From a very young age I knew that something about me was different from other people. I was very sensitive and frustrated. I can remember how, at a very young age, I would cry without knowing why, and make up excuses to my parents. Apart from that I don’t remember too much about my childhood moods, but what I do know is that I was an extremely depressed adolescent. I had always been a confident child, but my anxiety become so bad that, where once I was an award winning public speaker, I suddenly couldn’t stand in front of a crowd without shaking and sweating uncontrollably. I was forever obsessing about things and people. Especially people. I felt like I had no one to talk to and was absolutely alone. When I did try to reach out to people, I became obsessed with them. I couldn’t control it and I couldn’t understand it. I just wanted someone to talk to, but could not burden them with my problems. I started contemplating suicide when I was about 15, and started writing teenage angst poems about death. Most of the time I either felt suicidal, or trapped and frustrated. Before I left high school, I had seen about 6 different therapists; no one can say that I didn’t try to find help. Strangely enough, I was never referred to a psychiatrist. In the small town that I grew up in, and especially in my family, people just didn’t do that.
My situation was also complicated by the fact that my parents were going through a divorce at the same time and all my emotional baggage was put down to trauma from divorce. I won’t lie, it was traumatic, but no one thought to look further or deeper. I read all about depression, but as a 15 year old I couldn’t quite grasp it, and I didn’t understand what it was. Depression wasn’t really the problem though; it was the obsessions, compulsive racing thoughts, frustrations, sudden bursts of anger, irritability and anxiety that I didn’t not understand and didn’t have the vocabulary to identify. Now I look at my family and I clearly see a history of mental illness, but 15 years ago no one thought of or wanted to go there. Plus it can be difficult to distinguish between just being hormonal and being clinically depressed when dealing with teenagers.
Diagnosing most people with Bipolar Disorder is difficult, but diagnosing kids and teenagers are even more difficult, since their bodies and brains are still going through so many changes. To further complicate things, children and teens with Bipolar Disorder don’t display the same symptoms as adults. It is said that they generally experience more irritability and rapid cycling than adults, and the cycles might not be as ‘visible’. They do not exhibit the manic behaviour described in the DSM and their shifts in mood are not as clearly defined. This causes a lot of controversy around the topic. Some experts believe that Bipolar Disorder can appear in children as young as six years, while others believe that it does not exist in children. This is because the symptoms can easily be confused with that of ADHD or depression. Being treated for these illnesses when children actually have Bipolar Disorder can make the condition worse and trigger mania.
An Italian psychiatrist, Dr Franco Benazzi, explains it very well:
“Misdiagnosis of bipolar disorder as attention deficit hyperactivity disorder [ADHD] and major depressive disorder is common, leading to the use of stimulants and antidepressants, which might worsen the course instead of mood-stabilizing agents,” he notes.
When Bipolar Disorder runs in the family and other members of the family have been diagnosed, it at least gives doctors a bit more to work with, and they know to consider this. Like with adults, Bipolar Disorder can only be treated effectively if correctly diagnosed. At some point I read that if a child displays symptoms of depression it is more likely that he or she has Bipolar Disorder and therefore some psychiatrists would rather treat them with mood stabilisers first and antidepressants second. Even though I’m sure this is not false information I can’t find the original information and wouldn’t want you to just take my word for it, so if you are in this kind of situation with your child or teen, ask you psychiatrist about it. Here is some other advice about how to help your child with Bipolar Disorder. Also have a look at this article from a Psychiatry journal about the misdiagnosis of Bipolar Disorder, that I have also added on my resources page. The article says the following:
“Research supports frequent onset of bipolar illness prior to age 20. Pediatric bipolar disorder, unlike in adults, has been reported to present as nonepisodic, chronic, and mostly mixed manic states. The unique presentation of bipolar disorder in children and adolescents and its frequent comorbidity with ADHD, anxiety disorders, oppositional defiant disorder, and conduct disorder might be a significant contributor to the difficulties in accurate diagnosis.”
Doing research on this topic was much more difficult than I thought it would be. Clearly research is divided into two camps and although there is a lot of information out there, it all says the same things. From personal experience I can definitely say two things: 1) No matter what the DSM says about criteria, my Bipolar Disorder definitely started in my teenage or even childhood years, and 2) Antidepressants made my condition worse. Parents and doctors have to be more sensitive to these conditions in children and teenagers instead of just treating them for ADHD or Depression and worsening their symptoms. Kids should not have to experience the suicidal lows, excruciating mixed states or uncontrollable highs of Bipolar Disorder. It scars you for life.
Please share your own childhood stories or the stories of your children. It’s usually not the research in books by scientists that help us understand, but the real stories of real people.
*Small update: I spoke to my psychiatrist about this today. In his opinion Bipolar Disorder definitely exists in children, but is almost impossible to diagnose.