Being a teenager is never easy, but bipolar disorder in teens presents special challenges.
Accurate diagnosis of bipolar disorder is difficult because manic behavior can be confused with other conditions such as ADHD, conduct disorders, substance abuse, or illnesses such as borderline personality disorder.
So, how can you tell if your teen is just going through "typical teenage stuff" or suffering from a mood disorder such as bipolar?
In most cases bipolar disorder is not accurately diagnosed until later in life - sometimes much later. However, it is possible to detect bipolar disorder in teens.
According to the American Academy of Child & Adolescent Psychiatry:
"The diagnosis of Bipolar Disorder in children and teens is complex and involves careful observation over an extended period of time."
As bipolar disorder has a genetic and therefore a hereditary element, if one or both parents have bipolar disorder, there is an increased chance their child may also have it.
Any parent with bipolar disorder should be alert for signs and symptoms in their child as early diagnosis and treatment will greatly increase the chances of the teen having a high quality of life with few episodes or relapses.
Genuine bipolar disorder in young children is EXTREMELY rare. Onset in late teens is more typical.
There is so much to learn about bipolar disorder in teens. If you have an interest in this topic the minimum you need to know about includes:
1. Signs of bipolar disorder in young people.
2. Treatment and management of bipolar disorder.
3. How you can help a young person with bipolar disorder.
4. Where to get more information.
The best resource I know of for obtaining a basic education is this fact sheet on bipolar disorder in young people from The Black Dog Institute, a leading bipolar disorder research institute with special interest in bipolar teens and young people.
Recently there has been a lot of controversy about bipolar kids.
Many of us remain skeptical about the possibility of accurately diagnosing very young children. However, with teens it is a different issue.
The typical age for the emergence of bipolar disorder in teens is 15 - 18 years old.
As well symptom overlap with conditions such as ADHD and conduct disorders, a significant diagnostic challenge is that many of the signs and symptoms look exactly the same as the behavioral issues so common in teenagers. For example, irritability, impulsiveness, poor sleep habits, preoccupation with sex, and tantrums.
However, ONE VERY IMPORTANT CLUE IS THAT BIPOLAR DISORDER HAS A CLEAR AGE OF ONSET.
What does this mean?
It means that episodes of mania (the "highs" of bipolar) may involve symptoms such as anger, excessive talkativeness, mood swings, risky behavior, or grandiosity (exaggerated, unrealistic belief in own importance and ability) that will seem "out of character" and represent behavior THAT DIFFERS FROM THE TEEN'S "USUAL" OR PREVIOUS PERSONALITY STYLE.
Also, the teen must experience BOTH depression AND mania (or hypomania - a milder form).
Young people with a history of anxiety are at greater risk for bipolar disorder. Substance abuse also often co-occurs.
Although there may be serious adverse consequences if teen bipolar disorder is left untreated, the good news is that with medication and therapy it can be well managed.
Even simple lifestyle factors such as:
1. a healthy sleep routine
2. daily exercise, and
3. good nutrition (see The Bipolar Diet) can be extremely effective in maintaining level healthy moods and keeping episodes of both mania and depression at bay.
Just as with adults, bipolar teenagers will usually spend far more time in depression than in mania.
Also, bipolar disorder in teens is more likely to begin with a depressive episode.
Research has shown that certain features of teen depression tend to be predictive of teenage bipolar:
1. Rapid onset of their depression.
2. Psycho-motor retardation.
3. Psychotic features.
4. Family history of mood disorder.
5. Antidepressant induced mania or hypomania.
Other teen bipolar depression symptoms also linked to bipolar include:
1. Thoughts of suicide, suicide attempts, preoccupation with death.
2. Illnesses such as irritable bowel syndrome and complaints of stomach aches.
Of course, the "typical" depression symptoms will also be present, making bipolar in teens difficult to diagnose.
The most common symptoms of mania in adolescents are also very similar to what we see in bipolar adults:
1. Pressured speech.
Another study noted the two main symptoms to be:
1. Disorganized, distracted, and poor judgment - causing much confusion with ADHD.
2. Inflated self-esteem and increased activity.
Psychosis is a more prominent feature of teen bipolar mania than it is for adults. Studies indicate one-half to one-third of adolescents with bipolar mania have psychotic symptoms, making this a strong distinguishing feature of bipolar disorder in teens.
Substance abuse is a particular concern, given the high proportion of people with bipolar disorder who abuse alcohol and drugs. The high rates of dual diagnosis (for example bipolar AND alcoholism) greatly complicate treatment and lead to much poorer long term outcomes. The National Institute of Mental Health (NIMH) recently published its COBY STUDY (Course and Outcome of Bipolar Youth), and found teen experimentation with alcohol to be the biggest single predictor of subsequent substance abuse. In fact, the lead researcher described experimental alcohol and marijuana use by teenagers with bipolar disorder as literally "playing with fire".
He also explained things this way:
“we appear to have this window of 2-3 years during which we can attempt to prevent substance abuse in these youth. This study provides some clues regarding the types of preventive strategies that may be useful.”
Important and useful strategies include identifying and treating common co-morbid conditions such as panic attacks, addressing depression, and improving family cohesiveness. Parental substance abuse is also a strong predictor so if you are the parent of a teenager wih bipolar disorder, please get your own house in order.
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