Bipolar disorder (BD) in children is characterized by mood instability with prolonged episodes of mania (lasting a week or more), followed by episodes of depression. The condition was called “manic-depression” before 1980. It was changed to “bipolar disorder” to better describe the polarity of the condition and make it inclusive of those with less pronounced episodes of mania or depression.
A person suffering from BD can experience “mixed episodes,” in which they’ll experience manic and depressive symptoms at the same time. Manic episodes are distinct periods of time, usually lasting a week or more. During a manic episode, a child may experience inflated self-esteem, grandiosity, decreased need for sleep, rapid speech, distractibility, paranoia, increased goal-focus and risk-taking. Children in manic episodes are sometimes are unable to distinguish reality, which is called a psychotic break. In a depressive episode, a child may sleep too much, complain about physical pain, lose interest in fun activities, overeat or lose their appetite, and/or have suicidal thoughts. Children with BD can pose a threat to themselves or others, making it imperative that they receive help as soon as possible.
BD is far more common in adolescents than in young children, and is believed to affect from 1-3% of adolescents. It is believed that BD is caused by a chemical imbalance that misregulates moods. BD often has a hereditary component, and some patients report the onset of symptoms after a traumatic brain or spinal cord injury. Having a parent with BD increases and child’s risk of developing the condition; if both parents have the condition, the child is 3.5 times more likely to develop it. However, great strides have been met in the treatment of BD over the last decades, and it responds well to medication. Healthy lifestyle habits can minimize the frequency and severity of episodes, which we’ll discuss below.
BD is often a co-diagnosis of ADHD, anxiety disorders, and substance abuse. Symptoms may appear similar to those of ADHD, major depression, conduct disorder, disruptive mood dysresgulation disorder (DMDD), and oppositional defiant disorder. However, the episodic mood swings, rapid cycling of mood, and feelings of euphoria are distinct to BD. While irritability is a chronic feature of ADHD, it subsides in children with BD once their manic episode is over. Children with BD often cycle through manic and depressive episodes more quickly than adults.
There are four primary types of BD:
- Bipolar 1 - characterized by episodes of extreme mania and severe depression.
- Bipolar 2 - milder than bipolar 1, bipolar 2 is characterized by less severe mania (seldom requiring hospitalization) and severe depression.
- Cyclothymic disorder - less severe than bipolar 1 and 2, it is characterized by milder episodes of mania and depression for at least two years.
- Mixed - characterized by symptoms of mania and severe depression that occur simultaneously.
Demitri Papolos, MD, author of The Bipolar Child, has developed a new diagnosis for a subtype of pediatric BD, called the “fear of harm” profile. This syndrome, thought to be hereditary, is characterized by violent nightmares, a fear of being controlled and humiliated, aggressiveness towards others, disturbed sleep, and anxiety when separated from family members.