Defining and Diagnosing Bipolar Disorder
If it seems that the diagnosis of childhood depression just keeps getting harder to make, you're right. Overlooking bipolar depression, however, would be a mistake, as it is a more serious form of mental illness. Formerly called manic depression, it still sounds scary no matter what you call it.
Unfortunately, people with this disorder are unfairly labeled “crazy” or “out of control.” In fact, children and teens with bipolar disorder are typically bright, creative, and intuitive. However, these characteristics can get lost when bipolar symptoms are present.
When trying to define depression, dysthymia, and bipolar disorder, part of the diagnostic process must focus on how many times and how often a child's moods cycle. This describes the various degrees of the symptoms being exhibited and can serve as a way to fine-tune a diagnosis.
You know what a depressive episode looks like, but what is mania? If you are functioning normally, you can have moods that include extreme happiness that is different from your more natural level of functioning. Your extreme happiness usually doesn't last long, however. Mania is described by the DSM-IV criteria as:
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week
During this period, three (or more) of the following symptoms have persisted and have been present to a significant degree:
Inflated self-esteem or grandiosity
Decreased need for sleep (e.g., feels rested after only three hours of sleep)
More talkative than usual or pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
Small children rarely experience an episode of mania, but the risks increase when a child hits adolescence. If your child has had several major depressive episodes, you are probably relieved when he is feeling better. Early signs of mania can often be ignored because he seems happy.
Cyclothymia is another category of mood disorder that involves a continuous cycling of depressed and manic moods. Its difference from bipolar depression lies in its severity of the moods. The mood swings are there. It's just that the highs and lows are less extreme.
In order to better understand bipolar disorder, you'll need to understand the role that cycling plays in bipolar disorder. Cycling refers to how often a depressive or manic episode occurs and how long it lasts. If a child does indeed have periods of mania, her episodes of cycling are very rapid and almost appear continuous without a return to normal mood. To be considered continuous, symptoms must be present at least four hours a day.
Types of Bipolar
Now that you understand cycling, let's look at the two types of bipolar disorder, called bipolar I and bipolar II. Bipolar I is more severe. The mood elevation, in either direction, is more severe in bipolar I. The cycling is continuous and lasts for at least one week.
You probably know that many famous people had bipolar disorder. Like Vincent Van Gogh, many artists have this mental illness and have used it to their advantage to increase their creativity. Unfortunately, this often means avoiding treatment since they believe it will somehow curtail their talents.
Bipolar II involves less severe moods, but the moods still present themselves in the extreme. An easy way to think about it is that these extremes are not so obvious; you notice changes in your child's moods that are not quite right or out of character. The mania doesn't necessarily cause the problems that the mania in bipolar I does, and often, after you have nursed your child through a depression, you are hesitant to believe anything is wrong when she is more energetic, happy, or talkative.
There's another reason not to ignore your child's changes in mood. Part of the management and treatment of bipolar disorder lies in early detection. The chances for successful treatment — that is, having fewer episodes of depression and mania — increase significantly if you catch the disorder during the first manic episode or the first few depressive episodes.