Cyclothymia and anxiety are common as comorbid conditions and through what’s known as “anxious distress.”

Anxiety is a feeling of apprehension and anticipation. It can be a part of fear or excitement, but it’s a natural emotion that almost everyone experiences throughout life. While anxiety is often viewed negatively, it’s an important part of your body’s survival process.

Short-term anxiety is the body’s way of readying you for expected stress. Your heart rate quickens. Your breathing picks up. You might notice you’re on alert and ready to respond as quickly as possible.

Anxiety that sticks around, however, isn’t so beneficial. Chronic anxiety can keep the body in a state of readiness, and all the physiological changes from anxiety start to wear on you physically and mentally.

When it becomes impairing, it may meet the criteria of an anxiety disorder.

Living with certain mental health conditions can make you more likely to experience persistent anxiety. Cyclothymia and anxiety, for example, are linked through both comorbidity and symptomology.

Cyclothymia, also known as cyclothymic disorder, is a mood disorder listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) as a bipolar-related condition.

Like bipolar I and II disorders, cyclothymia features uncontrollable periods of elevated and low mood. What sets cyclothymia apart from other bipolar disorders is the severity of the mood episodes.

In cyclothymia, periods of elevated mood never reach the level of hypomania. Similarly, low periods of mood in cyclothymia never meet the diagnostic criteria of a major depressive episode.

A diagnosis of cyclothymia is given only after mood symptoms are present for 2 years or longer without a full hypomanic or major depressive episode. As soon as a major depressive or hypomanic episode occurs, a diagnosis of cyclothymia shifts to a diagnosis of bipolar I or II disorder.

Anxiety is a common experience in cyclothymia. It’s so common that the DSM-5-TR recognizes the need for a diagnostic modifier, a specificity tag that accompanies a general diagnosis.

Modifiers indicate additional features prevalent in a condition that isn’t a part of the core diagnostic criteria. They give doctors insight into the best care strategies for individual people.

Cyclothymia’s modifier for anxiety is “with anxious distress.”

Anxious distress is defined in the DSM-5-TR as two or more of the following symptoms present the majority of the time during your last mood episode:

  • worry that prevents concentration
  • excessive restlessness
  • feeling tense or keyed up
  • fear something awful will happen
  • feeling as though you might lose control of yourself

Anxious distress can be mild, moderate, or severe, depending on how many of these symptoms you experience at the same time.

If anxious distress persists outside of cyclothymia mood episodes, it may represent an anxiety disorder.

Cyclothymia symptoms

Cyclothymia includes symptoms of depressive and hypomanic episodes, but these symptoms do not meet the criteria for either major depression or hypomania. Additionally, symptoms must persist for at least 2 years and be present at least half of that time, with no more than 2 consecutive months symptom-free.

Symptoms of a depressive episode can include:

  • low energy
  • feeling sad, hopeless, or empty
  • feeling worried or anxious
  • unwarranted feelings of guilt
  • poor concentration
  • sleep disturbances
  • lack of interest in activities or daily routines
  • suicide ideation
  • appetite changes
  • indecisiveness and forgetfulness

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you are not in the same household, stay on the phone with them until help arrives.

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Symptoms of a hypomanic episode can include:

  • an elevated sense of excitement, happiness, or giddiness
  • excessive energy
  • restlessness
  • decreased need for sleep
  • fast talking
  • racing thoughts
  • impulsiveness
  • distractibility
  • increased self-esteem
  • irritability

While these are also the possible symptoms of mood episodes in bipolar I and II disorders, symptoms in cyclothymia are milder.

You can live with cyclothymia and also live with a separate anxiety disorder.

While the prevalence of anxiety disorders in cyclothymia, specifically, is understudied, anxiety disorders are a common comorbidity in bipolar disorders.

A 2019 review found almost half of all people living with bipolar disorder experience an anxiety-related disorder at some point in their lifetime. This includes conditions like:

The numbers appear similar when looking just at cyclothymia. It’s estimated as many as 20–50% of people living with depressive disorders and anxiety disorders also live with cyclothymia.

What is the most likely comorbidity with cyclothymia?

The verdict is still out on which condition is the most likely to occur alongside cyclothymia.

It’s a disorder often grouped in with other bipolar disorders in research, limiting the pool of specific data available.

The DSM-5-TR indicates substance-related disorders and sleep disorders are conditions typically seen alongside cyclothymia, but several other disorders have come to the forefront through advancing research.

In a 2017 review, for example, authors indicate cyclothymia in literature is frequently linked to comorbidities of:

The same review noted people living with cyclothymia often indicated symptoms of anxiety and depression are more distressing to them than any emotional instability or hypomania symptoms.

Cyclothymia is treated similarly to bipolar I and II disorders. It usually requires a treatment plan involving medications, psychotherapy, and functional support networks.

Your doctor may prescribe:

Like in other bipolar disorders, the use of antidepressant medications is often avoided in cyclothymia on the chance they may worsen existing symptoms.

As medications help take the edge off impairing symptoms, psychotherapy like cognitive behavioral therapy (CBT) can help you manage stress, develop coping mechanisms, and recognize — then change — unhelpful thoughts and behaviors.

Because cyclothymia may make everyday activities like work and school challenging, functional support programs, like community services and advocacies, can help improve your overall quality of life.

Cyclothymia is a mental health disorder that features periods of high and low mood instability. While it’s similar to bipolar I and II disorders, cyclothymia’s mood episodes are less severe.

Anxiety is a common experience when you live with cyclothymia. It can be a part of your persistent symptoms, or it can be a separate disorder of its own.

If you live with cyclothymia, medications, psychotherapy, and functional support programs can help you regain your quality of life.