Tag Archives: Bipolar

Mood Disorders in Children

Mood disorders in children, especially bipolar disorder and explosive mood disorders (also known as severe mood dysregulation and called disruptive mood dysregulation disorder in DSM-5), are controversial. Many children after all have temper tantrums, hyperactivity, sleep problems, etc., yet do not need a diagnosis. I found a list of fifteen symptoms of childhood bipolar disorder, of which I easily met the required four as a child. However, I never had the classic symptoms of bipolar disorder and do not have bipolar disorder now that I’m an adult. I did have mood disturbances as a child, but these could also be due to my autism and emotion regulation disorder.

Dsiruptive mood dysregulation disorder (DMDD) has much stricter criteria than those proposed in the above article for childhood bipolar disorder. In order to be diagnosed with DMDD, a child needs to meet many criteria, including temper outbursts on average at least three times a week over a twelve-month period, persistent irritability most of the day, nearly every day, symptoms occurring in at least two contexts and being severe in at least one (home, school, or with peers), etc. The diagnosis cannot be made in a child under six and should not be made for the first time in adulthood.

The diagnosis of disruptive mood dysregulation disorder cannot co-occur with oppositional defiant disorder (ODD), intermittent explosive disorder or bipolar disorder. If a child meets both criteria for DMDD and ODD, only the mood disorder needs to be diagnosed. If a child has ever had a manic or hypomanic episode, only the diagnosis of bipolar disorder must be made. For childhood bipolar disorder, the same criteria for a manic or hypomanic episode apply as for adults, except that the duration may be shorter. According to the accompanying text in DSM-5, rates of conversioon from DMDD to adult bipolar disorder are low. Adults with a history of DMDD are more likley to suffer frm depression or anxiety.

Mood disorders, including DMDD, can however co-occur with other disorders, such as ADHD or autism. ADHD and autism can also mimic a mood disorder. For example, if a child with autism or ADHD won’t stop talking, this shouldn’t be confused with the talkativeness seen in a (hypo)manic episode. However, mood symptoms can also be missed if a child has ADHD or autism, because irritability, temper outbursts, etc. are seen as a normal part of the ADHD or autism.

If a child’s mood disturbances are interfering with their daily functioning, take them to their doctor or psychologist for assessment. It isn’t always necessary to give them additional labels or prescribe them medication. Sometimes, just a change in handling strategy may help. You could’ve noticed this already, but, with a problem child, it’s often helpful to have a professional be your second pair of eyes.

Love Survives Mental Illness

Over at Bipolar Mom Life, there’s a great post for Valentine’s day on love surviving mental illness. This is a very powerful story. Unlike in my case, the author had not become mentally ill yet when she got married. Then again, with mental illness being unpredictable, it isn’t like my husband knew what to exppect when we started dating or even when we got married in 2011. IN fact, I didn’t know what to expect. Until roughly a year ago, we were expecting to go live together within the foreseeable future. We still hope to one day live together, of course.

Love does not always survive mental illness. In fact, love does not always survive the test of time, with around 40 percent of marriages failing in general. Then again, according to an article in BP magazine, 90 percent of marriages in which one partner has bipolar disorder, end in divorce. I bet that with borderline personality disorder, this percentage is at least as high.

There are several obstacles to a successful marriage for someone with BPD. There are of course those characteristics that are inherent in the disorder – higher risk of infidelity, aggression, idealizing and devaluing, etc. There are also problems that are not necessarily inherent in the condition, but which are more likely to occur due to the dynamics of partners not only being partners, but also having the patient or carer role. I cannot go into detail about this, but I want to warn mentally ill people who are in a relationship that their partner is their partner first, may be their carer second, and is not their therapist.

The Childhood Bipolar Controversy Reviewed

Bipolar disorder in children is controversial. It didn’t use to be diagnosed as often as it is now, especially in the U.S., and more atypical symptosm are suggested to be bipolar. In the journal Child and Adolescent Mental Health, Boris Birmaher reviewed the literature surrounding this controversy. It’s an interesting article, viewing the controversy from all sides.

Birmaher starts by describing the diffiuclties diagnosing manic, hypomanic and depressive episodes in children and adolescents. Particularly, it is hard to distinguish symptoms of (hypo)mania from normal episodes of increased activity or from ADHD. Depressed symptoms are also hard to diagnose because children do not always feel or look depressed all the time. Adolescents experiece more atypical symptoms (increased sleep and appetite and weight gain) than adults do. Birmaher discusses whether onepisodic mania can be seen as bipolar.

He fortunately also shreds the idea that irritability only is bipolar. It isn’t. In fact, it is not severe mood dysregulation (also known as disruptive mood dysregulation disorder) eitehr, which surprised me. Irritability only is more indicative of ADHD or disruptive behavior disorders than of bipolar or SMD. Elation only, also, is not common in childhood or adolescent bipolar. More likely, patients experience both irritability and mood elation.

Birmaher is quite clear that pediatric bipolar disorder exists. The prevalence is around 2%, with just over 1% of children and adolescents presenting with bipolar I. For some perspective, Levorich et al. (2007) show that as many as half of adult bipolar patients in their study reported onset in childhood (14%) or adolescence (36%).

Birmaher is not a bipolar proponent, in the sense that he thinks atypical symptoms warrant a diagnosis of BP. He makes it quite clear that more research is needed into the risk factors for converting from atypical or subsyndromal bipolar-like symptoms into full-blown bipolar in children and adolescents. It looks like family history of bipolar is one such factor. Levorich et al (2007) found that, the earlier the onset of bipolar disorder, the more likely the patients were to have a parental history of bipolar or depressive disorders.

Levorich et al. (2007) particularly studied prognosis in adults with bipolar disorder, comparing those with (retrospectively reported) childhood or adolescent onset bipolar to those with onset in adulthood. They found that, the earlier the onset of the disorder, the more likely patients were to suffer from dysphoric (irritable) rather than euphoric mania and the more likely they were to have comorbid anxiety and drug abuse. In addition, the researchers tracked all participants’ mood over a year’s period. This showed that those with early onset bipolar had more depressed episodes, more severe manic and depressive symptoms and fewer good days in a year than those whose bipolar started in adulthood. For these and other reasons, Levorich et al. advocate an active ruling in or outo f bipolar d isorder in children and adolescents, rather than it being considered a last resort diagnosis.

References

Birmaher B (2013), Bipolar Disorder in Children and Adolescents. Child and Adolescent Mental Health, 18: 140-148. DOI: 10.1111/camh.12021.

Levorich GS, Post RM, Keck PE, Altshuler LL, Frye MA, Kupka RW, Nolen WA, Suppes T, McElroy SL, Grunze H, Denicoff K, Moravec MKM, & Luckenbaugh D (2007), The Poor Prognosis of Childhood-Onset Bipolar Disorder. Journal of Pediatrics, the, 150(5):485-490. DOI: 10.1016/j.jpeds.2006.10.070.

Autism, Special Interests, and Elevated Moods

Many years ago, I read an article on Suite101 or About.com or the like that discussed similarities between Asperger’s Syndrome and bipolar disorder. The parent who wrote the article described her son’s mood swings from elated to depressed. However, she realized that these mood swings were related to whether the son could engage in some special interest.

I find the same thing happen to me, but in my case, it also ties in with the dissociative or emotion dysregulation symptoms. I find that when I’m in a particular personality state, I engage in a certain special interest a lot more than when I’m in another state. For example, Clarissa is my blogger part, who is behind most of the posts on this blog. Annemiek is my crafter. And I at this point can’t think of anyone else.

Getting back to mood swings, I must say that I get very elated when I engage in a particular interest for a certain period of time. I uttered the phrase that I would’ve been manic if I experienced this (mania) at all. In a way, this is extremely inappropriate and comparable to when a currently mentally healthy person talks about “going all OCD”. I in no way want to say I suffer from bipolar (hypo)mania, but these mood swings do get problematic at times.

For example, last night I didn’t sleep at all. I spent around $80 on useless online services without even bothering to read the not-so-fine print that clearly said these services would not be working for me. I actually took a PRN Phenergan at 2:00 AM, before I went ont he shopping spree, but swung right through it. Phenergan, for those not familiar with it, is a strong tranquilizer or low-potency neuroleptic. I’m now relatively calm again, so again I in no way mean to compare myself to people who have these experiences for weeks on end, but I do see actually how this could become a problem.

So, should autism parents limit their children’s special interests in order to prvent this from happening. I don’t think this is universally the case, but parents must teach their children about time and money management. I, having been pretty stingy as a child and teen, never really had to learn about this. I always had enough money on my hands anyway. I actually must say I have no clue about budgeting, and really don’t know whether I need to learn it yet. I guess so.