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Examining the Validity of Cyclothymic Disorder in a Youth Sample: Replication and Extension

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Abstract

DSM-IV-TR defines four subtypes of bipolar disorder (BP): bipolar I, bipolar II, cyclothymic disorder and bipolar not otherwise specified (NOS). However, cyclothymic disorder in children is rarely researched, or often subsumed in an “NOS” category. The present study tests the replicability of findings from an earlier study, and expands on the criterion validity of cyclothymic disorder in youth. Using the Robins and Guze (1970) framework we examined the validity of cyclothymic disorder as a subtype of BP. Using a youth (ages 5–17) outpatient clinical sample (N = 894), participants with cyclothymic disorder (n = 53) were compared to participants with other BP spectrum disorders (n = 399) and to participants with non-bipolar disorders (n = 442). Analyses tested differences in youth with cyclothymic disorder and bipolar disorder not otherwise specified who do, and those who do not, have a parent with BP. Compared to youth with non-bipolar disorders, youth with cyclothymic disorder had higher irritability (p < 0.001), more comorbidity (p < 0.001), greater sleep disturbance (p < 0.005), and were more likely to have a family history of BP (p < 0.001). Cyclothymic disorder was associated with a younger age of onset compared to depression (p < 0.001) and bipolar II (p = 0.05). Parental BP status was not significantly associated with any variables. Results support that cyclothymic disorder belongs on the bipolar spectrum. Epidemiological studies indicate that cyclothymic disorder is not uncommon and involves significant impairment. Failing to differentiate between cyclothymic disorder and bipolar NOS limits our knowledge about a significant proportion of cases of bipolarity.

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Authors and Affiliations

  1. CB 3270 University of North Carolina, Chapel Hill, NC, 27514, USA

    Anna Van Meter & Eric A. Youngstrom

  2. Case Western Reserve University, Cleveland, OH, USA

    Christine Demeter & Robert L. Findling

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  1. Anna Van Meter
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  2. Eric A. Youngstrom
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  3. Christine Demeter
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  4. Robert L. Findling
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Correspondence to Anna Van Meter.

Additional information

This study was generously supported by a Clinical Research Center Grant from the Stanley Medical Research Institute.

Dr. Findling receives or has received research support, acted as a consultant, received royalties from, and/or served on a speaker ‘s bureau for Abbott, Addrenex, Alexza, American Psychiatric Press, AstraZeneca, Biovail, BristolMyers Squibb, Dainippon Sumitomo Pharma, Forest, GlaxoSmithKline, Guilford Press, Johns Hopkins University Press, Johnson & Johnson, KemPharm Lilly, Lundbeck, Merck, National Institutes of Health, Neuropharm, Novartis, Noven, Organon, Otsuka, Pfizer, Physicians' Post-Graduate Press, Rhodes Pharmaceuticals, Roche, Sage, Sanofi-Aventis, Schering-Plough, Seaside Therapeutics, Sepracore, Shionogi, Shire, Solvay, Stanley Medical Research Institute, Sunovion, Supernus Pharmaceuticals, Transcept Pharmaceuticals, Validus, WebMD and Wyeth.

Dr. Youngstrom has received travel support from Bristol-Myers Squibb and provided consultation to Lundbeck for the selection of mood and neurocognitive measures.

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Van Meter, A., Youngstrom, E.A., Demeter, C. et al. Examining the Validity of Cyclothymic Disorder in a Youth Sample: Replication and Extension. J Abnorm Child Psychol 41, 367–378 (2013). https://doi.org/10.1007/s10802-012-9680-1

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