Bipolar Disorder in Children & Teens

More Information on Bipolar Disorder

How is Bipolar Disorder Treated?  -  What Can I Do To Help My Child?

What is Bipolar Disorder?

Bipolar disorder is defined as a medical condition in which people have mood swings out of proportion, or seemingly unrelated, to things going on in their lives.  These swings affect thoughts, feelings, physical health, behavior, and functioning.

Bipolar disorder is difficult to recognize and diagnose because:

Bipolar disorder in children and teens does not fit precisely the symptom criteria established for adults -- the symptoms can resemble or co-occur with those of other common childhood-onset mental disorders.

Bipolar disorder may be mistaken for normal emotions and behaviors of children and adolescents.

Bipolar disorder may be mistaken with symptoms of trauma or abuse.

Bipolar disorder may be mistaken with symptoms of drug use.

There is no objective medical test for bipolar disorder.

What are the symptoms of bipolar disorder?

Bipolar disorder is characterized by recurrent episodes of depression, mania, and/or mixed symptom states.  These episodes cause unusual and extreme shifts in mood, energy, and behavior that interfere significantly with normal, healthy functioning.

Manic symptoms include:

• Severe changes in mood — either extremely irritable or overly silly and elated

• Overly-inflated self-esteem; grandiosity

• Increased energy

• Decreased need for sleep — ability to go with very little or no sleep for days without tiring

• Increased talking — talks too much, too fast; changes topics too quickly; cannot be interrupted

• Distractibility — attention moves constantly from one thing to the next

• Hypersexuality — increased sexual thoughts, feelings, or behaviors; use of explicit sexual language

• Increased goal-directed activity or physical agitation

• Disregard of risk — excessive involvement in risky behaviors or activities

Depressive symptoms include:

• Persistent sad or irritable mood

• Loss of interest in activities once enjoyed

• Significant change in appetite or body weight

• Difficulty sleeping or oversleeping

• Physical agitation or slowing

• Loss of energy

• Feelings of worthlessness or inappropriate guilt

• Difficulty concentrating

• Recurrent thoughts of death or suicide

When manic, children and adolescents, in contrast to adults, are more likely to be irritable and prone to destructive outbursts than to be elated or euphoric.  

When depressed, there may be many physical complaints such as headaches, muscle aches, stomachaches or tiredness, frequent absences from school or poor performance in school, talk of or efforts to run away from home, irritability, complaining, unexplained crying, social isolation, poor communication, and extreme sensitivity to rejection or failure. 

Other manifestations of manic and depressive states may include alcohol or substance abuse and difficulty with relationships.

Existing evidence indicates that bipolar disorder beginning in childhood or early adolescence may be a different, possibly more severe form of the illness than older adolescent- and adult-onset bipolar disorder.

When the illness begins before or soon after puberty, it is often characterized by a continuous, rapid-cycling, irritable, and mixed symptom state that may co-occur with disruptive behavior disorders, particularly ADHD or conduct disorder (CD), or may have features of these disorders as initial symptoms.  

In contrast, later adolescent- or adult-onset bipolar disorder tends to begin suddenly, often with a classic manic episode, and to have a more episodic pattern with relatively stable periods between episodes.  There is also less co-occurring ADHD or CD among those with later onset illness.

A child or adolescent who appears to be depressed and exhibits ADHD-like symptoms that are very severe, with excessive temper outbursts and mood changes, should be evaluated by a mental health professional with experience in bipolar disorder, particularly if there is a family history of the illness.  This evaluation is especially important since psycho-stimulant medications, often prescribed for ADHD, may worsen manic symptoms.  There is also limited evidence suggesting that some of the symptoms of ADHD may be a forerunner of full-blown mania.

NEXT:  How is Bipolar Disorder Treated?

Are Migraines and Bipolar Disorder Related? ~ In two studies, it was found that patients with migraine had a higher frequency of affective temperaments and a higher number of anxiety disorders.

Bipolar Affective Disorder (Manic Depressive Disorder) in Children and Adolescents ~ Comprehensive examination of bipolar disorders -- all of which are a combination of mania with or without depression.

Bipolar Disorder in Childhood and Adolescence ~ Early onset mood disorders are often associated with an increased risk of developing other psychiatric disorders, substance abuse, and suicide and with poor academic, work, and social functioning.  The major complicating difficulties in the diagnosis are its overlap with ADHD, aggression, and conduct disorder, its overlap with substance abuse disorders, its association with trauma and adversity, and its response to treatment, which is atypical by adult standards.  In late adolescents with bipolar disorder, the most common mistaken diagnoses are schizophrenia (in up to 50% of cases) and conduct disorder.

Bipolar Disorder in Children Divides Professionals ~ Bipolar disorder and ADHD can look similar in children, with both producing impulsive behavior, hyperactivity, difficulty concentrating and distractibility.  But the intensity of anger and aggression in bipolar kids is more extreme and longer-lasting than in kids with ADHD.

Bipolar I Disorder ~  Diagnostic criteria from DSM-IV and DSM-IV-TR.

Bipolar II Disorder ~  Diagnostic criteria from DSM-IV and DSM-IV-TR.

Diagnosis of Mental Illness Hinges on Doctor As Much As Symptoms ~ Lacking genetic markers or brain scans to confirm psychiatric illnesses, doctors identify schizophrenia, phobias and other mental disorders based on a much more primitive diagnostic aid - the symptoms.

Fear Circuit Flares as Bipolar Youth Misread Faces ~ Youth with bipolar disorder misread facial expressions as hostile and show heightened neural reactions when they focus on emotional aspects of neutral faces.

Going to Extremes ~ Experts question rise in pediatric diagnosis of bipolar illness.

The Link Between Parental Alcoholism and Childhood Mood Disorders:  A Familial / Genetic Perspective ~ Family studies suggest that adult relatives of depressed children have increased rates of both alcoholism and mood disorders (major depression and bipolar disorder), and that the child and adolescent offspring of adult alcoholics have increased rates of mood disorders.   It is proposed that depressed children identify families with a specific form of bipolar disorder that shares some genetic components with alcoholism.

Misdiagnosing Narcissism - The Bipolar 1 Disorder ~ The manic phase of Bipolar 1 Disorder is often misdiagnosed as Narcissistic Personality Disorder.  Bipolar patients in the manic phase exhibit many of the signs and symptoms of pathological narcissism -- hyperactivity, self-centeredness, lack of empathy, and control freakery.

Mood Disorder:  Bipolar Disorder ~ Because no distinction is made for symptoms of adult-, adolescent-, or childhood-onset bipolar disorder, clinicians are challenged to distinguish abnormal mood symptoms in adolescents and children from normal developmental behaviors, oppositional or defiant behaviors, inattention or hyperactivity, and conduct problems.