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Bipolar Disorder and Adolescents

Symptoms of bipolar disorder in children and adolescents may look like other disorders

Traditionally bipolar disorder has been thought to first show in early adulthood – and more often in females.  Bipolar disorder was considered to be quite rare as few as 20 years ago, to be more exact. The first emergence came in the early 20s, mainly in females. But, our knowledge about bipolar disorder has grown rapidly in the last 20 years.

Instead of the single manic-depressive diagnosis – which included diagnostic criteria of both depressive periods, alternating with manic periods – described as “euphoria”?

Those who did not have clearly rhythmic, alternating periods of a “happy” and frantic manic phase with a classic depression period were mishandled, misdiagnosed, mistreated, or dismissed.

Bipolar ChildrenIn addition, it wasn’t really known that bipolar disorder could start in adolescence or even childhood, or that there are different types of bipolar disorder.  Today, it still isn’t “officially” recognized in the “psychiatric bible” – the Diagnostic Statistical Manual of Mental Disorders (DSM), but at least more practitioners do know that it exists.

Today, we don’t exactly know what causes bipolar disorder (only that there is a genetic link of some kind, and often some past trauma). But, we can at least identify adolescent and childhood bipolar illness.  We also recognize a variety of different types of bipolar disorder (Such as mixed manic episodes, rapid cyclers, people without a depressive phase, hypomania, dysphoria rather than euphoria and cyclothymia). We also have a “catch-all” type – Bipolar NOS or “not-otherwise-specified”.

Adolescent or childhood bipolar disorder is official known as: “early onset bipolar disorder”.  In fact, childhood bipolar disorder can be more serious than a similar disease in adults and may have slightly different symptoms.

Symptoms of bipolar illness in children can often be more severe, and the cycling period may be more frequent.  Children also have more mixed episodes.  Children also have slightly different symptoms – so even the depression phase of the cycle may not be obvious.

Pediatric patients (children and adolescents) with bipolar disorder may have:

Bipolar Disorder in Children•    Abrupt mood swings
•    Periods of hyperactivity followed by lethargy
•    Intense temper tantrums
•    Frustration
•    Defiant behavior
•    Chronic irritability

These symptoms have to appear in more than one setting (school and home) and cause “distress”.

The problem is that many of these symptoms may look like other disorders.  They might be disorders such as ADHD, childhood depression, anxiety disorder, obsessive compulsive disorder, conduct disorder, premenstrual syndrome, oppositional defiant disorder and others. The danger might come from a misdiagnosis and improper treatment.

Bipolar disorder is treated with anti-manic agents (lithium), anti-convulsants (Depakote, lamotrigine) or atypical antipsychotics (Abilify, Risperdal).  In many cases, anti-depressant won’t be needed.  Treatment for other disorders like ADHD or depression may make bipolar disorder worse. Childhood bipolar disorder is something that desperately needs treatment as the distress caused to the patient, and the family can predispose the youngster to

•    Drug or alcohol abuse
•    Stealing
•    Involvement with law enforcement
•    Poor social integration
•    Poor academic performance
•    Suicidal tendencies
•    Premature sexual behavior

The Balanced Mind has a good self-check list of symptoms that can help a parent or a teen decide if bipolar disorder might be an issue.  Self-testing is not always accurate and should be discussed with a doctor, (preferably with test results in hand).  Not all doctors accept pediatric bipolar disorder. Parents may have to seek advice from more than one mental health professional and be aware that insurance may not cover the illness.

Melissa Lind

Borderline Personality Disorder – True Story

A true Borderline Personality Disorder story

BPD – The likeable guy who suddenly isn’t

I once knew a man who I met through a friend.  When I met him, she was already planning on marrying him so I could not say much of anything.  He was an utterly likeable guy who was fun, fun-loving and an all-around joy to be near, but there was something I couldn’t understand.

My friend, due to her previous life experiences involving traumatic loss, was extremely opposed to anyone she loved being in the police service.  Her fiancé had been a marine and had later gone into the military police.  He had retired from the military and was working in his family business as the Vice President but had also grown his hair out, dressed in very casual clothing and loved race-cars.  He swore “blind” that he would never enter the military or law enforcement again.

This fun-loving person with long hair, wearing tank tops and racing cars was the guy I met.  He was also mechanically inept – couldn’t put a shelf on a wall or even put a barbeque grill together with instructions.  After they had got married, my husband and another friend spent many hours doing “fix-it” work around their house – taking things such as grass spreaders and playground sets apart to put them back together correctly.

Borderline Personality Disorder - Swirly MindHe was also very generous – spending money all the time for all and anyone around.  He would take 15 people to see a rock concert or a hockey game, bought the boys new video game systems and video games every weekend, bought garden supplies, supplies to put in a backyard kiln after my friend had said she thought she might want to make a pot, had a pool installed, bought a go-cart and mini-bike for the boys, $3000 vacuum cleaner… He traded her car in for a new, better, bigger car at least once a year, sometimes after only a few months. They were not in financial distress, but he was never concerned with how much money he spent.

I could never reconcile the goofball man with long hair and a beard who used to be a marine and an MP.

Fast forward a few years.  One day, my friend called me, totally hysterical because she came home to find him with a military style haircut, wearing a police uniform with guns and all – preparing to go to a part-time job that he had gotten with a police department in a small town nearby, having done all this in secret.  He swore it was only part-time because they needed the extra income (which they didn’t).

For several months, she expressed her extreme displeasure, fear, hatred.  Each time I would drive to their house, I would think, “What are the police doing here?”

Then I would remember that it was his patrol car.

Fast forward a few more months.  He is now working full-time as a cop – even though he promised it would only be part time.  She hates it.  He is also starting to exhibit bizarre behavior, restrictive rules for the kids, can’t keep from calling her every 10 minutes – even while he is at work, even while she is grocery shopping or picking up kids from school.

Tensions rise, arguments ensue, culminating in an episode involving him threatening to shoot himself in front of the 10 year old who runs from the house in his underwear to hide at the neighbors.

BPD - Borderline Personality DisorderHe eventually calms down and suggests that they need marital counseling – that she needs “help.”  Of course, he says it is “her” that needs help, and he is only going for her problems.

They go to the counseling where the therapist disagrees with his idea that the core issue is her problem.  They are both referred to a psychiatrist.  The psychiatrist diagnoses him with Borderline Personality Disorder – giving him medication and recommends extended therapy.  The psychiatrist gives her a prescription for situational anxiety disorder – as she is having intermittent panic attacks due to his behavior.  He recommends that my friend go to therapy to deal with her emotions surrounding the family issues and for their son to go to therapy to deal with the fact that his father flips out.

She decides to stay – based on his agreement to take medications and go to therapy.  Which he does not.  He does not believe the therapist or the physician were correct.
He then tells her that she needs to go to all of his police and wives functions – and makes plans to join the State Police Controlled Substances Crime division – sponsored by the governor.  Another episode involving a mental breakdown and a couple of loaded firearms occurs.

She puts her kid in the car – and leaves a beautiful home with a pool and all the money she could want, in order to escape.  He calls and calls and appears not to understand what happened, blaming the whole situation on her paranoia.  She never goes back and now lives as a single mom in a low-rent housing unit without financial assistance from him.  Apparently this is much better than dealing with him.

This man, my goofball friend – turned into a raving nutcase and likely it was not the first time (or the last time) he had done so.  He went back to his former wife to marry her for the third time.

Years later, we still get “restricted number” phone calls from him – for no apparent reason other than to check up on her.

Until this experience, I always thought that Borderline Personality Disorder was a fairly benign thing – they were secret manipulators but relatively innocuous – along the same lines as Narcissistic Personality Disorder, which is irritating but not dangerous.  Now I know that is not true, Borderline Personality Disorder, also known as Emotionally UnstablePersonality Disorder is a real and valid psychiatric disorder that should be treated.

It is characterized by:

•    Occupational – Economic issues such as a sudden shift in career field cue to sudden changes in values, self-opinion
•    Antagonism
•    Separation anxiety and abandonment issues
•    Suicidal behavior
•    Multiple separations or divorces
•    Unstable, intense close relationships are vacillating with extreme anger
•    Harmful impulsiveness – including spending, reckless driving, thrill-seeking
•    Physical Violence
•    Chronic feelings of boredom which may contribute to impulsive activities
•    Irresponsibility

The National Institute of Mental Health says that Borderline Personality disorder is likely to last for many years and may be subject to relapse of symptoms which remiss but those core symptoms such as highly changeable moods and impulsive behavior will likely continue.

Melissa Lind