Between the poles

Bipolar disorder been has called the ‘the great impersonator’ because it comes in many guises and often coexists with other problems – and numerous teenagers suffer from it

By MIKE GROPPER
Bipolar Teens521 (photo credit: MIKE GROPPER)
Bipolar Teens521
(photo credit: MIKE GROPPER)
The number of children and teens diagnosed with bipolar disorder has been rising sharply, prompting research and debate on how the illness should be characterized in young people.
Until recently, most professionals believed that the disorder rarely occurred before people reached their 20s and that it affected about 1 percent of the population. New research now puts the prevalence rate at 4% of the general population, and according to a 2012 US National Institute of Mental Health-funded research study, the rate of bipolar symptoms among US teens is nearly as high as the rate found among adults.
The researchers found that 2.5% of youth met criteria for bipolar disorder in their lifetime, and 2.2% met criteria within a given year. The researchers also found that rates increased with age – about 2% of younger teens reported bipolar disorder symptoms, whereas 3.1% of older teens did.
Bipolar disorder, formerly known as manic depression, is a brain disorder with genetic underpinnings that causes unusual shifts in mood and energy.
Symptoms of bipolar disorder can be severe. They are different from the normal ups and downs that every teen goes through from time to time. These bipolar mood swings, called “cycling” by professionals, can result in damaged relationships, poor school performance, destructive and explosive behavior, drug and/or alcohol abuse, depression, acting out sexually and promiscuity, and even suicide.
While it is true that drug and alcohol use and experimentation is common during adolescent years, 25% to 40% of the teens who become substance dependent are believed to have an underlying bipolar disorder. The drugs appeal to their need to self-medicate both depressive and manic states. Bipolar is by no means easy to diagnose. It has been has called the “the great impersonator” because it comes in many guises and often coexists with other problems such as ADHD, eating disorders (bulimia), cutting (self-mutilation), and anxiety disorders.
Bipolar disorder has different faces. If the mood swings from depression to a severe mania, it is called Bipolar I – the classical understanding of bipolar illness.
Bipolar II, commonly referred to as bipolar depression, is also characterized by mood swings, but the mania is of low intensity – referred to as hypomania – and the mania may not be noticed at all. In addition, there are also reported cases where the cycling behavior moves from severe depression to less severe depression, never exhibiting any signs of mania.
In these cases where mania is not observed or hard to identify, practitioners frequently misdiagnose many individuals that are in fact bipolar, calling them clinically depressed. Research has shown that this may be occurring in 20% to 40% of all cases where someone is diagnosed with clinical depression.
This may help to explain why it takes on average about 10 years for someone with bipolar disorder to be accurately diagnosed by a mental health professional.
During the course of that waiting period, an undetected bipolar teen can make impulsive and risky choices, including the possibility of a suicide attempt.
LISA, AGE 16, was referred to my clinic after being treated by other therapists for what was thought to be a clinical depression. She had been put on a few different anti-depressants but none seem to have any lasting effect. During my work with Lisa, she shared a secret.
She had been cutting her arms and legs with sharp objects for close to two years. At the beginning, she cut herself by using her fingernails, but later began to use razors and knives. Lisa was very open about her cutting behavior. She would state that when she cut herself, the blood actually excited her and made her feel more alive. It was her way of remedying her depression.
I knew from the literature that there were studies that showed a relationship between girls who cut and bipolar depression. I gave Lisa a mood scale and asked her to fill it out for a week.
The scale revealed that she cut when her depression was very strong and she was extremely irritable. Whenever her depression lifted, the cutting behavior would cease. Her shifting moods happened many times a day, something mental health practitioners call rapid cycling.
After establishing this up-and-down pattern, I suspected she had bipolar depression. I referred Lisa to a psychiatrist who agreed with my diagnosis. She was given a mood stabilizer, and within three weeks her cutting behavior completely disappeared. With the help of the proper medication and continuation of counseling, Lisa’s has not returned to cutting behavior for over three years.
JOSH, 18, was referred to me for treatment of substance abuse. He had smoked marijuana daily for almost three years and had tried a host of other drugs.
Josh’s parents divorced when he was 11, and both parents had remarried and started new families. Josh was caught in the middle and clearly had resorted to drugs as a way to alleviate his emotional pain. During my work with Josh, I learned that he was extremely hypersexual, having sex with many girls in high school. Furthermore, he had uncontrollable bouts of anger and rage. He was thrown out of school on two occasions for fighting, but was readmitted.
I asked Josh if his thoughts ever raced. He told me, “All the time.” The racing mind, intense sexual drive and irritability are typical indicators of bipolar mania, and Josh had all three.
At night, his mania kept him up and he could not fall asleep, so he resorted to smoking marijuana to help him relax.
During my work with him, Josh described how his high moods would unexpectedly crash into a deep depression where he felt life was not worth living.
I strongly suspected that Josh had bipolar I. A second opinion by a consulting psychiatrist confirmed my suspicion.
Today, Josh’s moods are stable with the help of a mood stabilizer. He attends Alcoholics Anonymous meetings, and is trying to build a normal life.
Bipolar disorder, although a chronic psychiatric disease, can be treated successfully if properly diagnosed. When treated, a bipolar teen, like an adult with this disorder, can live a healthy and happy life. ■
The writer is a marital, child and adult psychotherapist practicing in Jerusalem and Ra’anana. drmikegropper@gmail.com