VI. Family Support: Advice You Can Give to Help Family Members Live with Cyclothymic Individuals
It is possible that you will encounter spouses, children, parents and maybe even friends of individuals who suffer from Cyclothymic Disorder. Although it is not possible in many circumstances, it would help both the afflicted individual's family and the individual him or herself if their family and friends understood Cyclothymic Disorder. Will recalls that when he was first diagnosed he had a hard time accepting the "taboo" idea of having a mental illness, and that it was difficult for him to speak to his family about this problem. He believes that if a third party would have had the opportunity to explain his illness to his family, it may have avoided a lot of hardship.
This CEU will provide you with methods of explaining Cyclothymia to family and friends of Cyclothymic individuals, as well as some advice you might give them for improving their relationships with the afflicted individual. Of course, in all circumstances you should use your expertise and your knowledge of the individuals you are speaking with to tailor your explanation of the illness to your audience.
First, it is always helpful to have some handout material (such as the page attached at the end of the course) about Cyclothymic Disorder that you can distribute to family members and which they can contemplate and interpret in their own ways and on their own time. When you speak to the family of an afflicted individual you may find that they harbor a lot of anger towards the individual due to their past behavior. It would be valuable to attempt to explain that the individual does in fact have a clinical disorder that may account for some of his or her actions and that can be treated. Explain how the symptoms of Cyclothymia may have affected the specific actions and decisions of their family members. For example, if you were to encounter Will's father, you might explain to him that in a hypomanic stage Will felt the need to engage in pleasurable activities with little inhibitions, causing him to recklessly spend his money. If you were speaking with Karen's spouse, you could attempt to explain that the ups and downs of Cyclothymia often cause individuals in relationships to pull close to their partner and then abruptly push them away. You should try to encourage family members to forgive the inflicted individual for their past mishaps, and explain to them that their forgiveness and support will help the Cyclothymic individual's treatment process.
As when you speak to a Cyclothymic individual, it is important to express to their family members that while treatment is available and progress is likely, there is no magic cure or instant pill to vanish the illness. Treatment processes for Cyclothymia are directed towards coping, rather than curing, and support, patience and understanding from an individual's family will expedite and improve this difficult process.
It is important that you express to family members that the afflicted individual's mood swings are likely to continue even with treatment, although hopefully with a lesser degree of severity. You should encourage them to be thoughtful in their relationships with these individuals, realizing when they are going through hypomanic and depressive periods that they may not be able to control, and most importantly, not taking the mood swings personally.
Cyclothymic individuals often express feelings of being weak, annoying, immoral or lazy; and these feelings are often encouraged by unsupportive family members. In addition, many Cyclothymic individuals complain that their family and friends do not treat their illness with validation, believing that they are exaggerating or using the illness as an excuse for histrionics or extravagance. It is extremely important for family members and friends of these individuals to understand the severity of Cyclothymia, and encourage their relative to seek and maintain a treatment schedule.
On the other hand, it is important to explain the difference between Cyclothymia and Bipolar Disorder. It is especially recommended that you explain that with treatment, Cyclothymic individuals have a much stronger capability of living happy and reasonable lives.
Family members should be aware of the 15-50% chance that the individual will cycle into Bipolar Disorder. They should be made aware of the symptoms of this disorder as well so that they might catch any warning signs of deterioration and encourage their relative to seek immediate treatment. If the situation is appropriate, it may be helpful to tell family members that Cyclothymic individuals who do not use biomedical treatments often resort to drugs and alcohol to "self-medicate" and lessen their mood swings.
Cyclothymic individuals often have a great deal of difficulty with the feeling of being "stuck" inside a situation. This problem is an area in which family members can be extremely helpful. Often the outside pressures, which drive Cyclothymic individuals to the feeling of being trapped inside a project or commitment, originate from family and friends. If the relatives of the individual accept the individual's illness and the problems associated with it, they can be extremely helpful to their relative by relieving pressure when they notice that the individual is struggling. These feelings of being stuck often originate in the workplace or within relationships, and family members can help by supporting the individual in seeking flexible hours at work, or finding new solutions within a relationship to allow the Cyclothymic individual to feel less trapped.
You may advise receptive families to participate in support groups or online forums for relatives and friends of individuals with mental disorders. One online forum which contains a lot of information written by individuals with mood disorders and recommended by Cyclothymic individuals is the Icarus Project website.
When an individual is first diagnosed with Cyclothymia, it will most likely be extremely difficult for him or her to accept the diagnosis. The beginning of treatment is often additionally difficult as the patient struggles to understand Cyclothymia and wait for the medications and other treatments to take effect. During this period it is especially important for family members to be supportive.
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VII. Theories of Mood Disorders: The Reason Behind the Confusion
The study of mood disorders and their diagnosis and treatment is ongoing. The DSM-IV guidelines are widely accepted as a work-in-progress and it is known among mental health professionals that it is often impossible to accurately diagnose an individual solely according to that categorization. Currently there are several main theories of the cause and development of illnesses related to Cyclothymic Disorder. Understanding these theories may help you relate to Cyclothymic patients and will also help you to comprehend other individuals with similar symptoms and complaints. The two main theories in today's mental health forum are the Kindling Theory and the Spectrum Theory. These theories are conducive to one another and are widely accepted by mental health professionals around the world.
The Kindling Theory
The Kindling Theory implies that Cyclothymia and other related mood disorders function much like a fire. While when a fire is first lit, a large log, although appropriate fuel, will not catch flame; but after enough time and enough kindling, the log will burn. In the context of Cyclothymia, this theory means several things. First, an individual at the beginning stages of Cyclothymia may shift from hypomania to depression or vice versa due to external triggers, but as the disease develops their brain will be more susceptible to changes in mood even without outside stimulus. In addition, unchecked, the mood fluctuations are likely to occur more and more often. This deterioration occurs because with each episode the brain becomes increasingly sensitized (kindled) and the destructive pathways inside the central nervous system are strengthened. Further, the Kindling Theory is strongest in patients who had periods of noncompliance with medications, or patients who were diagnosed later rather than earlier. This implies that medication and treatment can prevent or delay deterioration of Cyclothymia and serves as an added incentive for healthcare professionals to encourage individuals whom they suspect to have Cyclothymic Disorder or any other mood disorder to seek treatment as soon as possible.
It may be advisable for you to inform Cyclothymic individuals of the adverse affects of kindling and the help that their medications can provide. There is always a danger of mental health patients stopping treatment after a period of time because they decide that they no longer need them. Premature halting of treatment is a frequent cause of worsening of mental health illnesses, and patients who are informed of the Kindling Theory may have an incentive to continue with their treatment as prescribed.
The Bipolar Spectrum Theory
Another significant theory relating to mood disorders is the theory of the Bipolar Spectrum. The spectrum theory describes Bipolar Disorder, Cyclothymic Disorder, Unipolar Depression and more as all different parts of the same spectrum of up/down cyclic disorders. The Bipolar Spectrum begins at severe mania and drops to major depression, with euthymic (normal mood state) in the middle. Mood disorders are then labeled as points on this spectrum depending on the severity of the mood swings. Cyclothymic Disorder lies between Bipolar Disorder and Unipolar Disorder on the spectrum. This theory is increasing in popularity as mental health professionals realize increasing discrepancies in their patients' symptoms from the DSM-IV guidelines.
As there are an infinite number of points between two points on a line, the spectrum theory basically states that while individuals may be diagnosed with either Bipolar II Disorder or Cyclothymia, they may in fact lie anywhere in between. Recently, many mental health professionals have taken the spectrum theory even further, saying that a patient who suffers from a reoccurrence of depression also experiences a cycle.
The Complications of Diagnosis
If you consider both the Kindling Theory and the Bipolar Spectrum in the context of Cyclothymia, you can see why this disorder is so difficult to diagnose. The symptoms may vary depending on the amount of time the illness has been untreated; and patients with Cyclothymic Disorder may closely border either Unipolar Disorder or Bipolar II Disorder.
An additional factor that complicates the identification of Cyclothymia is the Mixed State. Mixed States are the periods that Karen experienced when she was mistakenly treated with antidepressant medication. Because the medication was inappropriate for her disorder it thrust her into a continuous state of hypomania with mixed periods. During her mixed states Karen was simultaneously hypomanic and depressed. She described those periods as the most disturbing and functionally disruptive of all aspects of her illness. She would experience hopelessness and helplessness accompanied by restlessness and risk-taking behavior. For Cyclothymic individuals with more severe symptoms these periods are extremely dangerous, because recklessness and impulsiveness can arrive along with depression.
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VIII. The Silver Lining: How You Can Help Cyclothymic Individuals Accept and Embrace Aspects of Their Illness
Of the eleven individuals interviewed for this course, every one expressed positive aspects of their diagnosis and treatment processes. This information may allow medical professionals such as yourself to help Cyclothymic individuals not only accept their illness, but explore the possible positive sides to such a diagnosis.
Many Cyclothymic individuals, when first diagnosed, feel relief that many of their past, previously inexplicable, irrational behaviors had a cause. When Will was diagnosed, he began to understand why he had so unreasonably squandered his savings and why he had been unable to maintain a steady job or relationship. After learning that he had Cyclothymia he felt less guilt about his past behavior, which allowed him to cope better with his illness and move on with his life. Many Cyclothymic patients harbor intense guilt and shame over their past actions, and you can help them understand that with treatment they will learn to better understand and control their mood swings.
Karen's diagnosis with Cyclothymia allowed her to better analyze her relationship with her husband. She had been trapped in a cycle of getting angry and picking arguments with her husband during depressive states and then realizing that her anger was unjustified when she cycled back to hypomanic or neutral. When she comprehended that her arguments had been baseless, Karen would feel extremely guilty for hurting her husband and foolish and childlike for her unreasonable outburst. Understanding that her sudden irritability was caused by her Cyclothymic cycles helped Karen to analyze her thoughts and control her urges to start such unfounded fights. She uses her mood journal to write down her feelings in such moments, including why she felt angry with her husband and what caused her to feel that way. A sample list that Karen made when she began to feel angry with her husband one morning before he left for work was as follows:
- I think that he is thinking about other women
- He is not being thoughtful
- He is not loving enough
- He does not value my opinion
Using Dr. Burn's mood diary journal we discussed above Karen was able to understand that her thoughts were unreasonable and not worth fighting over. For example, according to the book, the feeling "I think he is thinking about other women," is called "mind reading." Dr. Burns describes mind reading as the act of being upset or angry with another person because of something that one assumes the person is thinking. Using her mood journal Karen was able to understand that her other feelings were unreasonable, as she does usually consider her husband to be a thoughtful, loving and respectful individual. Her feelings that he was being "mean" or thoughtless were based on her mood, and not on his actions. Since Karen's diagnosis she has noticed that her relationship with her husband has improved significantly. Her enhanced self-understanding has allowed her to control her mood swings and therefore strengthen her relationships with others.
Many Cyclothymic individuals expressed through their interviews that their illness has the benefit of making them more sensitive to their surroundings. This awareness causes many of these individuals to become involved in meaningful and charitable activities, which in turn give them a feeling of self-fulfillment and purposefulness. Will said during his interview that "there are benefits to this condition; I am glad that I am an emotional person." After Will graduated from university, he worked in Ecuador as a journalist for an American newspaper. He recalls an instance where he saw two children fighting in the street. The larger child was beating the other, who was cowering on his knees on the hot pavement. His fellow journalists were amused, and watched passively, but Will was concerned for the child, and came forward to intervene. The larger boy ran away when he saw Will approach, and Will comforted the other boy. He helped him bandage his cuts and bought him a soda. Will recalls that experience as one where his oversensitivity served a positive purpose. You should encourage Cyclothymic individuals to embrace these feelings and to put them to good use, as positive activism not only provides self-fulfillment but can also provide a steady activity for these individuals, which is a recommended and necessary part of their treatment.
While Cyclothymic patients are in a hypomanic state, they often express themselves as "full of ideas and plans," which often fall through when they revert to a depressive stage. However, many of these ideas may be valuable and feasible, and you should encourage Cyclothymic patients to write down these ideas as they occur to them. That way, when they are ready, they may work on some of those projects towards a positive outcome. You may also want to request from these individuals' family members not to disregard all ideas that come from hypomanic moods, but rather to gently encourage the Cyclothymic individual to consider their thoughts and follow-through on those that seem reasonable and positive.
While Cyclothymia is often hurtful to relationships, some individuals have expressed the positive affects of the disease in this arena. Cyclothymic individuals often describe themselves as deep, caring, thoughtful, loving and empathetic. These qualities can serve to strengthen a relationship, and you should encourage Cyclothymic individuals to embrace the positive characteristics that may be associated with Cyclothymia.
Many Cyclothymic individuals feel that their illness has helped them to pursue their artistic skills. Both Will and Karen believe that their extraordinary perceptiveness and sensitivity encourage their writing skills. Since Will has begun treatment he has been working on a novel; he believes that Cyclothymia has contributed to the emotional charge and thoughtfulness that he attributes to his writing. According to experts, healthcare professionals can help Cyclothymic individuals by urging them to pursue any artistic tendencies they may have. These activities may not only help these individuals to reach a state of active stability, but they will help them to seek the positive aspects of their diagnosis and their personalities.
* IMPORTANT NOTE: All of the positive attributes described above were portrayed by individuals with Cyclothymia who are currently receiving treatment. This section is designed for you to help Cyclothymic individuals accept their diagnosis and find the positive side to the situation, not to discourage any patient from seeking both biomedical and talk-therapy treatment.
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