<Li> Cyclothymia: A history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes . </Li> <P> When relevant, specifiers for peripartum onset and with rapid cycling should be used with any subtype . Individuals who have subthreshold symptoms that cause clinically significant distress or impairment, but do not meet full criteria for one of the three subtypes may be diagnosed with other specified or unspecified bipolar disorder . Other specified bipolar disorder is used when a clinician chooses to provide an explanation for why the full criteria were not met (e.g., hypomania without a prior major depressive episode). </P> <P> Most people who meet criteria for bipolar disorder experience a number of episodes, on average 0.4 to 0.7 per year, lasting three to six months . Rapid cycling, however, is a course specifier that may be applied to any of the above subtypes . It is defined as having four or more mood disturbance episodes within a one - year span and is found in a significant proportion of individuals with bipolar disorder . These episodes are separated from each other by a remission (partial or full) for at least two months or a switch in mood polarity (i.e., from a depressive episode to a manic episode or vice versa). The definition of rapid cycling most frequently cited in the literature (including the DSM) is that of Dunner and Fieve: at least four major depressive, manic, hypomanic or mixed episodes are required to have occurred during a 12 - month period . Ultra-rapid (days) and ultra-ultra rapid or ultradian (within a day) cycling have also been described . The literature examining the pharmacological treatment of rapid cycling is sparse and there is no clear consensus with respect to its optimal pharmacological management . </P> <P> There are a number of pharmacological and psychotherapeutic techniques used to treat bipolar disorder . Individuals may use self - help and pursue recovery . </P>

The rapid cycling specifier refers to an individual with bipolar disorder who experiences at least