Bipolar Disorder in Adolescence

The manifestations of bipolar disorder in adolescence are usually more severe than those in adults. Consequently, the deterioration is greater.
Bipolar Disorder in Adolescence

Last update: 13 November, 2022

Bipolar disorder is a serious mental disorder (SMD). There are 300 mental disorders listed in the DSM V. SMI (serious mental illnesses) is a small subset of these conditions. It includes schizophrenia, bipolar disorder, and borderline personality disorder.

Diagnosing and intervening in bipolar disorder in adolescence requires a great deal of clinical expertise. Fortunately, the rate at which studies are being conducted in this field is good. Moreover, the quality of training received by professionals who want to specialize in the area is also of a high standard.

However, a controversy exists regarding the definition of the central characteristics of this disorder in children and adolescents. In fact, the search for consensus and effective intervention guidelines are the subjects of current research.

troubled teen
Bipolar disorder in adolescence has a worse prognosis.

Understanding bipolar disorder

The American Psychological Association (APA) states that bipolar disorder occurs when there’s an episode of mania or mixed symptoms (with or without a history of depressive episodes). It also happens when a depressive episode is accompanied by at least one hypomanic episode. So, what’s a manic episode? The APA claims it must meet the following criteria:

  • Unusually elevated mood.
  • Lasts at least one week.
  • Demonstration of exaggerated self-esteem that can be described as grandiose. Also, a marked decrease in the need for sleep; pressured speech characterized by rapid, compulsive talking; fleeting ideas and motor agitation; and engaging in pleasurable activities with serious consequences.

The mixed episode is characterized, according to the World Health Organization (WHO), by a mixture or rapid alternation of manic and depressive symptoms. These cycles occur most days for at least two weeks. As a rule, in mania, the opposite symptoms appear to those that occur in depression. That said, there are two exceptions: both mania and depression share symptoms such as sleep problems or appetite disorders.

“I long ago abandoned the notion of a life without storms… And I am, by nature, too mercurial to be anything but deeply wary of the grave unnaturalness involved in any attempt to exert too much control over essentially uncontrollable forces.”-Kay Redfield Jamison-

Bipolar disorder in adolescence

The psychologist, Stanley Hall claimed that adolescence is a “time of storm and stress”. Indeed, in itself, adolescence poses challenges. Bipolar disorder not only poses new problems but can complicate existing issues.

In the adolescent population, bipolar disorder can appear in the form of affective storms in which tantrums are longer and more intense. Moreover, in this population, it’s more common to find irritability as opposed to euphoria.

Joan Luby, a psychiatrist at the University of Washington (USA) described a series of behavioral patterns characteristic of bipolar disorder in these populations:

  • Hypersexual behaviors. These may consist of touching others or even masturbation in inappropriate places.
  • Elation. A state of heightened joy, exaggerated optimism, and restless excitement.
  • Grandiosity. Sufferers don’t recognize authority, are extremely defiant, socially disinhibited, and don’t measure the risks of their actions or the consequences they entail.

Adolescent bipolar disorder is usually diagnosed uniformly in boys and girls between the ages of 13 and 18,  Normally, it occurs without warning, and there are no advance clues to its onset.

Differences between adolescent and adult bipolar disorder

The way adolescent-onset bipolar disorder progresses compared to that of adults can differ in several respects.

  • They have a higher rate of rapid or ultra-rapid cycling. Rapid cycling is considered to be when there are at least four manic or depressive episodes in 12 months. In adolescents, the changes can be really sudden and even occur on the same day.
  • They experience a greater number of psychotic symptoms. These are mainly auditory hallucinations.
  • The prognosis is worse. That’s because there’s thought to be a greater neurobiological alteration.
  • The recovery after each episode is worse. In periods when they’re free of manic or depressive symptoms their symptoms are worse than those of adults.
  • It’s a disorder with high heritability. Often, sufferers have relatives who also suffer from the disorder.
  • Suicidal ideation is higher compared to adult bipolar and death plans tend to be more structured.
  • Adolescent bipolar usually begins with a depressive episode that leads to a manic episode. This is contrary to what happens in adults.

Poor prognostic factors

Different factors have been isolated that, when they appear, worsen the prognosis and the course of bipolar. For example, a lack of maternal affection produces a faster development of relapses.

“Bipolarity robs you of that which is you.”

-Alyssa Reyans-

Family history of mood disorders also plays a role, since, as we mentioned earlier, it’s believed that adolescent bipolar is extremely sensitive to genetic influence. Low socioeconomic status is also a factor that hinders the improvement of minors, as well as the appearance of symptoms that may be resistant to treatment.

Dysfunctional family interactions also play a key role. Adolescent bipolar has also, in some cases, been linked to traumatic events such as sexual abuse in early childhood.

Teenage girl with mental problems
The cycles in adolescents with bipolar disorder occur more rapidly than in adults.

Treatment

Interventions aimed at adolescent bipolar disorder approach the condition from different battle fronts: pharmacological, psychological, and psychosocial. The most commonly used drugs are lithium and antiepileptic drugs with mood-stabilizing properties, such as valproic acid, or antipsychotics.

Psychological interventions seek to promote knowledge of the disease and improve the management of both manic and depressive symptoms. They also provide coping skills that allow adolescents and their families to combat bipolar and improve their social and family relationships.

Among the most outstanding interventions are psychoeducation, interpersonal and social rhythm psychotherapy, dialectical behavior therapy, and family therapy.

“Though I am often in the depths of misery, there is still calmness, pure harmony and music within me.”

-Vincent Van Gogh-

Some authors claim that adolescent bipolar is overdiagnosed. In other words, there are more adolescents labeled with the disorder than there should be. In fact, it’s currently believed that adolescent bipolar accounts for up to 15 percent of affective disorders in childhood and adolescence. However, more research is necessary to produce new lines of scientific evidence in this regard.

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