Bipolar Disorder Diagnoses Spike in Youth

Sept. 19, 2007 — -- The diagnosis of bipolar disorder in people under 20 astonishingly increased 40-fold between 1994 and 1995 and 2002 and 2003, according to a study reported in this month's issue of Archives of General Psychiatry, the leading scientific journal in our field.

The Archives was not the first to report this story. Time magazine, always quick to spot a trend, was there first with a cover story on the subject in 2002 called "Young and Bipolar." It began with: "It used to be called manic depression. Now, this volatile form of mental illness is increasingly showing up in children and teenagers."

But is it? Perhaps the illness is being recognized where it was missed before. Alternatively, perhaps it is being overdiagnosed in kids who do not truly have bipolar disorder, but, instead, only have symptoms reminiscent of the illness.

Take Benny, for example (name changed for confidentiality). This 9-year-old was diagnosed with bipolar disorder in an outpatient setting based on things like constant irritability, being easily bored, sleeping less than usual and being bossy with people.

A systematic psychiatric evaluation revealed that, while he met the criteria for attention deficit hyperactivity disorder, and oppositional defiant disorder, Benny did not meet the strict criteria for bipolar disorder.

So, what exactly is bipolar disorder?

Here is the simple version: The term refers to two poles of mood — the low end, which is depression, and the high end, which, when severe, is called mania, and when milder, is called hypomania.

Some people with bipolar disorder love their hypomanias; the episodes can have them feeling elated and important, with a high energy level.

Manic episodes, on the other hand, typically veer out of control. These episodes are defined by thoughts that race so fast they cannot be reined in and by grandiose ideas, such as thinking God has chosen you to save the world. Manic moods can be highly irritable, and can shift dramatically at the slightest provocation.