Bipolar Disorder in Children is Rare. What If It’s Something Else?

Randy Withers

By Randy Withers. Previously published on Blunt Therapy.

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Graphic by Randy Withers from Canva.

Can children have Bipolar Disorder? Ever since the days of Hippocrates, frustrated parents have been asking variations of that question. The fact is, Bipolar Disorder in children is quite rare. Though try telling that to parents who are convinced otherwise.

Bipolar Disorder has been called many things over the years.

It probably started with the word “Melancholy,” which derives itself from Ancient Greek. Back then, the term was used to describe mood shifts and depression and related mental disorders.

In the 19th century, the French called it “La Folie Circulaire,” which translates to “circular insanity.”

In the 20th century we called it “Manic-Depressive Disorder.” Over years the term morphed into “Bipolar Disorder” Types 1 and 2, along with “Cyclothymia,” which is its long term, low-grade cousin.

Like the Devil, it has gone by many names.

It’s not a good idea to apply such labels to children, but inexperienced therapists and even medical doctors do it all the time.

The truth is Bipolar Disorder is far more likely to develop in adulthood, and there’s way more to it than mood swings and foul tempers.

It is serious. It is debilitating. And it is often misdiagnosed.

Children don’t have as firm a grasp on their emotions as do their adult counterparts, and that’s one of several reasons why so many children present as emotionally unstable.

Consider a typical two-year-old. They are giggling one minute, sobbing hysterically the next. But the mood swings you see in a two-year-old are usually normal and perhaps even necessary for proper development.

But what if they’re still struggling with these issues when they are 7? Or 10? Or 12? Is that the same thing?

Let’s look at a diagnosis that might be more accurate. And appropriate for their age.

Disruptive Mood Dysregulation Disorder

In 2013, The American Psychiatric Association (APA) revised its mental health Bible and added several “new” disorders, some fraught with controversy. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as it is called is what clinicians use to assess and diagnose clients with mental health, developmental, and substance abuse disorders.

Bipolar Disorder is in there, a serious diagnosis usually reserved for adults.

This doesn’t mean that kids don’t present with behaviors associated with Bipolar Disorder in children. However, it should mean that clinicians use a diagnose that is more appropriate for kids.

Enter Disruptive Mood Dysregulation Disorder.

If there is such a thing as a “hot” new diagnosis in mental health, it is Disruptive Mood Dysregulation Disorder (DMDD). While classified (incorrectly, I believe) as a “Depressive Disorder,” DMDD is basically Bipolar Disorder in children.

While nobody likes to place labels on kids, the emergence of DMDD as a recognized disorder allows clinicians to provide appropriate treatment for kids who have repeated tantrums, verbal and/or physical aggression, and a persistent angry or irritable mood.

This is not Bipolar Disorder. It may look like Bipolar Disorder, but there are key differences that separate the two.

How DMDD Is Different From Bipolar Disorder In Children

Several key features distinguish DMDD from Bipolar Disorder in children. Bipolar can be a lifelong affliction and is episodic in nature. DMDD is persistent but does not manifest with severe mania (i.e., incredible energy, sleeplessness).

Take a look at the differences between the two.

Symptoms of Bipolar Disorder

  • A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
  • During the period of mood disturbance and increased energy or activity, 3 (or more) of the following symptoms (4 if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
  • Inflated self-esteem and grandiosity; Decreased need for sleep; More talkative than usual; Flight of ideas or racing thoughts; Distractibility; Increase in goal-directed activity; Excessive involvement in risky activities (e.g. overspending, sexual activity)
  • The depressive aspect of bipolar disorder is characterized by a major depressive episode that results in depressed mood or loss of interest or pleasure in life. A person must experience five or more of the following symptoms in two weeks to be diagnosed with a major depressive episode
  • Depressed mood most of the day, nearly every day; Loss of interest or pleasure in all, or almost all, activities; Significant weight loss or decrease or increase in appetite; Engaging in purposeless movements, such as pacing the room; Fatigue or loss of energy; Feelings of worthlessness or guilt; Diminished ability to think or concentrate, or indecisiveness; Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt
  • The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Symptoms of Disruptive Mood Dysregulation Disorder

  • Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation
  • The temper outbursts are inconsistent with developmental level (e.g., the child is older than you would expect to be having a temper tantrum)
  • The temper outbursts occur, on average, three or more times per week.
  • The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, friends)
  • The above criteria have been present for 1 year or more, without a relief period of longer than 3 months. The above criteria must also be present in two or more settings (e.g., at home and school), and are severe in at least one of these settings.
  • The diagnosis should not be made for the first time before age 6 years or after age 18. The age of onset of these symptoms must be before 10 years old

*Courtesy, DSM5 and American Psychiatric Association

As you can see, the two disorders are quite different. Furthermore, you might have noticed that “mood swings” are NOT characteristic of bipolar disorder. They are, however, a feature of DMDD.

Bipolar often leads to psychosis (delusions, hallucinations); DMDD does not. Grandiose thinking and elevated mood are typical with Bipolar; these symptoms are not present with DMDD. Severe tantrums are a feature of DMDD; this feature is absent from Bipolar Disorder in children.

In reality, bipolar disorder almost never afflicts people under 18 years of age. If your child demonstrates severe emotional and behavioral challenges, they may very well be struggling with DMDD.

Conclusion

Bipolar disorder in children is rare. The symptoms you see are far more likely to be the result of Disruptive Mood Dysregulation Disorder. If you suspect that your child suffers from DMDD, enlist the services of a licensed clinician who specializes in the diagnosis and treatment of children and adolescents.

Your regular primary care physician is often not qualified to do this. You need to see a specialist.

Anyone can Google the diagnostic criteria for any known mental illness, but it takes a trained clinician to confirm the existence of an actual disorder. Humans are not just a collection of symptoms.

Children are not adults. This is especially true when it comes to mental health diagnoses. Children are still navigating various developmental stages and learning how to regulate their moods and emotions in ways that are appropriate for their age.

Tantrums in children are to be expected, but a pattern of severe tantrums is a cause for concern. DMDD at least gives a name to a condition that many parents and clinicians already know exists and it provides a criterion-based framework for proper diagnosis and treatment.

References

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Board-Certified and Licensed Clinical Mental Health Counselor and Addictions Specialist. I write about mental health, therapy, substance abuse, and recovery. All opinions are my own.

Charlotte, NC
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