Twenty years ago, there was no such thing as Childhood Bipolar Disorder. Adult Bipolar Disorder, on the other hand, was recognized as a serious psychiatric illness, characterized by a pattern of mood swings, or mood cycling, going from a depressed state to one of high energy, or what is termed mania (the older name for bipolar disorder was Manic-Depressive Illness).
Adult Bipolar Disorder was once believed to be a rare disorder. In addition, public perception was distorted by highly sensational portrayals where a Dr. Jekyll-Mr. Hyde transformation was the hallmark of the illness. What changed the landscape for bipolar disorder was the discovery of subtypes. The old myth that all patients went through a rapid mood shift — from severe depression to a euphoric full-blown manic high, was dispelled. The finding that most adult bipolar patients had a milder version of the disorder allowed for greater diagnostic accuracy.
Here are the subtypes: Bipolar I: The classic severe form which includes full blown mania. Bipolar II: A milder form of shorter depressive episodes and lower levels of mania (hypomania). Cyclothymic Disorder: an even milder form of periods of elation and depression. Mixed Bipolar: A mixture of the “ up” phase with a simultaneous “down” phase.
When clinicians began to diagnose subtypes, two significant findings occurred. First, it was found that Bipolar Disorder was not rare. About 3% of adults have the disorder. Second, when adult patients, who had been accurately diagnosed with Bipolar Disorder, were asked details about the presence of emotional/behavioral problems in their childhood, a consistent pattern of symptoms was identified. We now call these patterns Early Onset Bipolar Disorder, or Childhood Bipolar Disorder.
Let’s look at the characteristics which define CBD (Source: “The Bipolar Child,” by Papolos & Papolos, 1999):
1. Erratic Sleep. No naps, fussy, not needing to sleep as an infant.
2. Separation Anxiety. As infants, the separation of child from mother results in extreme fear/anxiety.
3. Night Terrors: Childhood dreams filled with blood, gore and terror. Childhood drawings of violence and death.
4. Rages. Out-of-control rages triggered by a parental “no.” Rages can last two to three hours per episode.
5. Oppositional Behaviors. The child argues with adults and teachers, and refuses to obey authority figures.
6. Rapid Cycling of Mood. The child shows a constantly shifting mood, from agitation and irritability to sadness, from “up” to “down.”
7. Social Problems. Words used to describe Bipolar children include: “bossy, intrusive, too overwhelming or too aggressive.”
8. Oversensitivity to Stimuli. These children can be supersensitive to odors, tastes and labels on clothing. They often demand that their sneakers be tied with just the right amount of tension.
9. Suicidal Thoughts. Bipolar children as young as 4 or 5 years old report experiencing the thought that they do not want to be alive.
10. Mania. Restlessness, giddiness, racing thoughts, grandiosity.
Bipolar Disorder, once believed to be found only in adults, is now known to have its early origins in childhood. Genetic factors are responsible for the fact that this disorder tends to run in certain families. Two warning signs — a family history of alcoholism, and/or the presence of a mood disorder such as clinical depression, are tips that a child born into these families, who also exhibits some CBD symptoms, may be at risk for CBD.
The content of this article is for educational purposes only, and should not be used as a substitute for treatment by a professional. The characters in this story are not real. Names and details have been changed to protect confidentiality.
Dr. Richard Elghammer contributes his column each week to the Journal Review.
