DELINEATING IRRITABLE AND HYPERTHYMIC VARIANTS OF THE CYCLOTHYMIC TEMPERAMENT

Rates based on clinical and recent epidemiologic studies suggest that cyclothymia uncomplicated by major affective episodes occurs in 3-4% of young adults. Although this rubric is included in the diagnostic manual of the American Psychiatric Association (DSM-III) and the International Classification of Diseases (ICD-10), its classic temperamental variants consisting of irritable and hyperthymic types are not widely recognized. Instead, patients suffering from recurrent mood disorders-especially those with the bipolar II subtype-are often characterized as ''passive-aggressive,'' ''borderline,'' ''antisocial,'' 'histrionic,'' or ''narcissistic.'' Other terms unofficially applied to these patients include ''emotionally unstable,'' ''explosive,'' 'impulsive,'' and ''sensation seeking.'' Building on classical German treatises and more recent European and American research, the present review argues for the greater cogency and validity of describing the intermorbid and premorbid functioning of these disorders in the more classic affective language of temperaments rather than employing Axis II characterologic terminology.