If you are like me and suffered from unrecognized bipolar disorder as a child only to later have this mood disorder diagnosed upon reaching young adulthood, you might be pleased to learn that current research suggests bipolar disorder is increasingly being diagnosed as beginning in childhood. As a result, these bipolar kids are more likely to receive proper treatment and support such that they, their families and friends will suffer fewer of the deep emotional and social scars that can result from untreated bipolar disorder.
Bipolar disorder, historically known as manic depressive illness, is a serious psychiatric condition characterized by sudden and unpredictable mood swings between a state of euphoria, or mania, to paralyzing depression. This is the more serious “classical” form of the disorder, known as bipolar disorder, type 1. Type two differs from type one because a person’s moods only shift between depression and a much milder form of mania known as hypomania. Between mood swings, most people with bipolar disorder are symptom-free. However, people with bipolar disorder have a strong risk for suicide, particularly when they are experiencing mood swings. This mood disorder has long been known to have a strong genetic component, because it typically runs in families.
Until recently, the psychiatric paradigm was that bipolar disorder did not manifest itself until a person reached young adulthood. However, current research has been increasingly calling this into question since children as young as six years old appear to show at least some symptoms of bipolar disorder.
On the other hand, skeptics claim that bipolar disorder is being increasingly diagnosed in children either because bipolar disorder is the mental illness du jour or because of diagnostician confusion. For example, aggression or irritability — typical to bipolar disorder — are also characteristic of several other conditions such as attention-deficit hyperactivity disorder.
Thus, the challenge is to recognize and corretly treat bipolar disorder in children so its social and psychological effects can be limited.
“Children don’t get married four times, or max out their credit cards, or buy real estate they can’t afford,” said Dr. Barbara Geller of Washington University in St. Louis, who led the study. “We have to find the childhood equivalent of these behaviors.”
To do this study, Geller and her colleagues included grandiosity in addition to irritability or aggression as their study selection criteria that marked mania in children. Grandiosity, a common adult symptom of bipolar mania, is observed in children who engage in dangerous high-risk behaviors such as such as running into traffic because of a sense of invincibility.
After defining their diagnostic criteria, Geller and her colleagues identified and studied 115 children between the ages of 7 and 16 whom they diagnosed with bipolar disorder type one because they had or were suffering either with mania or a mixed state. A mixed state is characterized by both depressive and manic symptoms.
The children visited Geller and her colleagues at the start of the study and then for 9 follow up visits over eight more years. The team separately interviewed the children and their parents about the child’s symptoms, diagnoses, daily cycles of mania and depression, and interactions with others. One hundred and eight of the children completed the study.
During the ensuing eight years, Geller and her colleagues found that the children spent 60.2% of their weeks with some number of mood episodes, and 39.6% of the weeks with some episodes of mania. In total, 87.8% of Geller’s patients recovered from mania (figure 1);
However, nearly all (73.3%) of these bipolar children later relapsed with another manic or mixed state episode. Second and third episodes of mania in the children included psychosis, cycling between mania and depression, and were of long duration. For example, on average, the length of a second manic episode was 55.2 weeks and the average length of a third episode was 40 weeks. Further, the team found that the relapse rate in bipolar children was strongly influenced by maternal warmth (figure 2);
Of the 54 children who reached 18 years of age or older at the end of the study period, 44.4% continued to experience manic episodes, which is a rate that is much higher than for the general population. In this group of young adults, 35.2% developed substance abuse, a rate that is similar to people who are diagnosed with bipolar disorder as adults. The team says these findings indicate that there may be significant continuity between childhood and adult bipolar disorder.
“Children with mania grow into adults who have mania,” observed Dr. Geller.
The team concluded their paper by writing that this study emphasizes the need for further research into diagnosing and treating childhood bipolar disorder.
“In conclusion, mounting data support the existence of child bipolar disorder I, and the severity and chronicity of this disorder argue strongly for large efforts toward understanding the neurobiology and for developing prevention and intervention strategies.”
As an adult who suffered from an unrecognized bipolar type I disorder from childhood, I strongly agree with Dr. Geller and her colleagues, particularly since my own mood disorder was instrumental in destroying both my childhood and my relationship with my family.
Barbara Geller, MD; Rebecca Tillman, MS; Kristine Bolhofner, BS; Betsy Zimerman, MA (2008). Child Bipolar I Disorder: Prospective Continuity With Adult Bipolar I Disorder; Characteristics of Second and Third Episodes; Predictors of 8-Year Outcome Archives of General Psychiatry, 65 (10 ), 1125-1133 [free PDF].