Archives for 

suicidal tendencies

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

Cutting – An Actual Mental Disorder

Non-Suicidal Self-Injury

A lot of people are shocked and horrified at the thought of self-mutilation and for many years “cutting” was categorized only as a symptom of Borderline Personality DisorderBPD, as you may know, has symptoms of unstable personal relationships, impulsivity, and extreme mood changes (different from Bipolar disorder as they can change on a dime and swing wildly).

The new issue of the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition or DSM-5, includes it as a separate diagnosis of Non-Suicidal Self-Injury (NSSI).  Research has suggested that NSSI can occur independently of BPD but is also often a co-existing or co-morbid illness, occurring alongside BPD, Bipolar Disorder, one of the many anxiety disorders or with other disorders such as anorexia or bulimia.

Cutting DisorderI am the mother of pre-adolescent children – who are beginning to believe they know all about people who act “weird” or do “weird” things (their words, not mine).  My daughter has recently talked about the “EMO” kids – which as a dumb mom, I had to figure out was a social group of kids who were “emotionally dark.”  She includes in her description of an “EMO” as “you know, like kids who are cutters.”  It is stereotypical to think that they all wear black clothing and heavy eyeliner – as some may – but many do not.

Some people who have the disorder would never be suspected of such – but then we are also sometimes surprised when someone who seems to have everything commits suicide, only to find that under the polished exterior was extreme anguish.  Often, cutting will be dismissed as a “stage” and it may be a “stage” – but often it is not.  Many patients – have arms or hips full of patterned scars – proving that it is often a condition all to itself.

Cutting Disorder - Mental IllnessSelf-mutilation most often starts in the early teen years when adolescent emotions are at their height – but often extends well into adulthood.  The majority of “cutters” are female – but not all.  There is often a co-existing mental illness and may have a family history component – but also often occurs following events of abuse – including sexual, physical or emotional abuse.  Sudden life changes such as unemployment or divorce – and isolation may trigger an occurrence.

People who “cut” often express a desire to “feel” as if they cannot truly attach to their own emotions.  Others will say they “cut” to kill the pain – this is because the act of producing pain also causes the body to release endorphins (the body’s natural painkiller) that makes them feel better.  Unfortunately, even though the action may induce temporary euphoria – it is often followed by guilt and a return of the negative feelings.

NSSI is defined as:

• 5 or more days of intentional self-inflicted damage to the surface of the body without suicidal intent – in the past year.
Patients must be intending to:
o Seek relief from negative feelings or thoughts and/or
o Resolve interpersonal problems and/or
o Induce a positive emotional state
• The behavior must be associated with 1 of:
o Interpersonal problems
o Negative thoughts or feelings
o Premeditation
o Ruminating on injury (obsession)

NSSI includes not only “cutting” but also burning, hitting or punching, head banging, biting, non-aesthetic piercing or carving of skin (tattoos and body piercing don’t apply), pulling out hair or other “topical” mutilation.  If a patient has expressed suicidal thoughts or shows suicidal tendencies – it is not classified as NSSI as the intent of a person with NSSI is not to commit suicide.
NSSI should be first viewed as a serious medical condition that truly requires treatment.  It may be resolved by treating an existing co-morbid psychiatric condition – but likely it will also require psychotherapy to resolve some of the underlying issues.

Definition of Self-injury/cutting (Mayo Clinic)

Cutting and Self-Harm: Warning Signs and Treatment (WebMD)

If you see signs of NSSI or “cutting” in a child, teen, or adult that you know – encourage them to seek help.

Melissa Lind (WriterMelle)

An Actual Mental Disorder – Cutting