Bipolar disorder is a mood disorder that tends to be diagnosed in adults, but has been found to occur in childhood as well. As reported by the National Institute of Mental Health, bipolar disorder occurs in 2.6 percent of the adult population. In "Introduction to Abnormal Child and Adolescent Psychology," Robert Weis describes a study in the U.S. that found a prevalence rate of around 7 percent for adolescents with one of the four types of bipolar disorder. Further research on pediatric bipolar disorder is needed to better understand its prevalence and the differences in presentation from the adult onset of the disorder.
Types of Bipolar Disorders
The "Diagnostic and Statistical Manual of Mental Disorders" describes the four types of bipolar disorder. Bipolar I disorder requires that a child has had a manic or a mixed episode, and these symptoms must cause significant difficulty in day-to-day life. Bipolar II disorder requires that a child has had a major depressive episode and a hypomanic episode. Cyclothymic disorder describes individuals who have experienced symptoms of hypomania and depression over a one-year period, but have not met the requirements for any mood episodes. Finally, bipolar disorder (not otherwise specified) is diagnosed for those who demonstrate symptoms of bipolar disorder, but do not fit exactly in the other categories.
Manic and Hypomanic Episodes
The "Diagnostic and Statistical Manual of Mental Disorders" describes a manic episode as a time period with "abnormally and persistently elevated, expansive or irritable mood" over a one-week period. The individual must demonstrate three of these symptoms: inflated view of themselves (i.e. extreme self-confidence), little need for sleep, excessive talking that may seem rushed, constant flow of thoughts and ideas, becoming easily distracted, involvement in planning several activities, and becoming involved in dangerous or gratifying activities (e.g. shopping sprees, unsafe sexual behavior). A hypomanic episode has the same criteria, but must only occur over a four-day period and does not impair functioning to the point of psychosis or hospitalization.
Mania in Children
As discussed by Robert Weis in "Introduction to Abnormal Child and Adolescent Psychology," children manifest symptoms of mania somewhat differently than adults. Children with elevated mood often seem silly and happy; however, children with mania are most likely to appear irritable, seeming angry and having tantrums or emotional meltdowns without warning. Children demonstrate inflated self-views by believing that they have special powers or skills. They may sleep for only a few hours, but appear to have endless energy the next day. Weis indicated that children report that their thoughts are moving quickly, jumping from one thing to the next. When talking, children with bipolar disorder tend to change topics, talk constantly and are often hard to follow. They may appear to have trouble completing tasks and maintaining concentration, and may also appear impulsive and restless. They may start big projects without planning first, working on them intensely for a short time, then moving to something new. Dangerous behavior in children can include using drugs, stealing or other reckless activity.
Depressive Episode
A depressive episode, according to the "Diagnostic and Statistical Manual of Mental Disorders," is a two-week period with "depressed mood or the loss of interest or pleasure in nearly all activities." An individual must have five of these symptoms: feelings of depression or sadness, weight loss or gain, loss of pleasure in fun activities, difficulty sleeping, feeling restless or lethargic, feeling tired or without energy, difficulty concentrating, thoughts of death or suicide, and feeling guilty or worthless. Children often appear more irritable than sad or depressed. Additionally, Weis notes that depression in children is more likely to manifest as irritability or crankiness, insomnia (i.e. being unable to fall or stay asleep) and appearing restless by squirming or constantly moving. Children also tend not to report fatigue, but instead refuse to do certain activities. Also, difficulty concentrating may become evident with changes in school performance.
Mixed Episode
As reported by the "Diagnostic and Statistical Manual of Mental Disorders," the criterion for a mixed episode is that the individual must meet the requirements for a manic and depressive episode over a one-week period. Therefore, within this one week, the individual has symptoms of both mania and depression.
Differences From Adults
As discussed by Weis, adults often show straightforward symptoms of depression and mania, while children's symptoms look somewhat different. He reports that children with bipolar disorder tend to have mixed episodes, with a combination of irritability, elevated and depressed mood. Also, children tend to move more quickly between moods, a concept known as "rapid cycling." This is less common in adults. Weis also notes that while adult symptoms tend to occur quickly, symptoms in children become gradually apparent. Finally, children with bipolar disorder have more extreme disturbances in mood than adults, so their manifestation of symptoms tends to be more severe.
References
- "Diagnostic and Statistical Manual of Mental Disorders (fourth edition, text revision)"; American Psychiatric Association; 2000
- "Introduction to Abnormal Child and Adolescent Psychology"; Robert Weis; 2008
- National Institute of Mental Health: Mental Disorders in America
