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Hope for Bipolar Teens – Unique Challenges, Bright Futures | Part One: Dialing in the Diagnosis

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT

Meet The Team >

The teen years are a challenging period for any parent. Adolescence is a time of radical change on almost all levels. Teenagers transform physically, emotionally, and socially. As a parent, it’s easy to get caught on the back foot. It may seem that one moment your child is playing with dinosaur figurines and talking endlessly about dreams of becoming a paleontologist, and the next they’re obsessing over pop stars, dropping hints about nose piercings, and developing new romantic crushes faster than you can count.

For most teenagers, The Age of Dinosaurs – in their life – is like the Mesozoic Era for the earth: ancient history.

If you’re the parent of a teenager struggling with a mental health disorder, you understand these changes better than anyone. And if your child receives a diagnosis for one of the variations of Bipolar Disorder (BD-I, BD-II, BD-NOS) as described by the Diagnostic and Statistical Manual of Mental Disorders, (DSM), you face a set of particularly daunting challenges. The first challenge – which may come as a surprise to many parents – is the diagnosis itself. In many cases, children and teens receive a diagnosis for BD when their real, underlying disorder is something else altogether. This can lead to a course of treatment, including medication and therapeutic approaches, which can exacerbate the true issue and do more harm than good.

Adolescent Bipolar Disorder: The Problem of Diagnosis

To best support teens diagnosed with any form of BD, it’s important to understand the history of the diagnosis. Before 1980, the general consensus among mental health professionals was that BD in children was extremely rare, BD in early adolescence was rare but not unheard of, and typical early onset of BD occurred in the late teen years. In 1980, however, the publication of the DSM-III changed this traditional landscape by declaring the criteria used to diagnose BD in adults could also be applied to children and adolescents. This led to the gradual acceptance that youth could indeed present with BD, which, in turn, led to BD diagnoses adapted for age and stage of development.

By the 1990s, clinicians began to apply the BD diagnosis to young people who displayed symptoms such as severe irritability and hyperarousal, even though they did not display the discrete highs, lows, and intermediate periods of stability typically associated with adult BD. This led to an astounding increase in the diagnosis of youth BD. According to a study published in The Annual Review of Clinical Psychology in 2017, youth BD diagnoses increased 40-fold between 1994 and 2003, while hospital discharges for youth with a BD diagnosis increased from 10% to 30% over roughly the same time period. While some researchers and clinicians explained these dramatic increases as the logical result of previous under-diagnosis of the disorder, others disagreed, arguing that symptoms classified as aspects of BD – such as irritability and hyperarousal – were better classified as disorders like Severe Mood Dysregulation (SMD), Oppositional Defiant Disorder (ODD), or other depressive, attentional, or anxiety disorders.

The DSM-V: New Categories Help Bipolar Teens

Clinicians acknowledged significant overlap between these disorders and BD, but asserted that lumping all children and teens who displayed these symptoms under the BD diagnosis did them a disservice. As a result, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-V, includes a new diagnosis – Disruptive Mood Dysregulation Disorder (DMDD) – that accounts for symptoms that may appear as classic BD yet require different medications, different therapeutic approaches, and have significantly different long-term outcomes and consequences.

All of this is crucial to parents of bipolar teens because the first thing that must happen – the first challenge unique to bipolar teens – is getting the diagnosis right. Parents of teens diagnosed with BD can and should get a second opinion to ensure both the accuracy of the diagnosis and the appropriateness of the course of treatment. If your teen has been diagnosed with BD but doesn’t seem to be making any progress, there’s a very real chance they’ve been misdiagnosed. It’s possible they’re on medication that’s not helping them at all. It’s also possible the behavior modification techniques you employ, i.e. your child-specific parenting strategies, don’t match their emotional issues.

Therefore, hope for your bipolar teenager – the one who’s struggling and not making progress – may be found in an unexpected place: your teen may have another mental health disorder altogether. If this is the case, then a change in treatment may make all the difference in the world. If this is not the case, and your teen truly does have a form of bipolar disorder, then both you and your teen can focus on specific issues and learn how to manage the disorder. In the best-case scenario, you can help your teen discover ways to live, thrive, and change certain aspects of bipolar disorder from life-interrupting disadvantages to life-enriching advantages.

Part Two of this article will discuss the connection of bipolar disorder to creativity, offer tips and advice to help bipolar teens and their parents identify mania-inducing triggers, navigate highs and lows, and mitigate the negative impact of bipolar disorder on general health and well-being.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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