Te bible for clinicians ,The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) placed bipolar disorder in a new category—“Bipolar and Related Disorders.” Bipolar disorder involves two poles: mania and depression. During manic episodes, people feel up or elevated, sometimes excited, happy and on top of the world. During depressive episodes, they feel down, unhappy, and hopeless. It's not that simple though. Mania does not always feel good, and the symptoms can be more complicated. Many people feel irritable, and can have outbursts when manic, and also, the episodes are not that clear cut. They can experience what are called mixed states where they may feel manic and depressed at the same time. This is especially true for children. Or, they may feel anxious, along with their particular mood state.
There are many symptoms of bipolar that overlap with other disorders, and they occur on a spectrum. They vary in severity in different individuals and over the course of one's life.
I’ve been working with bipolar children and
adults for most of my career. I run an online facebook support group that I
developed as an offshoot of a local support group for parents of children with
bipolar disorder. You can find the link to this group here.
In order to understand bipolar disorder diagnosis in children, it helps to understand bipolar disorder is diagnosed in adults.
According to the DSM V , a specific number of symptoms must occur within a specified time frame in order to be diagnosed with bipolar disorder.
It's important that we get this diagnosis right. People with bipolar disorder can wait as long as 10 years to get a correct diagnosis according to some estimates! .
The details of the diagnostic criteria and the time frames are below. Bipolar disorder in children has become a controversial diagnosis. Some of the difficulty in diagnosis of bipolar in children is that they don't have their own criteria. The difficulty with these adult criteria is that the time frames for episodes are not applicable to children.
Children’s EPISODES may last minutes and hours instead of days. The outward expression of depression and mania also look somewhat different in children. This is one of our core problems in diagnosing bipolar disorder in children. You can learn about this in a radio interview I did here.
This page will explain some of the basic information necessary for understanding the diagnosis of bipolar disorder. This page is linked to many more pages about bipolar disorder in both children and adults. Scroll down to the bottom and check them all out!
To understand how bipolar disorder diagnosis is made, it is important to understand the concept of episodes. Episodes and their length are how psychiatric professionals determine whether someone meets the criteria for bipolar disorder.
It is important to note that even with these guidelines in place, mental health professionals make mistakes all the time when diagnosing bipolar disorder. Sometimes they diagnose it when it’s not there, and sometimes they don’t see it when it is there. Other pages on the site will go into more detail describing this. The purpose of this page is simply to describe the current system mental health professionals use when diagnosing bipolar disorder. I hope it's helpful.
A period of elevated, expansive, or irritable mood and increased activity or energy
B. There is evidence this is caused by another medical condition.
C. The is not better explained by another mental health condition
D. This does not occur during delirium
E. The disturbance causes disturbance in functioning in life, requires hospitalization or has psychotic features
1. A disturbed mood is present that is elevated expansive or irritable with or without a depressed mood or diminished interest in all activities
2. This occurred during or after substance intoxication or withdrawal
3. This actual substance can produce the mood disturbance
4. The symptoms weren’t there before the substance or medication
5. The symptoms didn’t persist for a m month after the intoxication or withdrawal
6. There isn’t a history of the episodes without the medication or substance
7. The mood disturbance didn’t occur during the course of delirium
8. The disturbance causes significant distress.
When diagnosing bipolar disorder, clinicians will use specifiers to describe more about the the particular kind of bipolar they are seeing.
These are some of the ways the describe bipolar disorder
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Łojko, Dorota & Suwalska, Aleksandra & Rybakowski, Janusz. (2014). [Bipolar and related disorders and depressive disorders in DSM-5]. Psychiatria polska. 48. 245-60.
SAMSHA Advisory. An Introduction to Bipolar Disorder and Co-Occurring Substance use Disorders ( 2016). (n.d.). Retrieved from https://store.samhsa.gov/product/Advisory-An-Introduction-to-Bipolar-Disorder-and-Co-Occurring-Substance-Use-Disorders/SMA16-4960