Example of Bipolar Disorder Simon is a 10-year-old 4th grader who has always had trouble paying attention and staying in his seat at school. For the last week, however, he has become much more disruptive than normal, talking constantly, telling the teacher he could have her fired for switching his seat, and laughing hysterically when told he would be sent to the office. There has also been trouble at home, where Simon, who typically needs 7-plus hours of sleep per night in order to feel rested, has been sleeping only 3-4 hours a night yet maintains a high level of energy all day. Though Simon frequently has been cranky with his parents and sister for the past two years, lately he has been downright nasty, cursing at family members and "throwing fits" at the smallest provocation. When told he had to stop playing his favorite video game at bedtime, for example, Simon shattered the game controller against the wall and slammed his bedroom door.

What is Bipolar Disorder?

Bipolar Disorder (BPD), formerly known as "Manic Depression", is characterized by extreme changes in mood that range from depressive "lows" to manic "highs" (typified by feelings of excessive happiness or rage). It is important to note that these moods exceed normal responses to life events, represent a change from the individual's normal functioning, and cause problems in daily activities --- for instance, in getting along with family, friends and teachers, or in completing schoolwork.

Depressive symptoms of BPD often include sadness, irritability, an inability to enjoy one's usual activities, changes in appetite or weight, and/or sleeping more than normal or having difficulty falling/staying asleep even when tired. For a more comprehensive description of common symptoms of depression, or if a child or adolescent's experience of these difficulties does not include the manic symptoms listed below click here.

Manic symptoms of BPD may include the following: inflated or unrealistic self-esteem; needing less sleep than normal and still feeling energetic; talking more/faster than normal; changing the topic of conversation so quickly/often that it interferes with communication; feeling that one's thoughts are "racing"; increased distractibility; difficulty sitting still; an unusual drive to engage in activities or pursue goals (e.g., excessive cleaning, making clearly unrealistic plans); and engaging in risky or dangerous behaviors (e.g., riding a bike on the highway; inappropriate sexual behaviors).

Identifying BPD in youth is challenging. While adults with BPD often have distinct periods of depression and mania that last for weeks, months, or longer, youth with BPD frequently have depressive and manic symptoms that occur daily, sometimes even simultaneously. As co-occurring disorders are common, determining what symptoms are signs of BPD and which are due to other disorders (e.g., depression, ADHD, disruptive behavior problems) is critical.

Sources:

Fristad, M.A., Verducci, J.S., Walters, K., & Young, M.E. (2009). Impact of multifamily psychoeducational psychotherapy in treating children aged 8 to 12 years with mood disorders. Archives of General Psychiatry, 66(9), 1013-1021.

Goldstein, T.R., Axelson, D.A., Birmaher, B., & Brent, D.A. (2007). Dialectical behavior therapy for adolescents with bipolar disorder: A 1-year open trial. Journal of the American Academy of Child and Adolescent Psychiatry, 46(7), 820-830.

Miklowitz, D.J., Axelson, D.A., Birmaher, B., George, E.L., Taylor, D.W., Schneck, C.D., Beresford, C.A., Dickinson, L.M., Craighead, W.E., & Brent, D.A. (2008). Family-focused treatment for adolescents with bipolar disorder: Results of a 2-year randomized trial. Archives of General Psychiatry, 65(9), 1053-1061.

West, A.E., Jacobs, R.H., Westerholm, R., Lee, A., Carbray, J., Heidenreich, J., & Pavuluri, M.N. (2009). Child and family-focused cognitive behavioral therapy for pediatric bipolar disorder: Pilot study of group treatment format. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 18(3), 239-246.

Young, M.E. & Fristad, M.A. (2007). Evidence based treatments for bipolar disorder in children and adolescents. Journal of Contemporary Psychotherapy, 37, 157-164.