Dear Dr. Wes and Julia: What is the rate of bipolar disorder in teenagers?

Wes: For future reference it's always better to give us a little more info in the questions so we can flesh out the answers - specifically why you're interested and what impact the information might have on your life, or what you're hypothesizing in your question. Here, I might surmise that you're hearing about this diagnosis more lately and wondering exactly why that is.

If so, you're definitely on to something. The very issue of incidence rates is both complicated and controversial - but I'll do my best to lay it out in 400 words. The generic rate of bipolar disorder is 1.2 percent among Americans. However, according to the National Institutes of Health (NIH), the rate of diagnosis among children and adolescents has increased by 40 times over the last decade, and the rate for adults has almost doubled, all of which jibes with my clinical experience.

Of course, that data alone should raise more questions than it answers. Are these actually new cases, or are we now overdiagnosing the condition? The NIH author actually proposes BOTH, noting that overdiagnosis may occur due to "a correction of historical under-recognition" as well as the appearance of new cases. In other words, physicians and mental health providers (MHPs) now realize that the condition is more prevalent than they previously thought, have become more finely tuned to it, and now tend to see it more easily - perhaps too easily.

However, I can explain it more simply than that. When it comes to mental health, people simply do not fit into diagnostic categories. Many of my colleagues may want to debate this, but our diagnostic manual is far more important in billing insurance and writing treatment plans than for understanding people in their infinite diversity. It's just not like having a broken leg or a thyroid problem. While those conditions can range from bad to worse, mental health concerns can range from barely noticeable to incredibly severe, and their severity will be directly related to numerous environmental and family variables. Mental health diagnoses are really just hypotheses - giving us a framework from which to work. So what that means in practice is that we try and find the best approximation for diagnosis from an extremely limited set of possibilities, and that means force-fitting people into imperfect boxes.

Beyond this, the most effective MHPs will tend to figure out what works best for a given patient in terms of therapy and medication and then do more of that. For many providers, what's proven to be most effective in the last few years has been the conceptualization of bipolar disorder. I've seen a great many lives improved and even saved by taking that tack. My major objection is in the ever-increasing breadth of the diagnosis. We are calling so many young people "bipolar" across such a wide range of severity that the term is losing any meaning. Fortunately there's a strong movement in the research and revision of the next diagnostic manual to break down this diagnosis into a number of different diagnoses so we can better describe what's actually going on with a given client. Less force-fitting, and more doing what works for the individual teenager, child or adult.

Julia: For almost every disease, disorder and malady, there is a number representing how much of the population has it. The numbers further group according to age group, sex, hobbies - anything you can think of. Although this grouping helps statistically, it throws a wrench into the bigger picture. To try to gauge the exact rate, or even an estimate, of the rate of bipolar disorder in teens is tough. Another problem arises from trying to nail down that number because of the range of circumstances associated with each individual case, and the number of cases that fall somewhere between real bipolar disorder and normal teenage mood swings. If your letter is stemming from a concern about having or knowing someone who might have bipolar disorder, do some in-depth research or recommend a doctor you trust.

Self-diagnosis is really untrustworthy, especially in an age when it seems that the person with the most problems "wins." There are many pills and medicines out there, and many people seeking a medical solution before taking their concerns into their own hands first. If you are witnessing an especially moody teen or you are one, ride it out for a little while, keep a close eye on the situation, but don't jump to conclusions. It is a parent's duty to protect their child and keep them safe, but that doesn't mean giving them unneeded diagnoses. You may find that focusing on a potential problem really only exacerbates your imagination. If it is evident that you are justified in your concerns and have done some research, talk to a doctor and get the necessary help.

Next week: A stepmother's struggles.

- Dr. Wes Crenshaw is a board-certified family psychologist and director of the Family Therapy Institute Midwest. Julia Davidson is a Bishop Seabury Academy junior. Opinions and advice given here are not meant as a substitute for psychological evaluation or therapy services. Send your questions about adolescent issues (limited to 200 words) to doubletake@ljworld.com. All correspondence is strictly confidential.