Parenting Guide – Teens and Bipolar

What is Bipolar?

Bipolar disorder is a mental health disorder characterized by dramatic or abnormal mood changes (or swings). The estimated number of teenagers with bipolar disorder is currently 2-3%. The mood changes typically fluctuate between major depression and extreme elation, or mania. The mood swings can be anywhere from mild to extreme and can change very quickly, or emerge in a slower, more progressive manner.

The onset of bipolar disorder is usually between the ages of 15 and 30, and is more prevalent in individuals who have a family history of mood disorders or psychiatric diagnoses.

Symptoms in Teens with Bipolar

Although there are some similar symptoms across the board when it comes to bipolar, it is important to distinguish between the two subtypes – bipolar I and bipolar II, when looking at how teens may present. Additionally, there are several other nuanced types of bipolar your teen may also be diagnosed with.

Bipolar I

Bipolar I is known is often the more obvious subtype of bipolar, as this is where the teenager alternates between extreme states of depression and intense mania. With the mania, the teen might be abnormally joyful and appear to have lots of energy.  This heightened state of energy can often mean he or she is extremely talkative and less likely to need sleep.  Within the mania phase of Bipolar I, the teenager may also experience hallucinations and/or delusions.

• Hallucinations – your teen may have either visual or auditory hallucinations (or both).
• Delusions – teens with bipolar I sometimes have delusions, meaning strong beliefs in things not based in reality.

Bipolar I typically persists throughout a person’s lifetime.

Bipolar II

A teen with bipolar II still experiences the depressive state, but the period of mania looks quite different.  A teen with bipolar II will instead go through times of “hypomania,” which is a less intense form of what is experienced in bipolar I. While hypomania is a milder version of mania, it is still marked by elation and hyperactivity.  In between periods of depression and hypomania, many with bipolar II live fairly normal lives.  Teens diagnosed with bipolar II have had at least one hypomanic episode in his or her life.

Because teenagers experience both manic and depressive episodes whether they have bipolar I or bipolar II, there are some commonalities when it comes to symptoms and things to look out for.

During a manic (or hypomanic) episode, a teen may:

• Have a short temper
• Find it difficult to maintain focus
• Speak in an excited and rapid manner
• Act silly in an atypical way
• Act impulsively

During a depressive episode, a teen may:

• Feel extremely sad or down
• Sleep more than usual
• Eat more or less than usual
• Be indecisive
• Express hopelessness or suicidal thoughts

Other Types of Bipolar Disorder

Though Bipolar I and Bipolar II are broad categories that describe most cases, there are a few additional variations of teen bipolar that may also be present.

• Cyclothymic Disorder is a condition characterized by brief period of hypomania alternating with brief periods of mild depression. This condition is milder than other forms of bipolar disorder, but still may require treatment.
• Mixed Feature Bipolar describes a condition when teens simultaneously experience opposite moods at the same time. For example, they may have intensely high energy while simultaneously feeling hopeless.

Rapid Cycling Bipolar occurs when an individual has four or more mood episodes within a year. This “episodes” are distinctively different than the simpler mood changes occurring in most bipolar patients. An individual with rapid cycling bipolar may be intensely manic and intensely depressed for several days within the same week.

The primary differences between types of bipolar are variations in mood, intensity, frequency, and other symptoms. Only a licensed clinician can make a proper diagnosis.

Common Signs of Bipolar Disorder

Because teenagers experience both manic and depressive episodes whether they have bipolar I or bipolar II, there are some commonalities when it comes to symptoms and things to look out for.

During a manic (or hypomanic) episode, a teen may:

• Have a short temper
• Find it difficult to maintain focus
• Speak in an excited and rapid manner
• Act silly in an atypical way
• Act impulsively

During a depressive episode, a teen may:

• Feel extremely sad or down
• Sleep more than usual
• Eat more or less than usual
• Be indecisive
• Express hopelessness or suicidal thoughts

What Causes Bipolar?

Unfortunately, it is still unclear as to what exactly causes bipolar in teenagers.  Nonetheless, doctors and researchers do have an understanding as to what may contribute to a teen developing bipolar disorder.

• Genetics – if a teenager comes from a family with a history of bipolar disorder, he or she is at an increased risk of developing bipolar as well.
• Brain structure – much research around bipolar has shown variations in brain activity and size in brain scans of individuals with bipolar.
• Environment – stressful and/or traumatic events can trigger an initial bipolar episode in teenagers.

Treatment Options

Once your teenager is diagnosed with bipolar, the doctor will likely suggest a specific treatment plan to help your teen manage symptoms and work through struggles.  Treatment for bipolar disorder usually consists of medication and/or therapeutic intervention.

• Medication – teens with bipolar (I or II) are typically prescribed one of two classifications of medication, either a mood stabilizer or an atypical antipsychotic.
• Therapy
  • Psychotherapy – also known as talk therapy, psychotherapy can help your teen open up and be validated in regard to his or her struggles and challenges. Psychotherapy can also provide the opportunity for your teen to learn about bipolar disorder.
  • Family therapy – provides support for the whole family, and can assist family members in better understanding what your teen is experiencing. Family therapy can also be a great venue for working through specific conflicts.
  • Cognitive behavioral therapy – can teach your teenager healthy coping skills and ways to challenge and change negative thoughts and/or behaviors.

How You Can Help Support Your Teen with Bipolar

Having a child diagnosed with bipolar disorder can be stressful.  Yet there are many things you can do to help support your teen and promote overall wellbeing.

• Educate yourself – read different books, articles, reports, etc. on bipolar. Talk to others who have experience with bipolar or children with bipolar.  Get information from your primary care physician or doctor.
• Communicate – do not be afraid to talk to your child about bipolar. Demonstrating openness around mental health may encourage your child to be open as well.
• Create routine and structure – helping your child maintain consistency through routines and schedules can be extremely important to overall wellbeing. A healthy routine involves regular meal and bed times, as well as scheduled activities and fun time/time to socialize.
• School support – talk with your teen’s school about his or her diagnosis and how the school can best support your teen in succeeding academically. Yet, it is important to let your child know you will be talking to the school, as he or she may want to be present.

Track moods – while this is something you may want to encourage your teenager to do, it may be helpful to also track your child’s moods.  This can assist in identifying any patterns of mood/behavior, and be helpful in understanding the cycles your teen is experiencing.

Dual Diagnosis: A New Approach in Teen Psychology

Over time, psychologists have come to recognize that many individuals have multiple mental health conditions at once. Because each of these individuals is unique, it is important to develop a comprehensive approach to treatment.

For example, many individuals who suffer from bipolar disorder may also present symptoms of substance abuse disorder, ADHD, various personality disorders, and numerous other conditions. Instead of treating each of these conditions in isolation, dual diagnosis is a strategy that attempts to address them all at once.

With dual diagnosis, the goal of mental health treatment remains unchanged. However, the methods of treatment that are used may be slightly modified. This may include changes in prescriptions, treatment modalities, and frequency of treatment. Most research suggests that using a holistic approach increases the probability of a successful recovery.

Providing Hope

Being a parent of a teenager with bipolar disorder can sometimes be rather frustrating. However, as one of their most valuable resources, your efforts are still important. By providing your teenager love and support, as well as access to the resources they need, you can have a profoundly positive impact on their life.

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