sad teen girlIn the late 1990s and early 2000s, diagnoses of pediatric bipolar disorder increased sharply. Children as young as preschoolers (and pre-preschoolers) entered treatment. However, most current experts agree that pediatric bipolar disorder is rare. People with bipolar disorder need medications in order to function, but these medications have side effects and should never be prescribed unless necessary.

The general impression we get about bipolar disorder is that it involves mood swings. Teens are famous for their mood swings, one day being miserable, and the next, chatty and animated. Some mood swings in adolescents are completely normal. However, when mood swings get to the point where someone’s behaviors and thinking seem unrecognizable, there may be a problem.

One of the hallmark signs of bipolar disorder is mania. Mania classically refers to a state where someone can display symptoms such as:

  • More than two nights with no or very little sleep, but tons of energy and no fatigue
  • Talking so quickly and tangentially that others can’t understand them
  • Making uncharacteristically grand and unrealistic plans that don’t really make sense given where they are in life (like curing cancer or solving world hunger right away)
  • An increase in goal-directed behaviors to a point that is unreasonable, like organizing every book in the house by title, and then author, and then publisher
  • Displaying very impulsive behaviors like gambling, casual sex, or taking drastic risks while driving
  • In severe forms, mania can lead to psychotic symptoms such as hearing voices, hallucinations, or paranoia

The key point about these behaviors is that they are not the person’s baseline. Someone who regularly drives fast, has casual sex, or talks quickly may have some issues- but mania is not one of them.

I should note that “grandiose thinking” is also a symptom of mania, but age needs to be considered.  A 13-year-old who expects to be a movie star despite not being a good actor can be well within the normal range. A 19-year-old who plans to be the next star quarterback for the NFL, despite the fact that they have never played sports before, is cause for concern.

Complicating the issue is the fact that mania can sometimes present as irritability. Most teens get irritable at some point. However, if your teen has extreme irritability that is a change from their normal functioning, it’s worth getting a mental health evaluation. Irritability is unlikely to be the only sign of bipolar disorder, but it could be a sign of depression, anxiety, or ADHD. In the past, children and teens with behavioral outbursts were often diagnosed with bipolar disorder. However, the new diagnosis of Intermittent Explosive Disorder now seeks to better characterize and treat this population.

The opposite “pole” of mania is depression. Teens with bipolar disorder will have deep depressions, but it’s worth noting that “regular” teen depression is much more common than bipolar disorder. People with bipolar disorder will cycle between episodes of mania and episodes of depression. These episodes usually last at least a few days each, but can last longer.

Adult bipolar disorder is uncommon, and pediatric bipolar disorder is a very rare occurrence. Here are some things to consider if you’re wondering if your teen has bipolar disorder.

  • Many conditions other than bipolar disorder can cause mania-like or depression-like symptoms. If you’re concerned about your teen, make sure to get a medical workup, including substance abuse screening, as well as a mental health workup.
  • Bipolar disorder tends to run in families. It’s not unheard of for a case of pediatric bipolar disorder to crop up with no family history, but it is unlikely. Please note that most teens with a family history of bipolar disorder do not develop the disorder.
  • If your teen is functioning at their baseline at school and/ or work, communicating as usual with peers, and carrying out their day-to-day activities, they are unlikely to be experiencing the symptoms of bipolar disorder.
  • Bipolar disorder indicates a change from prior functioning. Teens can seem to be changing every day. Nonetheless, episodes of mania and/ or depression should look quite different from what you’re used to seeing, and possibly from what you’re used to seeing in anyone.
  • If someone diagnoses your teen with bipolar disorder, and you’re uncomfortable or disagree with the diagnosis, ask the provider detailed questions about how they came to their decision. You can always seek a second opinion if you feel strongly that another set of eyes is needed. (This goes for all diagnoses, not just bipolar disorder.)
  • If your teen does have bipolar disorder, make sure you are getting the support you need while you care for them. Ask a mental health provider about the best ways to keep yourself functioning while your teen receives treatment.

Bipolar disorder in teens may be rare, but mental health problems are not. Seeking a mental health assessment for a struggling teen is an important first step in protecting their well-being. Good mental health is vital for your teen’s functioning and development, so don’t wait to address any problems that you see arising.