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Cyclothymic Personality Disorder

 

Personality disorder is a matter of false judgments of value. Listed below are the false value judgments that are at the root of Cyclothymic Personality Disorder.


False Good

False Bad

Personality Disorder
pleasure pain hedonistic
intense emotional experiences (excitement) hypomanic periods and moods alternating with depressive periods and moods
constant activity hyperactivity
pleasurable activities and experiences becomes excessively involved in pleasurable activities with lack of concern for the high potential of painful consequences
a positive view of past and future achievements alternates between over-optimism or exaggeration of past achievement, and a pessimistic attitude toward future or brooding about past events
social situations to be good, and to work out well more talkative than usual with inappropriate laughing, joking, and punning
to be able to go without sleep has a decreased need for sleep alternating with hypersomnia
to see oneself as excellent naive grandiose overconfidence alternating with lack of self-confidence
to have a high level of creativity periods of sharpened and creative thinking alternating with periods of mental confusion and apathy
a high level of productivity, and to produce high quality work marked unevenness in the quantity and quality of productivity
for people and sex engages in uninhibited people-seeking (that may lead to hypersexuality) alternating with introverted self-absorption
for one's activity, or interest, whatever one is doing, to be good frequently shifts line of work, study, interest, or future plans
money; possessions engages in occasional financial extravagance
romance and sex has a tendency toward promiscuity, with repeated conjugal or romantic failure
for the stimulation or relaxation of alcohol and/or drugs may use alcohol or drugs to control moods or to augment excitement
for current experiences to be good has irritable -angry-explosive outbursts that alienate loved ones
new residences and new geographic locations makes frequent changes in residence or geographical location
for knowledge, skill, expertise, and mastery in certain selected areas of interest perfectionism and devotion to an idealized self-image
self-confidence, sensuality, creativity, and efficiency perfectionism as to performance and outcomes
creative, or productive, work overly committed to creative work or productivity



Perspectives q.v.





The Disease Perspective



PTypes Personality Types proposes Cyclothymic Personality Disorder as a pervasive pattern of pronounced periodic changes in mood, behavior, thinking, sleep, and energy levels, beginning by early adulthood and present in a variety of contexts, as indicated by seven (or more) of the following:

  • has depressive periods: depressed mood or loss of interest or pleasure in all, or almost all, activities and pastimes alternating with hypomanic periods: elevated, expansive, or irritable mood (American Psychiatric Association, 1980, pg. 220);

  • becomes excessively involved in pleasurable activities with lack of concern for the high potential of painful consequences alternating with restriction of involvement in pleasurable activities and guilt over past activities (pg. 220);

  • alternates between over-optimism or exaggeration of past achievement and a pessimistic attitude toward the future, or brooding about past events (pg. 220);

  • is more talkative than usual, with inappropriate laughing, joking, and punning: and, then, less talkative, with tearfulness or crying (pg. 220);

  • has a decreased need for sleep alternating with hypersomnia (Akiskal, Khani, and Scott-Strauss qtd. in Jamison, pg. 264); 1

  • has shaky self-esteem: naive grandiose overconfidence alternating with lack of self-confidence (pg. 264);

  • has periods of sharpened and creative thinking alternating with periods of mental confusion and apathy (pg. 264);

  • displays marked unevenness in the quantity and quality of productivity, often associated with unusual working hours (pg. 264);

  • engages in uninhibited people-seeking (that may lead to hyper-sexuality) alternating with introverted self-absorption (pg. 264);

  • frequently shifts line of work, study, interest, or future plans (pg. 264);

  • engages in occasional financial extravagance (pg. 264);

  • has a tendency toward promiscuity, with repeated conjugal or romantic failure (pg. 264);

  • may use alcohol or drugs to control moods or to augment excitement (pg. 264);

  • has irritable-angry-explosive outbursts that alienate loved ones (pg. 264);

  • makes frequent changes in residence or geographical location (Akiskal, 1995, pg. 1143).



1Akiskal, H. S., Khani, M. K., and Scott-Strauss A. (1979). Cyclothymic temperamental disorders. Psychiatric Clinics of North America, 2: 527-554. Philadelphia: W. B. Saunders.





The Dimensional Perspective



Dimensions

Here is a hypothetical profile, in terms of the five-factor model of personality, for Cyclothymic Personality Disorder (speculatively constructed from McCrae, 1994, pg. 306):



High Neuroticism
Chronic negative affects, including anxiety, fearfulness, tension, irritability, anger, dejection, hopelessness, guilt, shame; difficulty in inhibiting impulses: for example, to eat, drink, or spend money; irrational beliefs: for example, unrealistic expectations, perfectionistic demands on self, unwarranted pessimism; unfounded somatic concerns; helplessness and dependence on others for emotional support and decision making.

Low Extraversion
Social isolation, interpersonal detachment, and lack of support networks; flattened affect; lack of joy and zest for life; reluctance to assert self or assume leadership roles, even when qualified; social inhibition and shyness.

Low Openness
Difficulty adapting to social or personal change; low tolerance or understanding of different points of view or lifestyles; emotional blandness and inability to understand and verbalize own feelings; alexythymia; constricted range of interests; insensitivity to art and beauty; excessive conformity to authority.

High Agreeableness
Gullibility: indiscriminate trust of others; excessive candor and generosity, to detriment of self-interest; inability to stand up to others and fight back; easily taken advantage of.

Low Conscientiousness
Underachievement: not fulfilling intellectual or artistic potential; poor academic performance relative to ability; disregard of rules and responsibilities can lead to trouble with the law; unable to discipline self (e.g., stick to diet, exercise plan) even when required for medical reasons; personal and occupational aimlessness.





Character Weaknesses and Vices

Abusiveness (bullying, cruelty, violence), adolescent behavior, bragging, cowardice and fearfulness, craziness, depressiveness, egotism, emotionalism, fatalism, hypocrisy, hypomania, insecurity, jealousy, lying (tall stories, exaggeration), machismo, oversensitivity, Puritanism, rages, rebelliousness, sadism, secretiveness, self-delusion, shyness, suffering, superman problem, superstitiousness, suspiciousness, weakness.*



* These are some of the "Personal characteristics" of Ernest Hemingway indexed by Denis Brian (353) in The True Gen.



Specific Affects

Fear of death, [mania]; fear of life, [depression] (Maddi, 57-60).

Chronic, fluctuating mood, hypomanic mood, depressed mood (American Psychiatric Association, 2000, pg. 398).

Persistently elevated, expansive, or irritable mood, enthusiasm, euphoria, uncritical self-confidence, distractibility, impulsiveness (American Psychiatric Association, 1994, pg. 335-336).

Feelings of worthlessness, or excessive or inappropriate guilt; sadness, hopelessness, discouragement, loss of interest or pleasure, tearfulness, anxiety, irritability, panic attacks, phobias (American Psychiatric Association, 1987, pp. 219-220).

Feelings of inadequacy, feelings of inflated self-esteem, low energy or chronic fatigue, more energy than usual, loss of interest in or enjoyment of sex, hypersexuality, feeling slowed down, physical restlessness (American Psychiatric Association, 1980, pg. 220).





The Behavior Perspective



Motivations

Want to be free to pursue creative, artistic, and other individualistic pleasurable activities while still getting dependency needs satisfied.



Behaviors

Decreased effectiveness or productivity at school, work or home; increased productivity, often associated with unusual and self-imposed working hours; Social withdrawal; uninhibited people-seeking (extreme gregariousness); hypersexuality without recognition of possibility of painful consequences; loss of interest in or enjoyment of sex; tearfulness or crying; inappropriate laughing, joking, punning; Excessive involvement in pleasurable activities with lack of concern for the high potential for painful consequences, e.g., buying sprees, foolish business investments, reckless driving (American Psychiatric Association, 1980, pg. 220).

Irritable-angry-explosive outbursts that alienate loved ones; episodic promiscuity; repeated conjugal or romantic failure; frequent shift in line of work, study, interest or future plans; resort to alcohol and drug abuse as a means for self-treatment or augmenting excitement; occasional financial extravagance (Akiskal, Khani, and Scott-Strauss qtd. in Jamison, pg. 264). 1



Associated Disorders

Substance-Related Disorders, Sleep Disorders, Mood Disorders (especially Bipolar Disorder) (American Psychiatric Association, 2000, pp. 398-399).






The Life Story Perspective



Childhood

Strong, aggressive mother; weak, passive father.

Erratic and neglectful parenting: failure to inculcate a discipline of emotional self-regulation.

Overbearing, inconsistent parenting: "the combination of swift, harsh, and often arbitrary punishment with loving overindulgence" (Spilka, pg. 22).



Cognitive Effects

Periods of low self-esteem alternating with periods of inflated self-esteem; pessimistic attitude toward the future or brooding about past events alternating with over-optimism or exaggeration of past achievements; decreased attention, concentration, or ability to think clearly alternating with periods of sharpened and unusually creative thinking (American Psychiatric Association, 1980, pg. 220).

Brooding or obsessive rumination, excessive concern with physical health (American Psychiatric Association, 1987, pg. 220).


Basic Belief: I must escape from painful feelings and thoughts. Strategy: Mastery through expertise.

The "idealized self is made up of beliefs about how we should feel, think, or act" (Tamney, pg. 32).

In Bipolar disorder: a cognitive therapy approach, Cory F. Newman et al. (pp. 73-74) list beliefs typical of those bipolar patients who "desire to experience the 'highs' (pg. 73)" of the disorder. According to my view, the beliefs and attitudes rationalize and reinforce the idealized image and the compulsive attachments and aversions. They are analogous to Karen Horney's "shoulds" and "neurotic claims." I include them as some of the typical beliefs that I associate with Cyclothymic Personality Disorder:

  • Life is boring if I stay in control of my moods.
  • I can't be creative unless I am in a high state of mind.
  • Being manic enables me to overcome my shyness.
  • I wouldn't be able to cope with life if I weren't so happy once in a while.
  • My moods are not a problem. I could control them if everybody just got off my case.
  • I can't get things accomplished unless I'm racing.
  • Why shouldn't I do wild and crazy things? It's my life!








Akiskal, Hagop S. (1992). Delineating irritable and hyperthymic variants of the cyclothymic temperament. Journal of Personality Disorders, 6(4), pp. 326-342. New York: Guilford Press.

Akiskal, Hagop S. (1995). Mood disorders: Clinical Features. Comprehensive Textbook of Psychiatry/VI, Vol. 1. Eds. Harold I. Kaplan and Benjamin J. Sadock. Baltimore: Williams & Wilkins.

American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. Washington: Author.

American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders. 3rd. ed., rev. Washington: Author.

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 4th ed. Washington: Author.

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 4th ed., text revision. Washington: Author.

Cooper, Terry D. (2003). Sin, Pride, and Self-Acceptance: The Problem of Identity in Theology and Psychology. Downers Grove, IL: InterVarsity Press.

Fawcett, Jan, Golden, Bernard, and Rosenfeld, Nancy (2000). New hope for people with bipolar disorder. Roseville, CA: Prima.

Goldenson, Robert M. (1975). Encyclopedia of human behavior: psychology, psychiatry, and mental health. New York: Dell.

Jamison, Kay Redfield (1993). Touched by Fire: Manic-depressive Illness and the Artistic Temperament. New York: Free Press.

McCrae, Robert R. (1994). "A Reformulation of Axis II: Personality and Personality-Related Problems." Costa, Paul T., Jr., Widiger, Thomas A., editors. Personality Disorders and the Five-Factor Model of Personality. Washington, D.C.: The American Psychological Association.

Newman, Cory F., Leahy, Robert L., Beck, Aaron T., Reilly-Harrington, Noreen A., and Gyulai, Laszlo (2001). Bipolar disorder: a cognitive therapy approach. Washington, D.C.: The American Psychological Association.

Spilka, Mark (1990). Hemingway's Quarrel with Androgeny. Lincoln: University of Nebraska.

Tamney, Joseph B. (2002). The Resilience of Conservative Religion. New York: Cambridge UP.



Until DSM-III (1980), Cyclothymic Disorder was classified as a personality disorder. In its section on Personality Disorders, the New Catholic Encyclopedia (1967) preserved the short description from DSM-I (1952) of the Cyclothymic Personality which was classified as a "personality pattern disturbance":

Cyclothymic Personality. "Such individuals are characterized by an extratensive and outgoing adjustment to life situations; and apparent personal warmth, friendliness, and superficial generosity; an emotional reaching out to the environment; and a ready enthusiasm for competition. Characteristic are frequently alternating moods of elation and sadness, stimulated apparently by internal factors rather than by external events. The individual may occasionally be either persistently euphoric or depressed, without falsification or distortion of reality."

The cyclothymic person functions according to an all-or-none principle. His elation and sadness are related to anticipatory states. When positive anticipation prevails, the laws of probability are discarded, and he acts as if failure or disappointment were not among the possible outcomes of an enterprise or a hope. Suggestions of risk and pleas for caution are good-naturedly rejected. As the dangers of disappointment become more apparent there is often a further elevation of mood as if to deny the danger.

The total positive anticipation turns to total negative anticipation when an obstacle is encountered or a disappointment is experienced. In the negative anticipation phase, obstacles are overemphasized, disappointment appears inevitable, and a sense of impotence and doom prevails.

When gross falsification or distortion of reality attends the extremes of elation or sadness, the cyclothymic label is no longer applied, and the term manic-depressive psychosis is used to describe the current state and its development. The patient can be helped by a psychotherapeutic approach in which he is encouraged to explore dangers, obstacles, and potential disappointment, and to learn new responses to them.



C. Robert Cloninger (2001, pg. 13) defines the cyclothymic personality in terms of the basic stimulus-response characteristics of novelty seeking, harm avoidance, and reward dependence.

"Cyclothymic personality is defined here in terms of the basic response characteristics of low novelty seeking, low harm avoidance, and high reward dependence, which are associated with the second order traits of being scrupulous and usually hyperthymic but gullible and vulnerable to frustration and rejection. Such individuals are warm and socially sympathetic but highly self-confident authoritarians. Although they are usually cheerful and optimistic, they are also moody or dysphoric in response to being cheated or rejected. This corresponds closely to classical descriptions of cyclothymic personality.

"However current criteria in the DSM-III and ICD do not strictly distinguish between such a stable temperamental variant and mild endogenous mood disorder without the associated temperamental variant. In fact, in the DSM-III, cyclothymic disorder is listed only with affective disorders, not personality disorders. Reliable methods are available for identifying a broadly defined group of individuals with subclinical affective disorders. However, it should be possible to distinguish between personality disorder defined here and mild affective disorders without the associated personality variant. Individuals with the personality variant should have other personality traits that are not necessarily associated with mood disturbances. For example, the cyclothymic personality should be associated with being frugal (low novelty seeking) and persistent (high reward dependence), with the dysphoric states being reactive to frustrative loss or expected rewards, rather than autonomous."

Cloninger, C. R. (1987) A systematic method for clinical description and classification of personality variants. Archives of General Psychiatry, 44, 573-588.

Cloninger, C. Robert. (2001). A systematic method for clinical description and classification of personality variants. In The Science of Mental Health, Vol. 7, Personality and Personality Disorder. New York: Routledge.

 

Mania and Pleasure

A Stoic diagnosis of the cyclothymic personality would surely focus on the role of the passion of pleasure:

"Pleasure rarely figures in the description or conceptualization of mental disorders, where attention more commonly falls on the many varieties of misery (e.g., anxiety, fear , guilt, sadness, shame). However, this lack of attention is far from absolute, and pleasure is sometimes discussed in the context of mania, depression, and schizophrenia. The connection is clearest in the case of mania, which is one manifestation of the cycling emotional disturbance known as bipolar disorder. People in a manic state often experience elevated or euphoric mood and an increased involvement in pleasurable activities, in addition to inflated self-esteem, destructibility, decreased need for sleep, and racing thoughts. Their frenetic seeking of pleasurable experiences often results in impulsive and self-destructive behavior, such as spending sprees, excessive gambling, reckless driving, sexual promiscuity, and illegal drug use. In mania, then, the unrestrained augmentation of pleasure frequently leads to consequences that the person regrets once the episode is over. However, people who experience mild forms of this mood disturbance, known as hypomania, sometimes fondly look back on their hypomanic episode as a time of self-confidence, sensuality, creativity, and efficiency. Indeed, many highly creative people, especially in the arts and literature, have been prone to manic or hypomanic episodes, as well as the recurrent depressions that usually accompany them" (Levinson et al., pg. 519).


Encyclopedia of Human Emotions. Vol. 2. Eds., David Levinson, James Ponzetti, Peter Jorgensen. New York: Macmillan Reference USA, c1999.

 

Black and White Thinking

Black and White Thinking - Wikipedia

A common form of the false dilemma is black-and-white thinking. Many people routinely engage in black-and-white thinking, an example of which is feeling boundless optimism when things are going well and suddenly switching to total despair at the first setback. Another example is someone who labels other people as all good or all bad.



Cyclothymic Personality Disorder (page 2)



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