BI-POLAR DISORDER (BiPD)

  
The DSM IV TR number is 296. There are various types and sub-types of Bi-Polar Disorder that are delineated in the DSM-IV. The classic feature of BiPD, formally known as Bi-Polar I, involves fluctuating between being depressed or being in a manic, euphoric state. The disorder can include delusions and hallucinations (i.e. psychotic features). Unfortunately, the various sub-types speak to the complexities of BiPD, and include Bi-Polar II (still depressed with less severe mania), Cyclothymia (not the depth of depression or mania as in BiPD I), and Mixed States BiPD which itself has two subtypes, Mixed BiPD (simultaneous depression and mania) and Rapid Cycling (frequent switches between depression and mania). Diagnostic criteria for BiPolar I (296.xx): http://behavenet.com/capsules/disorders/bip1dis.htm; for BiPolar II (296.89): http://behavenet.com/capsules/disorders/bip2dis.htm and for Cyclothymia (301.13), go here: http://behavenet.com/capsules/disorders/cclthymcdis.htm. As of now (approaching 2009) there are no DSM IV TR diagnostic criteria for children and adolescents which leaves clinicians with having to apply inappropriate adult criteria to them. This issue will supposedly be addressed by the DSM V due between now and 2012.

BiPD (historically referred to as Manic-Depressive Disorder) is an extremely complicated and serious disorder, especially when encountered in childhood and adolescence. When diagnosed in children, it is known as Early-Onset (Childhood or Juvenile) Bi-Polar Disorder (EOBiPD). The scope of the disorder in children tends to be more severe than the adult version. It is characterized by depressive and manic states that manifest in various forms and combinations and to varying degrees. It is often said that children with this disorder are "manically depressed," indicating a mixed state.

Beyond the usual manic or depressive symptoms of BiPD there are the more serious concerns of accompanying psychotic features or actual episodes. Children and adolescents are often more irritable and destructive than their adult counterparts. They experience nightmares and often have thoughts of a bizarre, bloody and ghoulish nature. Self-mutilation (i.e. cutting) sometimes exists and the risk of suicide is a concern. Perhaps the most serious of all the impulse disorders, young people with BiPD tend to be quite impulsive and reactionary with many potential self-destructive tendencies.

Further complicating the picture is the often mis-diagnosis with ADHD. Some believe that BiPD can be and is, co-morbid with ADHD because of the cognitive executive deficits. The mis-diagnosis is understandable as the severe hyperactivity of ADHD can easily be mistaken or actually mask the mania of EOBiPD. It is, however, imperative to insure a proper diagnosis as the medication issue is crucial. Medicating for ADHD runs the risk of exacerbating BiPD, assuming the diagnosis is incorrect. The path to take is one of patience. The clinician needs to take time to insure what proper condition exists.

For a more full-featured discussion and lists of various symptoms, please refer to the Juvenile Bipolar Research Foundation at: http://www.jbrf.org.

See also the BiPD Bibliography on the Resources page: http://www.garryearles.com/resources.html

Tourette Syndrome
Attention Deficit Hyperactivity Disorder
Obsessive Compulsive Disorder
Oppositional Defiant Disorder
Intermittent Explosive Disorder
Generalized Anxiety Disorder

All material on this website ©2009 by Bridging the Chasm and Garry L. Earles, L.I.C.S.W.