Therapists don’t tell their patients what to do; they help them illuminate and explore their options.
Most people have heard of bipolar disorder, marked by periods of alternating moods, which shift from euphoric highs to debilitating lows. But few know about a less severe form of it, which is positively correlated with perfectionistic tendencies, called cyclothymic disorder. Patients with this diagnosis note an almost overwhelming desire, contributing significantly to a pattern, to “chase highs.” Cyclothymic disorder is characterized by mood shifts that don’t meet the criteria for hypomanic episodes (episodes that are considered less severe than manic ones) or depressive ones (usually due to their duration), yet, outside of one’s baseline (normal degree of contentment), each shift encompasses some of the symptoms of each episode. It’s sometimes thought that the shifts in mood merely happen to the individual with either of the above-mentioned disorders, but, in reality, highs are also pursued, especially to escape the lows.
The Pursuit of Success
This may entail an unrelenting pursuit of success, wherein the downswings of mood are countered with the pleasures of increased status, recognition, and even admiration. For some, there might even be a belief that, at some point, achievements will break the spell of the depressive side of this ailment. And for others, there’s a sense, or better yet a fear, that if they discontinue their pursuits, the loss of hope will create an emotional black hole from which they won’t be able to lift themselves, even with aid. This diagnosis, therefore, tends to entail a fluctuation between an almost blind optimism and intense dread, both of which contribute to a strong work ethic, which often helps to sustain the belief in a self-cultivated cure.
You can likely tell that these cycles, when left unabated, can spiral into hopelessness and full-blown depressive episodes. It’s important for anyone reading this to consult a psychiatrist and or psychotherapist if you believe you’re dealing with significant mood shifts. This post is meant to describe what this diagnosis is, its link to the false hopes of unhealthy perfectionism, and what treatment may look like. Often, patients are afforded prescriptions for mood stabilizers, some of which decrease the production of dopamine, related to the pursuit of rewards, and norepinephrine, related to alertness, and increase serotonin, which is related to a sense of calmness and satisfaction. These medications may help one manage the need to obsessively pursue any sort of pleasure as, in part, a means to manage depression.
There’s Also Therapy.
Therapy addresses the expectations associated with the hypomanic-like episodes and the hopelessness and catastrophic thinking associated with the depressive-like ones. Additionally, therapy helps the individual explore the potential of some of the everyday joys they’ve been missing while compulsively pursuing remedies for their low mood.
Questions include:
Is some of your perfectionism a means to an end, helping you cope with or even try to permanently eliminate an almost debilitating sadness?
Does it feel like spending time with friends or doing something boring is a slippery slope, one step away from a depressive episode?
Is that why, at least in part, boredom feels intolerable, because it’s scary?
Do you believe that if your moods were more stable you’d like to try to enjoy a day in the park or, more generally, a day off of work?
Would you regret some of your decisions if, toward the end of your life, you realized that each victory or achievement only provided you with a mild-moderate sense of satisfaction?
Does your sense that you’re not enough drive you, indirectly, to neglect significant others?
How would you feel if you lost them?
The above helps patients better understand and learn to navigate their decisions. Initially ruled by compulsion, it may feel as if they don’t have much of a choice, or as some would say, “I just like what I like.” Presented here are more options; I’m not necessarily advocating for any. Cyclothymic disorder is often overlooked because it doesn’t reach the severity of other ailments, like bipolar disorder, but can still damage a person’s relationships, as they relentlessly pursue external rewards, affect their finances, if they make risky investments, whether chronic or not, in pursuit of a substantially better life, and preclude them from experiencing ordinary joys. I want to be clear that I’m not pathologizing the pursuit of success, as the endeavor doesn’t necessarily betray some underlying form of mental illness. I’m suggesting that treatment is worth considering if one’s decisions are contributing to significant harm.
Some fear treatment cultivating a completely distinct personality, which is far from the truth. Hardly, if ever, are patients talked out of perfectionism; they’re taught how to relate to it better. They learn about the limits of success, not only what they can achieve, but also what an achievement can do for them. They learn to take stock of their positions in comparison to their past selves and to discontinue comparing themselves to amalgams of others, meaning taking only their good parts (unconsciously piecing them together into the image of a perfect human) and comparing their bad ones to them. They may decide to pursue excellence, learning how to focus more on their positions in their disciplines and less on their mistakes or shortcomings. Finally, they learn how their distorted thoughts, like the catastrophizing mentioned above, contribute to each emotional state.
