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Bipolar children can have anger and rage episodes lasting several hours. What can be done to control these episodes?
All kids get angry and upset from time to time, but bipolar children can have severe episodes of anger, irritability, and hostile behavior. Unlike other children, bipolar children aren’t usually able to manage their anger with timeouts and other disciplinary measures. “Fortunately, treatments and therapies are available to help bipolar children deal with their anger,” says David Fassler, MD, clinical professor of psychiatry at the University of Vermont College of Medicine in Burlington, Vt., and author of Help Me, I’m Sad: Recognizing, Treating and Preventing Childhood Depression.
Bipolar Disorder: Why Do Bipolar Children Struggle with Anger?
Anger is more common in people with bipolar disorder than in those suffering from general depression, and bipolar children tend to feel anger more intensely than adults with bipolar disorder. “When bipolar children have manic episodes, they’re more likely to feel anger and rage than the elation or euphoria that is common in adults,” says Dr. Fassler. What’s more, bipolar children don’t yet have the skills and emotional maturity to handle their anger outbursts.
While the cause of bipolar disorder is not well understood, it’s thought that chemistry imbalances in the brain play a major role in the condition. Anger in bipolar children is often triggered by stress, but it’s unknown exactly why so many bipolar children have anger issues. “It’s known that bipolar children and teens have more rapid mood changes than adults with bipolar disorder,” says Fassler. These mood changes often manifest themselves as anger episodes.
Bipolar Disorder: What Anger in Bipolar Children Looks Like
Anger in bipolar children can appear as extreme temper tantrums involving verbal and physical aggression. Children with bipolar disorder may physically attack playmates or family members, destroy their favorite toys or siblings’ toys, kick, spit, cry, and scream. It’s common for bipolar children to become extremely upset when they are disciplined or told “no.” These temper tantrums can turn into rages lasting for hours. Bipolar children are often intentionally “dare-devilish” and tend to be risk-takers, which may bring injury to themselves or others. In addition to severe anger episodes, irritability is common in bipolar children, especially when first waking up in the morning.
Bipolar Disorder: Anger in Bipolar Children vs. ADHD Children
Bipolar disorder is sometimes misdiagnosed as attention deficit hyperactivity disorder (ADHD) because the illnesses have some similar behavior characteristics, including irritability and hyperactivity. But anger in bipolar children tends to be much more severe. “ADHD kids calm down in 20 to 30 minutes,” says Fassler. Anger in bipolar children typically goes on much longer.
While ADHD kids may break toys and destroy things carelessly due to their hyperactive behavior, bipolar children do so in anger. Bipolar children also react much more violently and aggressively to parental limit-setting and may conflict with authority figures. And while an ADHD child may stumble into a fight, bipolar children are more likely to enjoy danger, seek it out, and look for a fight.
Bipolar Disorder: Treating Anger in Bipolar Children
Children exhibiting extreme anger outbursts should be evaluated by a child psychiatrist or behavioral pediatrician experienced in working with bipolar children. “It’s important to get an accurate diagnosis before initiating a treatment plan,” says Fassler.
Medication may be the first intervention recommended. Medicines can help restore the chemicals in the brain to a more normal level. This means that the bipolar child is less likely to be flooded with brain chemicals that cause anger outbursts. Family-focused therapy and individual psychotherapy tailored for children can also help bipolar children control anger outbursts. “These therapies help bipolar children tolerate frustration and express angry thoughts and feelings in ways are less disruptive and destructive,” says Fassler. Additionally, family therapy sessions teach parents how to implement techniques at home that can reinforce positive behavior and reduce the frequency of angry outbursts in bipolar children.
There is currently no cure for bipolar disorder, but a combination of medicine and psychotherapy can help reduce the frequency of anger episodes and help bipolar children learn to better manage their anger and disruptive behavior.