Does Your Teenager Have Bipolar Disorder?

By Dr. Ben Goldstein

Why is bipolar disorder among the most complicated medical conditions to diagnose? Depression alternates with mania. Related “comorbid” conditions such as anxiety, substance abuse and ADHD are the rule rather than the exception. Bipolar disorder is highly environmental: Mood episodes can be triggered by stress, and therapies targeting family communication and social routines are often helpful. Bipolar disorder is also strongly biological: It runs in families, usually requires medication, and is associated with blood markers and brain imaging findings. Nonetheless, thus far there are no blood tests or imaging techniques that can be used to diagnose bipolar disorder. Diagnosis relies almost exclusively on the clinical skills of observation and interviewing.

Diagnosing bipolar disorder in teenagers is often even more challenging than in adults. Compared to adults with bipolar disorder, teenagers with bipolar disorder are more often symptomatic, have more changes in mood “polarity” (depression to mania and vice versa), and have more comorbid conditions. Normal adolescence presents another challenge, as it is often characterized by more mood swings, impulsivity, hormonal flux, and less consistent nutritional, sleep and social rhythms, as compared to adulthood. 

Finally, prevailing attitudes about bipolar disorder further complicate diagnosis. Despite recent progress, stigma remains a meaningful barrier. Even severe symptoms are often attributed to so-called “teenage angst” or “poor parenting”. There is ongoing skepticism about the legitimacy of bipolar disorder (and other psychiatric disorders). Improving the future for teens and families affected by bipolar disorder will require a concerted effort between teens, families, health professionals, scientists, advocacy groups, the media and policy makers.

Meanwhile, parents and families can make a difference by arming themselves with knowledge about bipolar disorder. To that end, here are a couple of facts and tips to consider when deciding whether a moody teenager may need professional evaluation for bipolar disorder:

Fact: Mania is more than a mood swing.

Manic episodes are characterized by elation and/or irritability, accompanied by increased energy/activity and several other symptoms such as reduced need for sleep, increased distractibility, faster speaking and thinking and increased productivity. Episodes often last from days to weeks, comprise a change from normal behavior and can lead to dangerous decision making.

Tip: Think of mania as C-D-E.

C: symptoms are Concurrent/Clustered. D: symptoms are Durable, not just fleeting. E: symptoms are Episodic, and are different from the teen’s usual behavior.

Fact: 1% of teens have classical bipolar disorder with severe manic episodes lasting a week or longer, and up to 5% of teens will experience shorter and/or less severe episodes. Up to 50% of these teens will develop classical bipolar disorder, and for those who don’t, these symptoms could still suggest the need for different types of treatment than would otherwise be chosen.

Tip:  If your teen is currently suffering from depression or anxiety, but has previously had even brief episodes such as those described above, be sure to describe these episodes to your teen’s doctor or therapist.

Dr. Ben GoldsteinDr. Benjamin Goldstein is a psychiatrist and Director of the Centre for Youth Bipolar Disorder at Sunnybrook. He is an international expert on the overlap between bipolar disorder and physical health.

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