Oscillating Wildly

Recently, there's been quite a bit of cyber-chatter about a certain author who posted an open letter on his blog, listing his frustrations with his (now former) publisher. Although he raised some valid issues, the method of delivery has been criticized by some as ... let's see ... some of the adjectives used: "misguided", "unprofessional", and "crazy." In that very long, f-bomb-laden post, the author mentioned that he has been diagnosed with cyclothymia.

I saw enough confusion in the comments attached to that post to wonder how much people actually know about the disorder. And now that the author has posted a shirtless diatribe on YouTube, well. I guess it's time to do a post on cyclothymia. Note: I'm going to focus more on the mania-hypomania continuum of symptoms here and leave the major depression-dysthymia continuum for another post.

To understand cyclothymic disorder, you should probably first understand bipolar disorder I and II, as well as the criteria for dysthymic disorder and a major depressive episode. What's that, you say? Why can't I just rattle off the criteria for cyclothymia? OK. They are:

1. For a period of at least two years, the presence of numerous periods of hypomanic symptoms and numerous periods of depressive symptoms that don't meet criteria for major depressive disorder.

2. The person has gone no longer than 2 months without either hypomanic or depressive symptoms.

3. At no point during the past 2 years has the person had an episode that met critiera for major depressive episode, manic episode, or mixed episode.

There are a few more, but you get the gist. Cyclothymia is as much about what's not there as it is about what's there. It's basically a lighter, less severe version of bipolar disorder. While the symptoms still cause distress and are impairing, they are usually not as life-threatening as those for bipolar disorder (especially bipolar I).

In the author's post, he talks about long periods of productivity, during which he has some reduced need for sleep and a lot of great ideas, sometimes for months at a time, interspersed with periods of general funk (which he described as severe enough to make me question whether bipolar II wasn't a more appropriate diagnosis, but obviously I don't have enough information to make that call). Here are the criteria for an actual manic episode (you have to have at least 3 of these):

1. inflated self-esteem or grandiosity
2. reduced need for sleep
3. more talkative than usual
4. racing thoughts
5. high distractibility
6. increase in goal-directed activity or psychomotor agitation
7. excessive involvement in pleasurable but risky activities (buying sprees, sexual ... sprees)

Symptoms have to be present for at least a week, and are accompanied by peristently elevated or irritable mood (yes, a manic person might be irritable). The episode has to be severe enough to cause marked impairment or even hospitalization.

The criteria for hypomania are: basically the same. EXCEPT: the episode, although noticeable, is NOT severe enough to cause marked impairment. To accurately diagnose mood disorders, it takes a lot of good assessment and monitoring, because it's actually more complicated than it looks, and you have to pay attention to all these technical definitions. Well ... I guess we could argue about the definition of marked impairment in light of this. However, if you read this, you might make a different call.

The whole thing is pretty fascinating from a mental health perspective, not to mention a business/publishing perspective. Have you heard about this kerfuffle? If so, did you notice the mention of cyclothymia? Did it change the way you interpreted the post and the author's behavior? Do you think it was made more or less effective by the mention of cyclothymia?

You know who's probably really good at making those diagnostic calls? Laura Diamond, that's who. So go check out her Mental Health Monday post. Also, don't forget Lydia Kang's Medical Monday post. I love learning from these two!