Background: Contrary to DSM-5 definition based on recurrence of low grade hypomanic and
depressive symptoms, cyclothymia is better defined in a neurodevelopmental perspective as an
exaggeration of cyclothymic temperament. Emotional dysregulation with extreme mood instability and
reactivity is the core features of the complex symptomatology.
Method: In the present article, we critically reviewed the literature on the diagnosis and treatment of
cyclothymia, focusing on the temperamental and neurodevelopmental perspectives.
Results: Current epidemiological and clinical research showed the high prevalence and the validity of
cyclothymia as a distinct form of bipolarity, frequently associated with multiple comorbidities with
anxiety, impulse control, substance use, and so called “personality” disorders. Many patients receive
correct diagnosis and treatments after many years of illness, when the superposition of complications
reduces the possibility of complete remission. A therapeutic model combining the focus on symptomatic
presentations with a temperamental perspective seems to represent an effective approach for cyclothymic
patients with complex clinical presentations.
Conclusion: Cyclothymic mood instability is an understudied issue despite the evidence of its clinical
relevance. Unresolved issues concern its diagnostic delimitation and the possible relationships with
emotional dysregulation observed in other neurodevelopmental disorders. We need to confirm the
specificity of the disorder and to improve its recognition in early phase of the life, especially in youth.
Early recognition means avoiding unnecessary complications and establishing specific treatments and
clinical management since the beginning.