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1) Jennifer Leiter (4.1)

The following are some of the challenges in diagnosing an individual with cyclothymic disorder versus more severe counterparts:

Onset during adolescence

One of the criteria according to the DSM-5 for Cyclothymic disorder (F34.0) is that of hypomanic symptoms. These symptoms usually begin in adolescence or early adulthood and can be interpreted by the family members as a person/adolescent having a temperamental disposition towards life. Though there is a consistent pattern over 2 years, it is less severe than a fully hypomanic or depressive episode (Dziegielewski, 2015, p. 214). Therefore, this disorder may fly under the radar of detection.

Family of origin issues

The family of origin the person is from may also be using illicit substances and have their own mental health issues. There is a genetic and physiological risk factor with this disease. The family may not notice the disease because they are self-medicating their own mental health issues by using illicit substances. There is a co-morbidity that has been passed on to first-degree biological relatives and the presenting symptoms may present as a normal way of being in the world. Due to this “There may also be an increased familial risk of substance-related disorders” (American Psychiatric Association [APA], 2013, p. 141)

Chronic condition but less severe and masquerades as something else

Once again because it is chronic and less severe, homeostasis happens where this becomes the norm for the patient, family and the social environment that they inhabit. Yes, there is a mood disturbance and it is chronic and ongoing, but it does not meet the full criteria for hypomania, mania or depression (Janicak & Esposito, 2015). Also, of not is that this may masquerade as a person who has “difficulties in initiating and maintaining sleep” (APA, 2013, p. 141).


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th). Arlington, VA: American Psychiatric Publishing.

Dziegielewski, S. F. (2015). DSM-5 in action. Hoboken, New Jersey: John Wiley & Sons.

Janicak, P. G., & Esposito, J. (2015, November). An update on the diagnosis and treatment of Bipolar Disorder, part 1: Mania. Psychiatric Times, 29-35. Retrieved from www.psychiatrictimes.com

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2) Paul Hoffman (4.1)

Cyclothymic disorder is a milder disorder than those who suffer from bipolar disorder or other severe disorders (Dziegielewski, 2015). With this disorder, the client must have symptoms for at least two years, continuous symptoms, and the individual cannot be without symptoms for two months (Dziegielewski, 2015). Persistent depressive disorder is also considered a milder condition than compared to more severe disorders such as major depressive disorder. It also looks at a two-year history of the client, not without symptoms for two months, continual symptoms for the time period and experiences issues daily (Dziegielewski, 2015). One of the challenges that I could see being an issue is the time period of a two-year requirement because this is a long period of time and could potentially be a hard criteria to meet. The more severe cases may only be two weeks or a year. Cyclothymic disorder has been under-investigated and researched particularly with children meaning that individuals who have cyclothymic disorder are often misdiagnosed (Van Meter, Youngstrom, Demeter, & Findling, 2013). Many of these individuals are diagnosed with bipolar disorder when they should be diagnosed with cyclothymic disorder (Van Meter et al., 2013). Since this disorder is has not been researched as much as bipolar disorder this makes it challenging for clinicians to diagnose due to the lack of research.


Dziegielewski, S. F. (2015). DSM-5 in action. Hoboken, NJ: John Wiley & Sons.

Van Meter, A., Youngstrom, E. A., Demeter, C., & Findling, R. L. (2013). Examining the validity of cyclothymic disorder in a youth sample: Replication and extension. Journal of Abnormal Child Psychology, 41(3), 367-78. doi:http://dx.doi.org.lopes.idm.oclc.org/10.1007/s1080…

3) Christina Fife (4.2)

Jack presents for therapy due to his wife being concerned with mood and memory changes that have occurred since Jack underwent knee surgery 3 years ago. His wife reports, due to Jack responding with short or closed-ended remarks or shrugging, that he is grumpier since retiring 3 years ago. She states that this is not typical, as Jack used to be energetic, happy and optimistic. She also reports that Jack has lost 10 lbs. in one year and had issues with sleep. It was also reported that during Jack’s rehabilitation in a skilled nursing facility following his knee surgery, he experienced issues with memory. He needed tasks broken down into smaller parts, had difficulty recalling events for that day, and used a notebook to write down things he needed to remember. Jack also demonstrated difficulty recalling words, facts or situations. He became less affectionate towards his wife and became less empathetic towards her. She reports he was easily irritated by staff and frustrated with himself. His wife also reports that since he has returned home, she is managing the home by paying bills and other tasks that he is not able to complete reliably.

Jack meets criteria for Persistent Depressive Disorder, with persistent major depressive episode. Criteria met include issues with sleep, low self-esteem, poor concentration, drastic weight loss, and apathy towards others and events. Currently, his sleep is improved with the use of a sleep aid and he is not losing weight as he had before. He is given this diagnosis as they symptoms have been present consistently for over 2 years. The specifier of persistent major depressive episode is justified at the DSM-5 states this is met when full criteria for a major depressive episode have been met through-out the preceding 2-year period (American Psychiatric Association, 2013).

Jack is also given the diagnosis given the diagnosis of Major Neurocognitive Disorder, unspecified. Criteria met include difficulties in the language domain, including not recalling simple words. He also has issues in the learning and memory domain evidenced by not being able to recall events or activities that he has scheduled (American Psychiatric Association, 2013). Because of his inability to remember things, he is not able to perform the daily tasks he used to perform, and his wife is taking care of him.

The issue that needs to be assessed is when did Jack’s depressive symptoms originally begin. Were they present prior to his surgery or did the surgery and extensive rehabilitation bring about the depression? It also needs to be addressed that symptoms of a neurocognitive disorder may present as symptoms associated with depression. Therefore, I gave the diagnosis of persistent depressive disorder first with the neurocognitive disorder second. It would be interesting to see if Jacks memory issues improved as he progressed with treatment and therapy for his depression.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author

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