Does your child have Bipolar Disorder? Probably not.
Child Bipolar Disorder was becoming a common diagnosis when I was in graduate school about 15 years ago. There was a lot of controversy over this among mental health professionals. Was this the best way to describe problem behavior in certain children? Enough said yes for the diagnosis to be included in the 2015 edition of the manual of mental health disorders, but thinking is starting to change, because the science doesn't support it.
Again, bipolar disorder has become a very common diagnosis in children. But the incidence in adults is only 2%! Is there a sudden, massive bipolar epidemic in children? That would be weird. In the January edition of the American Association of Pediatrics' magazine, a child psychologist wrote an article encouraging us to rethink things based on the evidence (the article is reproduced in full as a picture below this blog entry).
The author, Dr. Winston Chung, notes, "I realized that nearly every one of my [child] patients had been given the diagnosis of bipolar disorder at one point or another." But when he would interview these children and their parents, the story was nearly always the same, that the children were highly irritable, going from "zero to 60" in two seconds. Although this is a popular conception of bipolar disorder, it is a MISCONCEPTION. I even hear "bipolar" used as an insult to describe irritable people, adults and children. However, Bipolar II Disorder involves a complex and rare set of symptoms that do not resemble extreme, easy irritability in any way (please see the article for details of what real bipolar disorder looks like). Why were physicians and therapists who knew better misdiagnosing this? When I encounter the common misdiagnosis of bipolar disorder, the explanation is always the same: the doctor or therapist either didn't take an adequate history, or wasn't even listening.
Dr. Chung notes that the expanding diagnosis of bipolar disorder in children led to a massive increase in children taking heavy-duty mood stabilizers and antipsychotics. These things have side effects. Were they necessary?
In the article, the author presents evidence that among these children who had symptoms of easy irritability ("zero to 60 in two seconds"), only 1% had the usual symptoms of bipolar disorder (type I or II--it is also not well-known that there are two types, each quite different and both rare). And when children diagnosed with bipolar disorder in childhood grew up (the article cites several studies, including a 20-year study), they did not display signs of bipolar disorder, but rather anxiety and depressive disorders. It doesn't fit.
The author, Dr. Chung, concludes: "the question is resolved--the consensus is that chronic irritability, no matter how severe, is not sufficient for a diagnosis of bipolar disorder." He goes on to say that "the episodic nature" of real bipolar disorder would mean that irritability would go up and down with the manic and depressive states. The author concludes that the children were simply exhibiting traits characteristic of children who are exhibiting the early traits of depression or anxiety.
Again, you can read the full article at the bottom of this blog entry, and skip the next section if you wish.
When "anxiety" and "depression" are something more: My opinion, if you want to keep reading.
One thing I have noted is that adults who come to me reporting anxiety or depression rarely have anxiety for "no reason" or were "born" with an anxiety or depressive disorder. I am not talking about when someone has recently experienced something that would make anyone anxious or depressed. 9 times out of 10, someone who comes to me with years of depression or anxiety has one or more traumatic events in their past that have resulted in anxiety and depression, and a diagnosis of a trauma disorder is much more appropriate.
Many therapists and physicians do not ask "what has happened to you?" but rather "what is wrong with you?" This second question, "what is wrong with you," beyond being a demeaning label, focuses only on present symptoms, and not their origin. So many clients, until they come to see me, talk to me, and take research-validated testing with me, do not realize the effects that traumatic events have had on their lives.
Trauma disorders are curable. You don't have to "cope," as non-trauma-informed therapists tell you to do. It can go away. If I were making a false claim in stating this, I would be out of business, because it's about 80% of what I do with my day. You also don't have to take medications that don't work, or that just numb you out, so you can "cope," as though taking a Xanax when you have a panic attack is "coping."
Trauma disorders are curable, and the cure does not involve re-living trauma or having "heavy" sessions that leave you exhausted. Effective trauma treatment is nothing like this. There are several highly effective trauma treatments, all of which I respect, and EMDR is one of the most effective and most painless. I am EMDRIA Approved Certified Consultant, and spent a number of years training in this therapy, and how to teach it to others. Spend some time on my blog researching EMDR trauma therapy.