Bipolar disorder harder to assess in teens

Dear Dr. Wes & Marissa: Could you do an article about bipolar teens and the illness?

– Parent

Marissa: About one in five adults in the United States has been diagnosed as having bipolar disorder. That figures to roughly 22.1 percent or 44.3 million people, according to the Mental Illness Research Assn. As for children, the figure is about 1 million, and about 7 percent of children seen in psychiatric facilities have bipolar disorder.

Even I’m not too proud to admit that teenagers are usually a big bag of emotions. Although I try to distance myself from it, drama runs wild in high school, and people tend to overreact and even get a little crazy sometimes. I’ve had friends who were diagnosed with bipolar and other disorders, so I know this is a real issue. However, I think that sometimes people can be too hasty to write off moody teens as having something wrong with them.

When this question first came in, I went directly to a friend of mine who has bipolar and asked him some questions to familiarize myself with the disease. One of the things he specifically mentioned was how it can be crippling, especially when it comes to relationships. The difficulty of trying to build or maintain a regular teenage relationship is intensified to at least double of that of someone without bipolar. It’s hard to keep a level head and express emotions. Interestingly, he said that his condition improved dramatically after he also was diagnosed with Attention Deficit and Hyperactivity Disorder and began taking medication for it. He said that his doctor told him that there might be a link between bipolar and ADHD.

Bottom line, I think that people should be tested or evaluated by an experienced professional if they suspect that they might have bipolar. It’s very important to make sure that there aren’t any deeper issues going on besides being a moody teenager. While our information might help, it would take seeing someone in person to know for sure.

Dr. Wes: Marissa is right on all counts. This issue is so vast that it’s hard to contain in a single response. However, it is such an important concern that we’ll give it a once over.

In the last few years, bipolar has expanded to include a wider range of severity. The next edition of the diagnostic manual will probably contain several subtypes of the diagnosis that are already in conceptual use. So just being diagnosed “bipolar” doesn’t tell you much about the actual level of symptoms. I’ve seen some people so out of control they required hospitalization. However, most present with less severe forms of the disorder and respond pretty well to medication and outpatient therapy.

There has been a dramatic increase in the diagnosis of bipolar in teens. However, the criteria present differently for adolescents, making it a bit harder to detect. In addition to the standard depressive symptoms, bipolar teens will have:

¢ Severe changes in mood, irritability and unusual oppositional/defiant behavior.

¢ Inflated self-esteem and grandiosity or an incredibly deflated self-esteem (feeling like the worst person on earth, in school, etc).

¢ Wildly increased energy and restlessness, often followed by an emotional crash.

¢ Decreased need for sleep.

¢ Increased talking, rapid speech, frequent change of topic, inability to be interrupted.

¢ Distractibility (attention moves constantly from one thing to the next).

¢ Increased sexual thoughts, feelings or behaviors. This is not just liking to have sex. It is needing to have sex – and never considering the consequences.

¢ Increased goal-directed activity or physical agitation.

¢ Excessive involvement in risky behaviors or activities without thought to consequences.

Marissa is also quite correct about ADHD and bipolar. Research suggests that ADHD often follows bipolar, and if you don’t catch both, things do not go so well. More importantly, if a young person is diagnosed as ADHD and there is underlying bipolar, the treatment will be very unhelpful. Bipolar must be managed before ADHD can be addressed.

Beyond this there are several important things to know about bipolar. Bipolar kids and adults are more likely to commit suicide than depressed people, so it is extremely important to get a good diagnosis. Additionally, a quick or inaccurate diagnosis of uni-polar depression can lead prescribers (psychiatrists, nurse practitioners, etc.) to put kids on medicine that may actually make them worse. Finally – and I know we’ll get letters from all over the country decrying the horror of what I’m about to say – the recognized treatment for correctly-diagnosed bipolar is medication plus specialized counseling – not one or the other, but both.

I was a skeptic once, too, but I’ve seen too many young peoples’ lives turned completely around by this combination to simply discount the value of the right medication. While getting to that point often takes a lot of time and work, it can be a truly life-saving proposition. Bottom line: Folks with bipolar respond well to treatment. The secret is getting a good diagnosis and treatment from people who actually see a lot of kids with this condition and know how to address it. Not everybody does, so shop wisely. I also suggest reading some of the good books on the topic. I’ve posted two on under the bookstore link.

Coming up after spring break: Would you like Marissa’s job? Write an answer to our test question and become the next columnist for Double Take in fall 2006.

– Dr. Wes Crenshaw is a board-certified family psychologist and director of the Family Therapy Institute Midwest. Marissa Ballard is a Lawrence High School senior. Opinions and advice given here are not meant as a substitute for psychological evaluation or therapy services. Send your questions about adolescent issues to All correspondence is strictly confidential.