Читать книгу Bipolar Disorder For Dummies - Joe Kraynak - Страница 11

The diagnosis of bipolar disorder in children (up to the age of 12) and adolescents (teenagers) has been an area of debate and controversy for close to 20 years. Even professionals in the field fundamentally disagree about some features of diagnosing this disorder in young age groups. The consensus that’s evolving, however, is straightforward: To be diagnosed with bipolar disorder, children need to exhibit the same patterns of energy and mood changes that adults do – at least one period of mania or hypomania, often associated with episodes of depression.

Adolescents are more likely than younger children to show classic symptoms of bipolar – mania in particular. True mania does occur in children before puberty, but it’s infrequent. And recent research suggests that children who exhibit a lot of problems with mood dysregulation, particularly anger and irritability, aren’t more likely to exhibit bipolar disorder later in life. Instead, they more often experience anxiety and/or depression when they get older.

The high energy and impulsivity that are prominent in manic episodes are core symptoms of one of the most common psychiatric conditions in children – ADHD. The evolving diagnostic criteria for bipolar disorder in children don’t count high energy and impulsivity toward a manic episode diagnosis unless these symptoms become significantly worse during a sustained period of time (not just a few hours).

Irritable mood – one possible symptom in mania – is also a common symptom in childhood, and many medical, developmental, or psychiatric issues can cause it. Unless the irritability occurs in cycles – sustained periods of time in which it’s much more severe than the child’s usual temperament – it doesn’t count toward a diagnosis of bipolar disorder. DSM-5 contains a new diagnosis called disruptive mood dysregulation disorder. The purpose of introducing this diagnosis is to have a way to describe and research chronically irritable and explosive children without inappropriately labeling them as having bipolar disorder. The criteria for DMDD include

✔ Severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation or provocation.

✔ The temper outbursts are inconsistent with developmental level.

✔ The outbursts occur on average three or more times per week.

✔ The mood between outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others.

✔ The symptoms have been present for 12 or more months and there hasn’t been a period lasting three or more consecutive months without the patterns of irritability and outbursts.

✔ The symptoms aren’t part of a manic episode or better explained by major depression or other psychiatric or neurodevelopmental disorders, including anxiety disorders and autism.

This research is ongoing, and many researchers are still exploring whether bipolar disorder can look significantly different in children and teens. But, whatever the studies reveal, doctors know that they must be cautious and diligent when evaluating young patients with mood symptoms. The medications used to treat mania are powerful and have many side effects, and a diagnosis of bipolar may prevent the use of medications to treat ADHD or anxiety and depression. Therefore, a misdiagnosis in a child can have significant long-term consequences.

Obtaining an early, accurate diagnosis of a child’s difficulties and identifying whether the cause is bipolar disorder or something else is the most critical step in helping the child or adolescent manage a mood problem. See Chapter 21 for more about diagnosis and treatment options for children and teenagers who may be dealing with a mood disorder.

Battling the stigma of a bipolar diagnosis

During my battle with bipolar disorder, I was unaware of the consequences of my risky behavior – abusing substances, having promiscuous sex, staying up all night, and counterfeiting art – but I was high-functioning.

My diagnosis put me in a category of the population called bipolar. In my mind, I was a lunatic, freak, psycho, crack-up, and mental case. I had officially stigmatized myself, long before anyone else had the chance.

I invited my parents to dinner to tell them the news, and they had a ton of questions. “Are you sure your doctor is right? Where did it come from? What's going to happen to you? Is it genetic?” They struggled with the stigma of having a son with bipolar, and, even worse, they worried that it might run in the family – we might have more like me!

Family and friends didn’t come rushing to my side to support me in my battle. In 1993, the mere mention of bipolar disorder frightened people; someone with bipolar was “crazy.” And because my insidious illness wasn’t tangible, like diabetes or MS, it was easier for people to blame it on me. At a time when I was most in need of support from my friends and family, stigma pushed them away.

Most people thought I had the skills and strength to “kick” my bipolar disorder and get better on my own because the symptoms didn’t show up on my body as a wound. Many people thought it was a figment of my imagination, that I was lazy or just seeking attention, and I started believing these ideas. But when symptoms surfaced, I was reminded that I really was suffering from bipolar disorder.

When medication didn’t quell the mania, I opted for the last resort – electroshock therapy. That decision in itself pretty much confirmed that I was officially mentally ill. It was too much for some of my friends to handle, and they simply disappeared. Nobody seemed to want a friend who was now a psychiatric patient and, after electroshock, a “certifiable zombie.”

Stigma prevents many us from seeking help and isolates us when we’re most in need of supportive friends and family. Even in my recovery today, when I speak openly about my diagnosis, I’m keenly aware that many people are uncomfortable and afraid. Stigma is a form of discrimination, and debunking the myths about bipolar disorder and disseminating the truths are critical to educating the public and creating a social environment that’s more conducive to mental health and recovery.

– Andy Behrman (http://electroboy.com), author of Electroboy: A Memoir of Mania