Bipolar disorder is receiving much attention in the media and is more frequently diagnosed today by many mental health specialists than ever before. It has in fact almost become as commonplace as the flu or common cold. Toddlers who do not sleep well are Bipolar, young children with temper tantrums are Bipolar, husbands who get angry are Bipolar, wives with incredible stress in their lives are Bipolar and the individual who spends too much money is also Bipolar. That pretty much covers 70% of the human race. Is it possible that this number of the population can be chronically mentally ill? Prior to this increase in Bipolar diagnosis over the past 10 or 15 years, the National Institute of Mental Health reported Bipolar to exist in approximately 1% of the population, similar to the statistics held for Schizophrenia. Bipolar Disorder is a serious mental illness typically accompanied by lifelong struggles for those who truly suffer from it and not a diagnosis to be taken lightly.
A diagnosis of Bipolar Disorder can follow you for life and alter your opportunities. As a serious mental disorder, you will not be allowed in the military, certain job opportunities will be closed to you, health insurance may be denied and you will most certainly be placed on medications that can take a toll on your system over time. Although unfortunate, there is still a social stigma associated with mental illness. An incorrect diagnosis, especially for a child, can and will alter a life path, even in how the person views themselves and the expectations they then set for themselves.
So where is all the Bipolar coming from? In addition to the normal rise we see in any illness as the general population increases, it may also be a product of a combination of factors such as a general misunderstanding by the public of the terms and criteria used to diagnose the disorder, too little time spent by professionals delving into the client’s self reported symptoms and background situations to ensure understanding, the trend of public acceptance that our behaviors are a product of disease rather than choice, and finally, in Pediatric Bipolar, a lack of parenting information and appropriate expectations for children.
The first issue appears to be that our understanding of the criteria and terminology for diagnosing Bipolar Disorder is a bit too simplistic. The symptoms are not as straightforward as they sound. For example, not being able to sleep because you are worried about something is not the same as not sleeping or a decreased need for sleep due to Bipolar episode. Drifting in and out of sleep is also not the same. Waking up too early and not getting back to sleep, ditto. These can be associated with depression and/or anxiety disorders as well as other disturbances and should be fully examined for patterns and in the context or your current life circumstances. Dwelling on your daily activities or worrying about the future while trying to get to sleep are also not the same. These occurrences can be part of normal existence in a very busy and demanding world.
The terms “racing thoughts”, “feeling manic”, and “mood swings” have become commonplace. When questioned closely, clients report their “racing thoughts” to be anything from their thoughts jumping from topic to topic and being products of feeling overwhelmed to thoughts of constant worry about a particular topic. These are not examples of the type of racing thoughts characteristic of Bipolar Disorder. “Manic” and “Hyper” are not interchangeable terms meaning that someone has a lot of extra energy or stress related energy. “Manic “is a state where an individual exhibits extra or excessive energy that is often goal directed and an irritable, inflated or expansive mood that is different from the individual’s normal self. They may lose touch with reality and believe they are capable of great feats such as lifting a sofa with their mind or that they are receiving direct messages from a higher power. Once that starts to happen you don’t have to look closely to see if something is very wrong.
Everyone experiences mood swings to a degree, particularly as events occur that do not please us. One major difference between a “normal” mood swing and one occurring due to an episode of Bipolar Disorder is that a mood swing related to Bipolar is not always in relation to an external event, it can happen randomly as brain chemicals shift (sometimes excessive stress can trigger a Bipolar episode). We have probably all experienced the “mood swing” that comes when we receive bad news in the form of a bill in the mail, a friend says something hurtful, our job becomes more stressful, etc…We then go from being Ok one minute to angry , elated or sad the next due to the occurrence and our emotional response to it. Individuals with difficulty regulating their emotions may exhibit considerable swings but it is not necessarily Bipolar Disorder.
As humans, we like it when things are relatively easy. When our behavior is out of control such as with chronic spending or substance abuse, it is often easier to believe it is a product of mental illness beyond our control and to medicate it or allow others to care for us. This pretty much takes it out of our hands. This is not to say we are all lazy, but sometimes we are overwhelmed with emotions that lead us to these behaviors and controlling them feels impossible. We hang on to the little bits of pleasure we derive from our newly purchased item or getting inebriated, causing us to repeat these patterns until corrected. This does not mean we are Bipolar. These can simply be poor coping strategies that we have developed or learned. Maybe we grew up in dysfunctional families and saw that this is the way they coped so we do the same. There are a multitude of reasons why we do these things and exploring our actual motives helps our doctors make the correct diagnosis. Understanding why we engage in these behaviors also empowers us to “fix” ourselves.
One very common misdiagnosis that I see is confusing Bipolar Disorder with Borderline Personality Disorder. Those suffering from Borderline Personality Disorder actually exhibit more rapid mood shifts and can do so all day long, one minute angry, the next happy and smiling, back to throwing something across the room if they are crossed or something upsets them. These individuals typically engage in multiple poor coping strategies such as over spending, driving recklessly, substance abuse and many shallow relationships. Typically this is seen more often in women than men and it cannot be diagnosed with children or those under the age of 18. Usually the symptoms will begin to appear in adolescence. Taking the time to fully understand the client’s history and level of disturbance is the key to correct treatment.
Physical problems, inconsistent or inappropriate parenting, and unreasonable expectations for children often lead to symptoms or perceived symptoms in children that mimic Bipolar. There is still a school of thought with some mental health professionals that Bipolar cannot and should not be diagnosed until mid to late adolescence at the earliest. There are, however, those who believe it can be diagnosed very early in life, even in toddlers. Temper tantrums, mood swings, irritability and inability to sleep properly should be studied very carefully in children to ensure they are not a product of parenting patterns or that they may be normal childhood occurrences. It is often difficult for a parent to accept that they may be causing their children’s difficulties inadvertently and their children’s responses are developmentally normal, predictable and expected given whatever is occurring. The literature on inconsistent parenting alone is vast and every parent contemplating seeking psychiatric help for their child should read up prior to doing so. Parenting is difficult but there are many resources available for learning and making life easier as a parent. Good parenting is actually easier in the long run.
In conclusion, these types of misunderstandings can be easily clarified to make sure you or your child have received a correct diagnosis. Be sure to fully explain what you mean when you report symptoms to your professional and if they are not listening or do not have time, you may be better off with another professional. Bipolar disorder is a serious diagnosis with lasting effects on your life.