140 Bipolar and Related Disorders
F. The symptoms cause clinically significant distress or impairment in social, occupa-
tional, or other important areas of functioning.
Specify if:
With anxious distress (see p. 149)
Diagnostic Features
The essential feature of cyclot hymic disorder is a chronic, fluctuating mood disturbance
involving numerous periods of hypomanic symptoms and periods of depressive symp-
toms that are distinct from each other (Criterion A). The hypomanic symptoms are of
insufficient number, severity, pervasiveness, or  duration to meet full criteria for a hypo-
manic episode, and the depressive symptoms ar e of insufficient nu mber, severity, perva-
siveness, or duration to meet full criteria for a major depressive episode. During the initial
2-year period (1 year for children or adolescents), the symptoms must be persistent (pres-
ent more days than not), and any symptom-fr ee intervals last no longer than 2 months
(Criterion B). The diagnosis of cyclothymic disorder is made only if the criteria for a major
depressive, manic, or hypomanic episode  have never been met (Criterion C).
If an individual with cyclothymic disorder su bsequently (i.e., after the initial 2 years in
adults or 1 year in children or adolescents) experiences a major depressive, manic, or hy-
pomanic episode, the diagnosis changes to majo r depressive disorder , bipolar I disorder,
or other specified or unspecified bipolar and related disorder (subclassified as hypomanic
episode without prior major depressive episod e), respectively, and the cyclothymic disor-
der diagnosis is dropped.
The cyclothymic disorder diagnosis is not made  if the pattern of mood swings is better
explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delu-