drank together in the kitchen. My grandfather seemed to have much composure. I can’t say the say for the rest of the family.

I told the doctor about my experiences with Lexapro, and how I had very disturbing nightmares. These nightmares dealt with the macabre- death and decay. I found it very difficult to shake these dreams from my waking moments. When I quit taking the medication abruptly, I experienced unpleasant withdrawal symptoms. I prayed that I would avoid getting into trouble or jeopardizing any relationship. The other medications made me feel dull but balanced. While on the meds, I was neither happy nor sad. My face felt like a mask. Any creative inclination I had previously experienced during my “manic” episodes had all but diminished.

My psychiatrist said that my periods likely trigger my underlying condition of bipolar disorder. She told me that more than likely, my mother and grandmother had mood disorders and drank to cope with their issues. The nightmares that I experienced while taking antidepressants was common in bipolar patients.

“Your family doctor sent you here because she didn’t know what else could be wrong”, she explained. I read that in order to be diagnosed with PMDD, the doctor must rule out any mental health issues that could possibly be causing the symptoms. Although I was not thrilled with being diagnosed with any mental disorder, bipolar disorder was less-embarrassing than PMDD. PMDD is not socially-acceptable and most people misunderstand the meaning of “being bipolar.”

When I need to tell people about my disorder (so they don’t think I’m speaking rapidly because I’m strung-out on drugs), I am met with a dismissive attitude. The term “bipolar” has become synonymous with being “edgy”. The term “bipolar” is used to broadly define any rebellious, hip, or bold attitude. Mood disorders are NOT attitudes.

Bipolar disorder is defined by the American Psychological Association as “a serious mental illness in which common emotions become intensely and often unpredictably magnified. Individuals with bipolar disorder can quickly swing from extremes of happiness, energy, and clarity to sadness, fatigue, and confusion. These shifts can be so devastating that individuals may choose suicide.”-APA.org

As a society, we have all but surpassed the days of unrelenting stigmatizing of mental illness, at least for bipolar disorder. In fact, we now must contend with the ignorance associated with bipolar disorder. Much of this ignorance is due in part from people not recognizing bipolar disorder as a real medical condition.

During a manic episode, people suffering from extreme cases of this illness may indulge in risky, foolish or erratic behavior. They may spend money and put their family in debt. They may become promiscuous and wreck their marriage by having affairs. During a depressed cycle, they may experience psychotic episodes, or attempt suicide and/or self-harm. While I have not experienced those elements of bipolar disorder, I have become so depressed that I have ruminated over my own death. I am certain that such dark moods are not appealing to my family.

Bipolar disorder affects each person differently. My variety of this trendy illness doesn’t involve getting tattoos, drinking and driving, or staying up all night like a rock star. Rather, my bipolar can be managed most days, and I have been given the ability to function enough to hold down a full-time job.

Others are not able to work or even manage to get out of bed and get dressed when they are debilitated by depression. When weekends arrive, I am partially relieved because I can rest at home, or so I believe. Often, I become so manic in the afternoon that I am not able to sit down. Weekend mornings, when the kids are still asleep and my worries are quenched for a little bit of time, are the only times I can spend writing. I “binge,” write during such times, except when I am depressed, or when I am trying a new medication.

When I was in my twenties, I started to become aware that something was not right about my moods. Listening to music from Jimi Hendrix and Nirvana opened my mind to certain mental health issues (i.e., “Manic-Depression”, “Frances Farmer Will Have Her Revenge”). I was old enough to drink and I drank exceedingly to suppress or to accelerate my mood shifts. Those were some of the worst years of my life!

When people passively listen to me talk about my mood issues, they appear to be dismissive or they appear to “know it all” about manic depression/bipolar disorder. They do not care or they wish to remain blissfully ignorant. After a while, I let them stew in their ignorance or I pretend to not have a mood disorder. Such people love to use a broad lens when depicting bipolar disorder. The lens they prefer to use, however, does not liberate, it merely conveys a broad, generic perspective of the term “bipolar”.