What is bipolar disorder, and how does it affect children?

Bipolar disorder is a mental illness that causes children to be very irritable and have significant swings in mood. Bipolar disorder was previously called manic-depressive disorder.

Children with this illness experience unusual mood changes, moving from feeling very happy and joyful to feeling deeply sad. Other children experience chronic irritability, sometimes accompanied by mood shifts. Additional symptoms include grandiose behavior, pressured speech, racing thoughts, decreased need for sleep, risky behavior and hypersexuality.

If the illness goes untreated, school, relationships and daily life may become difficult. Youth with bipolar disorder are also at increased risk for suicide and/or delinquent behavior with incarceration.

It’s important to note that even if you see some of these symptoms in your child, the diagnosis isn’t necessarily bipolar disorder. There is some disagreement in the children’s mental health field over how symptoms differ between children and adults, and when bipolar disorder should be diagnosed. A mental health professional can help you identify the problem.

How is bipolar disorder different in children than in adults?

Children with bipolar disorder may switch moods more often than adults. For example, a child may exhibit periods of giddiness and silliness, anger outbursts, and crying all in one day. Children with bipolar disorder also tend to show less clear episodes and instead may show chronic irritability or mixed moods that involve a combination of mania and depression symptoms.

What causes bipolar disorder in children?

It is not yet known what causes bipolar disorder. However, there are several factors that may be associated with it:

  • Family History: Children with a parent or sibling with bipolar disorder are more likely to get the illness. This is approximately five times more likely when a first degree relative has a bipolar disorder.
  • Anxiety Disorder: Many children with bipolar disorder also experience significant anxiety.
  • Neurotransmitters: Bipolar disorder is a disorder of brain development that likely involves differences in neurotransmitters, brain structures and/or the function of specific brain structures.
  • Environment: Stress, loss of a loved one and/or abuse may trigger bipolar disorder. Both negative and positive stresses (achieving an award or accomplishment) can serve as a contributing trigger to bipolar disorder symptoms.

What are the symptoms of bipolar disorder?

To understand bipolar disorder, it's helpful to know how mental health providers talk about severe mood swings. Mood swings are often termed as "mood episodes." Manic episodes describe periods when the child feels overly excited and confident. These feelings can quickly give way to confusion, anger and possibly rage.

Depressive episodes describe periods when the child feels very sad (depressed). Children may not have clear-cut episodes. Instead, they may have "mixed" episodes and exhibit both manic and depressive symptoms. Some children may show "rapid cycling" where they shift quickly between mania or hypomania and depression, sometimes even within the same day.

Depressive, manic, or mixed episodes, by definition, are a change in behavior that differs from the individual’s baseline. Children with symptoms suggestive of bipolar disorder but with chronic course should also be evaluated by a psychiatrist, in order to identify other disorders.

During manic or hypomanic periods, children with bipolar disorder may:

  • Be overly happy, hopeful and excited often inconsistent with external events.
  • Be irritable and have a short temper.
  • Become restless.
  • Show increases in distractibility.
  • Talk rapidly and in a pressured way where it is difficult to "get a word in."
  • Believe they have many skills and powers and can do things other people can't do (such as the children believe that they are in charge and not adults – in the extreme thinking, they believe they have special powers like a superhero).
  • Have a lot of energy and need very little sleep.
  • Talk and think about sex, and/or act older than their age.
  • Show poor judgment and make impulsive, harmful decisions.
  • Engage in risky behavior, including sexual or very impulsive behaviors such as charging parents' credit cards, abusing substances or putting themselves in unsafe circumstances.

During depressive periods, they may:

  • Feel empty, sad or hopeless.
  • Feel guilty, worthless or helpless.
  • Cry often.
  • Eat too little or too much.
  • Lose interest in things they usually enjoy.
  • Be unable to think clearly, make decisions, or remember things.
  • Sleep poorly.
  • Lose or gain weight.
  • Have low energy.
  • Have extreme sensitivity to rejection or failure.
  • Become focused on death.
  • Have thoughts of death, develop a plan or intentions to hurt themselves or someone else, and even attempt suicide or severe aggressive behavior.

The most frequent and useful symptoms for distinguishing bipolar disorder from other problems in youth are:

  • Rapid mood shifts.
  • Significant irritability.
  • Grandiosity.
  • Decreased need for sleep over a period of three to seven days.

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