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Diagnoses of bipolar disorder in children and teenagers are growing, but experts disagree on the reasons.

Although bipolar disorder is usually diagnosed in early adulthood, it can appear in children and teens. And the incidence seems to be increasing — a 2007 study in the Archives of General Psychiatry showed a 40-fold increase in the number of children treated for bipolar disorder between 1994 and 2003. “We’re seeing it much more in kids and adolescents than in the past,” says Roy Boorady, MD, a bipolar expert at the New York University Child Study Center and assistant professor of adolescent and childhood psychiatry at NYU School of Medicine. The reasons for the increase aren’t known; some experts attribute it to overly aggressive diagnosis, while others believe the increase reflects increasing awareness and more knowledge about the disorder in children. “It was once believed that bipolar only developed later in life, but now we know that’s not the case,” says Michael First, MD, a professor of clinical psychiatry at Columbia University and editor of the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association’s diagnostic guidelines.

Bipolar Children: Making the Diagnosis
Diagnosing bipolar disorder in children and teens is not always easy, partly because mania and depression symptoms look different in youngsters than in adults. While adults tend to be elated or euphoric during manic episodes, bipolar children and teens are likely to be irritable and prone to extreme temper tantrums and destructive outbursts during manic periods. When depressed, youngsters may have physical complaints like headaches, muscle aches, stomachaches or tiredness. Additionally, many bipolar children change frequently between mania and depression, sometimes several times in the same day. “Adults with bipolar can have periods in between the mania and depression of looking pretty normal, but with kids the transition between episodes is much more rapid, and it’s often all mixed together,” says Dr. Boorady.

Symptoms of bipolar in kids and teens can vary by individual, but the following red flags are common:

• Frequent irritability
• Violent temper tantrums
• Constant complaining
• Unexplained crying
• Headaches, muscle aches, stomachaches, or fatigue
• Extreme sensitivity to rejection or criticism
• Talk of running away from home
• Alcohol or substance abuse (in teens)
• Preoccupation with death or suicide

Is It Bipolar Disorder or ADD/ADHD?
Many bipolar children also have attention deficit disorder (ADD) or attention-deficit hyperactivity disorder (ADHD), further complicating the diagnosis. “ADHD can develop as early as age 4, while bipolar usually doesn’t develop until age 10 or later,” says Boorady. One problem is that medications used to treat ADD/ADHD are stimulants, which can worsen mania in children with bipolar disorder. Family history is often helpful in distinguishing between the two conditions, since a child has a greater risk of developing bipolar disorder if a close family member (parent, brother, sister, or grandparent) is bipolar.

Bipolar Children: Getting Help
Because diagnosing bipolar disorder in youngsters is so complex, it’s best to get a referral to a child and adolescent psychiatrist for evaluation and appropriatetreatment. A number of medications can be helpful in managing the disorder. It’s not yet known whether children with bipolar disorder will grow into bipolar adults. However, studies show that the earlier treatment is started, the better the long-term prognosis. Psychotherapy, lifestyle changes, and support groups can also be helpful. “Support groups help kids realize that they’re not alone and also give families practical tips for coping with the disorder from other parents dealing with the same thing,” says Dr. First. The Web site of the Child & Adolescent Bipolar Foundation lists a number of support groups for kids and teens with bipolar disorder, as well as the Depression and Bipolar Support Alliance and the National Alliance for Mental Illness.

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Bipolar disorder in one family member can disrupt life for everyone, but getting outside support and working together to meet challenges as a family can help.

Sheila Rosmarin*, 57, a New Jersey mom, wasn’t totally surprised when her son Brandon* was diagnosed with bipolar disorder at age 24. “He’d had temper tantrums as a toddler and bouts of adolescent anger that were way more intense than normal,” Rosmarin says. “He was diagnosed with ADD [attention deficit disorder] just before he went to college, and struggled so much living away from home.”

At the time the diagnosis was made — as it so frequently is, in young adulthood — the medication Brandon began taking was helpful. Soon, although he hadn’t completed his degree, Brandon decided to move to Florida, get a job, and re-establish his independence. For a while, Brandon seemed to thrive. “Then in April 2007, he wouldn’t answer our calls, and his friends let us know he wasn’t doing well,” Rosmarin recounts. “So I left my job temporarily and we went down to Florida to find him. I was making deals with God the whole way.”

His parents did find Brandon, and after a two-hour screaming match, “he finally admitted that he wasn’t taking his medication,” Rosmarin says. “That day, if you’d said eighteen months later I’d been telling you this as a success story, I never would have believed you.”

Brandon agreed to move back home, began working in the family business, and with the help of his parents, psychiatrist, therapist, and support groups, “is doing so well that as often as I ask him if he’s taken his medication — which he does, unfailingly — he asks me if I’ve taken my high blood pressure medication,” says Rosmarin. She adds wryly, “It’s no coincidence that I’ve had to begin taking [that medication] in the last year.”

Bipolar Disorder and Families: The Bipolar Parent

It’s also difficult to be the child of a bipolar parent — even in adulthood. Bill DiSalvo* of Long Island, New York, knows this well. He says that he is one of four adult children of a mother who developed full-blown bipolar disorder 23 years ago at age 64, although Bill recalls that she did show signs of milder mood swingsearlier in life.

DiSalvo’s mother will sometimes throw away her medication, and her disorder is not well-controlled. Her manic states (when, DiSalvo says, “she gives money away and is very abrasive and obnoxious”) and severe depressions are a constant topic of family discussion.

Bipolar Disorder and Families: Finding Support

For a family, having a member with bipolar disorder can be truly traumatic, says Joyce Burland, Ph.D., national director of the Education, Training, and Peer Support Center of the National Alliance on Mental Illness (NAMI). To best cope with the impact on the family, Burland suggests these strategies:

• Realize that a first response of denial is natural. “It’s protective,” says Burland, “but you can’t let it inhibit proactive planning.”
• Put together a team. “Imagine that your family member had cancer or diabetes instead of bipolar disorder,” Burland states, “and do what you’d do in that case: Get as much education as you can, as quickly as you can. Find a doctor you and the person with bipolar disorder can trust.”
• Discard the myths. “We all absorb some misconceptions about mental illness, that if the person just tried a little harder, he could beat it. You wouldn’t say that if he had, say, leukemia,” Burland points out. In addition, “family members must realize it’s common for people with mental illness to suffer from anosognosia — not recognizing their own illness.”
• Enter family therapy, as long as “the therapist understands the family is not to be blamed in any way,” Burland says.
• Parents often don’t want to feel controlled by their kids, just as, “young-adult bipolar children often don’t trust their parents,” Burland points out. In a marriage, however, when there is one bipolar spouse, “hopefully the trust is there,” Burland says. “You can say to your partner, ‘I know you don’t want to get into treatment, but do it for your job, our financial security, the kids. And the sooner you start, the better.'”

Talking to other people who also have family members with bipolar disorder and are already familiar with the ups and downs can be invaluable, Burland says. On the other hand, “my two dearest friends in the world don’t know 90 percent of what’s gone on with Brandon,” Rosmarin confesses.” You just never know how other people are going to react.”

* Names have been changed.

Many brain disorders bring with them built-in limits. Bipolar disorders do not. Some would even argue that they may equip the affected person with certain strengths: a high energy level, strong verbal skills, sometimes an especially creative way of looking at the world and solving problems. All parents hope that their adult children will find a way to use their special talents, and for people with bipolar disorders, these talents can help make up for the down side of their illness.

Encourage the good sides that you see. There’s nothing wrong with your child having a bunch of instant energy. They can take things that they really like and obsess on them, and maybe turn them into their careers. I think I’m a more creative person [because of this disorder]… sometimes, anyway.

—Carmen, age 17

As you consider helping your child to move from dependency to independence, know that he has many strengths to build a good future on. During this period, as it has been throughout your child’s life, your goal should be to help him internalize personal rules and habits that will continue to keep him safe, sober, and level for life.

Parents share their hopes

Following are five parents’ responses to the question, “What are your hopes for your child?”

I hope that he does not have to suffer the severe psychic pain of full-blown bipolar disorder. I hope he will be able to develop his talents and strengths and contribute to the world while enjoying life.

—Marlene, mother of 8-year-old Billy (diagnosed cyclothymic disorder)

My main hope is that one day she’ll be able to live on her own. As it is right now, I’m not certain that will happen. She’s still afraid to be by herself for any length of time.

—Donna, mother of 16-year-old Lisa (diagnosed bipolar II disorder, post-traumatic stress disorder, anxiety disorder)

I hope that she will be as successful as I have been. That she will eventually be able to self-regulate so she can marry and have children. I hope she will be a happy, loving wife and mother, and an adult friend to me.

—Stephanie, mother of 7-year-old Cassidy (diagnosed bipolar disorder, Tourette syndrome, OCD, ADHD)

I want her to get a handle on her mental health before she’s in her thirties, like I was. I hope for her to be able to apply her many artistic talents (art, music, etc.) as part of her career.

—Sue, mother of 16-year-old Vanessa (diagnosed bipolar disorder, OCD,borderline personality disorder, passive-aggressive personality disorder)

I hope that he can go to college, get a good job, live independently, marry, and stay stable and happy.

—Lynn, mother of 11-year-old Michael (diagnosed bipolar I disorder with mixed states and psychosis, OCD, tic disorder)

Dream for your child with bipolar disorder, just as you would for any child. Ground your dreams in reality as you must—for a child with severe symptoms, good health and safety are enough to want for now. But keep at least a little dream about a productive and happy life for your adult child alive, no matter what. Patients, their families, and the medical profession are learning so much that we all have reason to hope.

Are the highs and lows of a loved one’s bipolar disorder bringing you down? Here’s an expert’s advice on how to stay strong — physically and psychologically.

While caring for someone with bipolar disorder is often a labor of love, it is also (understandably) exhausting and disruptive, and chances are that much of what you do on a day-to-day basis goes overlooked and unnoticed.

Though you’re not in it for the applause or the accolades, occasionally you need a little TLC, when the focus is firmly on you for a change. Think of it this way: On an airplane, you’re instructed to put the oxygen mask on yourself first — before your child. That’s because if you pass out, how can you possibly be of help? The same case can be made when taking care of a bipolar loved one. Since you’re the support provider, you have to stay strong — both mentally and physically.

Everyday Health’s Emotional Health expert Ruth Wolever, PhD, clinical health psychologist and research director at the Duke Center for Integrative Medicine, Duke University School of Medicine, has some useful tips on how to make your own health a priority.

1. Get adequate rest and sleep.Sounds like a no-brainer — but it’s easy to put your own basic needs aside and not even realize you’re headed for burnout. Getting enough sleep is essential for the healthy functioning of every system in your body.
2. Exercise — even if it’s minimal. “Just a 10-minute walk — but on an almost-daily basis — is hugely important,” says Dr. Wolever. Besides keeping you fit, exercise is also a great stress buster.
3. Eat nourishing foods. Staying physically healthy is particularly critical when you’re a caregiver, and a healthful diet is key to this effort. Keep in mind that an overreliance on caffeine, processed foods, and sugar will increase your own mood swings and leave you feeling even more stressed.
4. Take some moments for yourself. “Having some private time is really, really important,” says Wolever. You’ll need to plan ahead so you can participate in outside activities that you enjoy (a book group, sports event, dinner with a friend). In addition, try to carve a few minutes out of each day to concentrate on something you enjoy — this can be remarkably restorative, Wolever notes.
5. Understand the negative emotions. Guilt, resentment, and anger are normal parts of the caregiving process, but that’s not always easy to acknowledge. When you find yourself harboring these feelings, consider this to be a red flag signaling that you need to take a step back and think about what’s really going on. Remember, your loved one’s irritability and mood swings are due to a chemical imbalance and aren’t necessarily intentional or aimed at you personally — so don’t be so quick to make assumptions about the reasons behind his or her behavior. Learning as much as possible about bipolar disorder can also help.
6. Validate your efforts. Your loved one with bipolar disorder may not be in a position to express gratitude to you, but don’t forget to give yourself a pat on the back from time to time. Take a moment to appreciate your efforts and how they’re paying off — for example, you may consider your efforts successful if the person you’re caring for is getting up in the morning, going to work, or developing friendships.
7. Find support. Difficult situations can seem so much worse when you think you’re alone, so connecting with others in similar circumstances — for example, in a structured support group — can help provide some needed perspective. (All-out gripe sessions, though, aren’t necessarily useful.) “You want to find people who understand and whose outlook you also value,” says Wolever. You may also want to seek out some professional help for yourself if you feel overwhelmed.
8. Laugh it off. Try to find humor in your circumstances. While this may sometimes be difficult, lightening up a tough situation with laughter is one of the world’s oldest and best coping mechanisms. A joke can help defuse a tense moment and nudge a potentially difficult situation in a different, happier direction.
9. Conserve energy. Because you may already be expending a good amount of your energy dealing with a loved one’s mania, you may not have much left over — so adjust your expectations accordingly. It is probably more useful in the long run to go to bed on time, for example, than to have all the dishes washed and the kitchen picked up perfectly every night.
10. Make a mission statement. According to Wolever, it’s important for caregivers to think about a mission statement for themselves — in other words, what do you want from your life? Taking care of a loved one with bipolar disorder might be a really important part of that mission, but there are likely to be other objectives as well. When you have a clear idea of your own goals and desires, you’ll be better able to prioritize all the demands on your time and know when to say no.

Coping with feeling overwhelmed while in recovery from posttraumatic stress disorder (PTSD) can be challenging. I know when I become overwhelmed with anything–emotional, physical, or mental–I am likely to just want to shut down and avoid life. My anxiety kicks in and it feels like everything is out of control, moving too fast, and I become irritable, whiny, and tired. Sometimes when that happens, I absolutely need a full-stop (a nap or a good night’s sleep) to recharge and feel better. But more often, I’m able to use coping skills that I have learned in PTSD recovery to deal with feeling overwhelmed (What’s Your PTSD Recovery Program?).

Why Does PTSD Make You Feel Overwhelmed?

First and foremost, PTSD is an anxiety disorder, and anxiety and stress often cause feelings of being overwhelmed. It may feel like there is just too much to do, too much you haven’t accomplished, or too many other people in your life who need your time and attention. For me, it’s a feeling of being out of control and not knowing where to start to make things better. I become apt to just freeze or distract myself with something that allows me to escape the feelings. These are not healthy or productive ways of handling it, I know.

I recently read a great description of how it feels to be overwhelmed due to PTSD: It’s like waking up in the morning with your stress bucket already almost full, and adding anything else will cause it to overflow.

I’m paraphrasing, but you get the idea. I know that feeling. In fact, I have said many times, “If one more thing happens, I don’t know what I’ll do,” or “I just can’t handle anything more,” when I am feeling overwhelmed.

The truth is: I usually can handle it when I recognize that what I am feeling is manageable and I use one or more of the PTSD coping skills I have learned.

What to Do When You Feel Overwhelmed in PTSD Recovery

These are the things that work for me when I feel overwhelmed:

• Caring for myself– Many times, self-care is the thing that helps me the most. When I realize that I am feeling anxious and overwhelmed, I have to do what it is necessary to take care of myself. It may be a nap, doing something that I enjoy, or, if possible, removing myself from whatever the stressful situation is.
• Saying “no” – I often have a hard time saying “no” to things, even when I know I am going to feel overwhelmed by saying “yes.” However, when I do actually say “no” (nicely, of course) I feel better, and a little bit empowered.
• Journaling – Writing is my go-to anxiety reliever. Many times, just the simple act ofputting my feelings on paper is enough to lessen my stress and anxiety. It’s no different when I am having overwhelming feelings. Even if I don’t discuss my feelings with anyone, writing gets them out of my head.
• Praying or meditating – When I take the time to pray or meditate, it’s like a resetting of my anxiety clock. If I am able to give up my overwhelming feelings to God, or breathe in faith and breathe out fear through meditation, I always feel better.
• Making lists – For some people lists are anxiety-provoking, so if you are one of those people, don’t do this. For me, lists usually help me to see that when things are written down instead of swirling around in my head, there is order and it’s not nearly as bad as my what my brain would lead me to believe. Also, the act of crossing things off of my listslessens my anxiety with every check mark.
• Asking for help – I do still have trouble with this sometimes, but I have gotten better about asking those close to me for help in lightening my load when I’m overwhelmed. I have found my loved ones are willing to help me when I ask; they don’t like it when I’m anxious anymore than I do.

Life gets stressful and everyone feels overwhelmed at times, but for those of us who have PTSD, it’s important to find things to help with that feeling so that we don’t spiral into feeling completely out of control. Finding the things that offer you relaxation and comfort when you’re not feeling overwhelmed will give you a good idea of what might work for you when you are. Give some a try and see how you do.

Bipolar Disorder: Key Facts

What is bipolar disorder?Bipolar disorder is a condition in which your mood can swing very high, or very low, for weeks or months. It used to be called Manic Depression.

Your mood can be:

• low with intense depression and despair
• high or ‘manic’ with elation, over-activity or anger
• a ‘mixed state’ with symptoms of depression and mania.

Bipolar disorder is less common than depression. It affects about 1 person in a 100.

What causes bipolar disorder?

• It seems to run in families, so genes are involved. Genetic causes are less common in the elderly.
• There may be a physical problem with the brain systems which control mood.
• Stress can trigger episodes.

How does it feel to have bipolar disorder?

In a severe mood swing, you can have psychotic symptoms.

• When depressed, you may believe that you are evil or guilty, that you are worse than anybody else, or even that you don’t exist.
• When manic, you may feel that you are on an important mission or that you have special powers and abilities.
• You might also experience hallucinations – when you hear or see something that isn’t there.

Treatment

• Treating a high: lithium, antipsychotics and sodium valproate are the medications most commonly used. Sodium valproate should not be prescribed to women of child-bearing age.
• Treating depression: antidepressants should be used carefully as they can make people go high. It’s best to stop them as soon as the depression goes away.
• Psychological treatments: these can also help. Methods include:
  • psycho-education: learning about the condition and how to control it
  • mood monitoring: you learn to notice when your mood is starting to change
  • Cognitive Behavioural Therapy (CBT) to prevent a full blown manic or depressive episode.

Self help

• Learn to spot the early warning signs so you can get help early.
• Find out as much as you can about bipolar disorder.
• Be aware of how stress affects you.
• Have at least one person that you can rely on and confide in – someone who can warn you if you think you are not well.
• Balance your life and work, leisure, and relationships.
• Do things that you enjoy and that give your life meaning.
• Don’t stop medication suddenly.
• You may find it useful to keep a diary to record your daily mood.
• You may want to write an ‘advance directive’ with your doctor and family to say how you want to be treated if you become unwell again.
• Try to eat a healthy diet and to sleep well.
• If you drink alcohol, stick to the safe limits.

Helping someone else

• When someone is depressed, it can be difficult to know what to say. They see everything in a negative light. Listen and try to be patient and understanding.
• During mania, the person will appear to be happy, energetic and outgoing. But the excitement of any social situations will risk sending their mood even higher and their doing things that are out of character for them. Try to steer them away from parties or heated discussions. Persuade them to get help.
• In between mood episodes, find out more about the condition. Go to appointments with them (if they are willing). Make sure you give yourself space and time to recharge your batteries.

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