Abnormal Psychology

224 CHAPTER 6

Cyclothymia usually unfolds slowly during early adolescence or young

adulthood, and it has a chronic course, as Mr. F’s history reveals (see Case 6.5).

Approximately 15–50% of people with cyclothymia go on to develop some type

of bipolar disorder (American Psychiatric Association, 2000).

CASE 6.5 • FROM THE OUTSIDE: Cyclothymic Disorder

At his girlfriend’s insistence, Mr. F., a 27-year-old single man, goes for a psychiatric evalua-

tion. Mr. F. reports that he is excessively energetic, unable to sleep, irritable, and isn’t satisfi ed

with the humdrum nature of his work and personal life. He was often dissatisfi ed and irrita-

ble for periods of time ranging from a few days to a few weeks. These periods alternate with

longer periods of feeling dejected, hopeless, worn out, and wanting to die; his moods can shift

up to 20–30 times each year, and he describes himself as on an “emotional roller-coaster,”

and has been for as long as he can remember. He twice impulsively tried to commit suicide

with alcohol and sleeping pills, although he has never had prominent vegetative symptoms,

nor has he had psychotic symptoms.

(Adapted from Frances & Ross, 1996, p. 140)

Because Jamison had both MDEs and manic episodes,

her symptoms do not meet the criteria for cyclothymic disor-

der. Figure 6.4 identifi es the key mood episodes that are the

diagnostic building blocks of the various mood disorders.

Understanding Bipolar Disorders

Manic-depression... is an illness that is biological in its ori-

gins, yet one that feels psychological in the experience of it; an

illness that is unique in conferring advantage and pleasure, yet

one that brings in its wake almost unendurable suffering and,

not infrequently, suicide.

I am fortunate that I have not died from my illness, fortu-

nate in having received the best medical care available, and for-

tunate in having the friends, colleagues, and family that I do.

(Jamison, 1995, p. 6)

Kay Jamison made her professional life into a quest to under-

stand mood disorders and why some people develop them.

Let’s examine what is known about bipolar disorders using

the neuropsychosocial approach.

Neurological Factors

As with depressive disorders, both distinctive brain function-

ing and genetics are associated with bipolar disorders.

Brain Systems

One hint about a neurological factor that may contribute to

bipolar disorders is the fi nding that the amygdala is enlarged

in people who have been diagnosed with a bipolar disorder

(Altshuler et al., 1998). This fi nding is pertinent because the

amygdala is involved in expressing emotion, as well as regu-

lating mood and accessing emotional memories (LeDoux,

1996). A larger amygdala may be a more emotionally reac-

tive amygdala. Consistent with this idea, researchers have

also found that the amygdala is more active in people who

Figure 6.4

6.4 • Differential Diagnosis of Mood Disorders

g4

Manic episode

(current or in the past)

Mixed episode

(current or in the past)

Hypomanic episode (current or in

the past, plus at least one MDE)

MDE only

(current or in the past)

Periods of hypomanic symptoms

alternating with periods of

depressive symptoms, over 2 years

At least three symptoms of an

MDE for at least 2 years duration

Bipolar I disorder*

Bipolar I disorder*

Bipolar II disorder*

Major depressive disorder

(specify single

episode or recurrent)

Cyclothymic Disorder

Dysthymic disorder

MDE = Major depressive episode

* According to DSM-IV-TR, once this diagnosis is made, the clinician should also note

what type of mood episode is current or most recent.