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Bipolar is a mental illness that causes changes in a person's mood, energy, activities, and concentration. People with bipolar often struggle with very high and very low episodes in their emotions. Bipolar affects 4% of people under the age of 18.

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National Institute of Mental Health (NIMH)

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Overview

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes unusual shifts in a person's mood, energy, activity levels, and concentration. These shifts can make it difficult to carry out day-to-day tasks.

There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely "up," elated, irritable, or energized behavior (known as manic episodes) to very "down," sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

Bipolar I disorder is defined by manic episodes that last for at least 7 days (nearly every day for most of the day) or by manic symptoms that are so severe that the person needs immediate medical care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible. Experiencing four or more episodes of mania or depression within 1 year is called "rapid cycling."

Bipolar II disorder is defined by a pattern of depressive episodes and hypomanic episodes. The hypomanic episodes are less severe than the manic episodes in bipolar I disorder.

Cyclothymic disorder (also called cyclothymia) is defined by recurring hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes.

Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, and this is referred to as "other specified and unspecified bipolar and related disorders."

Bipolar disorder is often diagnosed during late adolescence (teen years) or early adulthood. Sometimes, bipolar symptoms can appear in children. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.

Signs and symptoms

Risk factors

Treatments and therapies

Join a study

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Learn about bipolar disorder, including signs and symptoms, types, risk factors, how it is diagnosed, and potential treatments and therapies.

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Symptoms

Elevated mood, euphoria

Rapid speech, racing thoughts

Impulsive behavior

Decreased need for sleep

Period of sadness or withdrawal

Difficulty focusing and controlling emotions

Mood swings lasting for days

Diagnosis

The initial concern

Gathering information from the family, and history of the child

A behavioral and emotional assessment done by professionals

Ruling out other conditions and matching symptoms to Bipolar Disorder

Evaluation

Final diagnosis and treatment plan with a licensed professional (most likely a doctor, psychologist/psychiatrist).

Treatment

Medication if required

Behavioral therapy (focusing on emotional skills, behavior, family communication)

Family, Educational, and Community Support

Structured routines/lifestyles

School support and accommodations

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Overview

What is bipolar disorder, and how does it affect children?

Bipolar disorder is a mental illness that causes children to be very irritable and have significant swings in mood. Bipolar disorder was previously called manic-depressive disorder.

Children with this illness experience unusual mood changes, moving from feeling very happy and joyful to feeling deeply sad. Other children experience chronic irritability, sometimes accompanied by mood shifts. Additional symptoms include grandiose behavior, pressured speech, racing thoughts, decreased need for sleep, risky behavior and hypersexuality.

If the illness goes untreated, school, relationships and daily life may become difficult. Youth with bipolar disorder are also at increased risk for suicide and/or delinquent behavior with incarceration.

It's important to note that even if you see some of these symptoms in your child, the diagnosis isn't necessarily bipolar disorder. There is some disagreement in the children's mental health field over how symptoms differ between children and adults, and when bipolar disorder should be diagnosed. A mental health professional can help you identify the problem.

How is bipolar disorder different in children than in adults?

Children with bipolar disorder may switch moods more often than adults. For example, a child may exhibit periods of giddiness and silliness, anger outbursts, and crying all in one day. Children with bipolar disorder also tend to show less clear episodes and instead may show chronic irritability or mixed moods that involve a combination of mania and depression symptoms.

Symptoms and Causes

What causes bipolar disorder in children?

It is not yet known what causes bipolar disorder. However, there are several factors that may be associated with it:

Family History: Children with a parent or sibling with bipolar disorder are more likely to get the illness. This is approximately five times more likely when a first degree relative has a bipolar disorder.

Anxiety Disorder: Many children with bipolar disorder also experience significant anxiety.

Neurotransmitters: Bipolar disorder is a disorder of brain development that likely involves differences in neurotransmitters, brain structures and/or the function of specific brain structures.

Environment: Stress, loss of a loved one and/or abuse may trigger bipolar disorder. Both negative and positive stresses (achieving an award or accomplishment) can serve as a contributing trigger to bipolar disorder symptoms.

What are the symptoms of bipolar disorder?

To understand bipolar disorder, it's helpful to know how mental health providers talk about severe mood swings. Mood swings are often termed as "mood episodes." Manic episodes describe periods when the child feels overly excited and confident. These feelings can quickly give way to confusion, anger and possibly rage.

Depressive episodes describe periods when the child feels very sad ( depressed). Children may not have clear-cut episodes. Instead, they may have "mixed" episodes and exhibit both manic and depressive symptoms. Some children may show "rapid cycling" where they shift quickly between mania or hypomania and depression, sometimes even within the same day.

Depressive, manic, or mixed episodes, by definition, are a change in behavior that differs from the individual's baseline. Children with symptoms suggestive of bipolar disorder but with chronic course should also be evaluated by a psychiatrist, in order to identify other disorders.
During manic or hypomanic periods, children with bipolar disorder may:

Be overly happy, hopeful and excited often inconsistent with external events.

Be irritable and have a short temper.

Become restless.

Show increases in distractibility.

Talk rapidly and in a pressured way where it is difficult to "get a word in."

Believe they have many skills and powers and can do things other people can't do (such as the children believe that they are in charge and not adults - in the extreme thinking, they believe they have special powers like a superhero).

Have a lot of energy and need very little sleep.

Talk and think about sex, and/or act older than their age.

Show poor judgment and make impulsive, harmful decisions.

Engage in risky behavior, including sexual or very impulsive behaviors such as charging parents' credit cards, abusing substances or putting themselves in unsafe circumstances.

During depressive periods, they may:

Feel empty, sad or hopeless.

Feel guilty, worthless or helpless.

Cry often.

Eat too little or too much.

Lose interest in things they usually enjoy.

Be unable to think clearly, make decisions, or remember things.

Sleep poorly.

Lose or gain weight.

Have low energy.

Have extreme sensitivity to rejection or failure.

Become focused on death.

Have thoughts of death, develop a plan or intentions to hurt themselves or someone else, and even attempt suicide or severe aggressive behavior.

The most frequent and useful symptoms for distinguishing bipolar disorder from other problems in youth are:

Rapid mood shifts.

Significant irritability.

Grandiosity.

Decreased need for sleep over a period of three to seven days.

Diagnosis and Tests

How is bipolar disorder diagnosed in children?

Bipolar disorder is diagnosed by an experienced mental health professional. There are no medical tests that can diagnose the illness. Instead, you'll be asked about the child's mood, behavior and sleeping patterns.

You may be asked to make a mood chart that documents all of this information for a certain period of time that could help with diagnosis and finding the right treatment. Family and medical history are also useful in helping to diagnose the illness.

Management and Treatment

How can I help my child who may have bipolar disorder?

If you think that your child may have bipolar disorder, make an appointment with your doctor to discuss the symptoms that you have noticed. Other basic things you can do:

Be patient.

Be understanding.

Be supportive.

Encourage your child to talk, and listen carefully.

Explain how treatment works.

Help your child have fun.

Seek medical help when needed.

How is bipolar disorder treated?

There is no cure for bipolar disorder, but with effective treatment it is possible for children to live normal lives. Doctors treat children with bipolar disorder with medications and therapy.

Medication: Children respond to medicine differently than adults, so the type and dosage of medication depends on the child, as well as their symptoms. It is best for the child to start at the smallest amount of medication as possible to help their symptoms, then gradually up the dosage if necessary.

Therapy: There are different types of psychotherapy that can help children with bipolar disorder. Therapy can help children manage their episodes and alter their behavior. It can also help with other psychosocial elements associated with bipolar disorder such as depression, low self-esteem and communication issues with family and friends. Family therapy and education about the illness is an important part of the overall treatment.

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Bipolar disorder is a mental illness that causes children to be very irritable and have significant swings in mood. Bipolar disorder was previously called manic-depressive disorder. Children with this illness experience unusual mood changes, moving from feeling very happy and joyful to feeling deeply sad. Other children experience chronic irritability, sometimes accompanied by mood shifts.

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Bipolar can be caused and linked to by:

Family history of mood disorders

Chemical imbalances in the brain

Abnormal brain activity

Developmental and Neurological Differences

Trauma or early life stress

Prenatal factors

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Bipolar can make it hard for children to participate in everyday activities. It can cause

Sleep disturbances

Unstable relationships

Poor eating habits

Affected school performance

Trouble in family dynamics

Emotional and behavioral challenges

Difficult self-esteem and social confidence

Potential risky or harmful behaviors

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Website 1: NAMI (National Alliance on Mental Illness)

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Website 1: NAMI (National Alliance on Mental Illness)

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NAMI provides information, support, and advocacy for people and families affected by mental illness. They offer educational programs, support groups, and information with community resources.

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In this 2-part podcast series, NAMI Chief Medical Officer Dr. Ken Duckworth guides discussions on bipolar disorder that offer insights from individuals, family members and mental health professionals. Read the transcript.
Note: Content includes discussions on topics such as suicide attempts and may be triggering.

Bipolar disorder is a mental illness that causes dramatic shifts in a person's mood, energy and ability to think clearly. People with bipolar experience high and low moods-known as mania and depression-which differ from the typical ups-and-downs most people experience.

The average age-of-onset is about 25, but it can occur in the teens, or more uncommonly, in childhood. The condition affects men and women equally, with about 2.8% of the U.S. population diagnosed with bipolar disorder and nearly 83% of cases classified as severe.

If left untreated, bipolar disorder usually worsens. However, with a good treatment plan including psychotherapy, medications, a healthy lifestyle, a regular schedule and early identification of symptoms, many people live well with the condition.

Symptoms

Symptoms and their severity can vary. A person with bipolar disorder may have distinct manic or depressed states but may also have extended periods-sometimes years-without symptoms. A person can also experience both extremes simultaneously or in rapid sequence.

Severe bipolar episodes of mania or depression may include psychotic symptoms such as hallucinations or delusions. Usually, these psychotic symptoms mirror a person's extreme mood. People with bipolar disorder who have psychotic symptoms can be wrongly diagnosed as having schizophrenia.

Mania. To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania. Hypomania is a milder form of mania that doesn't include psychotic episodes. People with hypomania can often function well in social situations or at work. Some people with bipolar disorder will have episodes of mania or hypomania many times throughout their life; others may experience them only rarely.

Although someone with bipolar may find an elevated mood of mania appealing-especially if it occurs after depression-the "high" does not stop at a comfortable or controllable level. Moods can rapidly become more irritable, behavior more unpredictable and judgment more impaired. During periods of mania, people frequently behave impulsively, make reckless decisions and take unusual risks.

Most of the time, people in manic states are unaware of the negative consequences of their actions. With bipolar disorder, suicide is an ever-present danger because some people become suicidal even in manic states. Learning from prior episodes what kinds of behavior signals "red flags" of manic behavior can help manage the symptoms of the illness.

Depression. The lows of bipolar depression are often so debilitating that people may be unable to get out of bed. Typically, people experiencing a depressive episode have difficulty falling and staying asleep, while others sleep far more than usual. When people are depressed, even minor decisions such as what to eat for dinner can be overwhelming. They may become obsessed with feelings of loss, personal failure, guilt or helplessness; this negative thinking can lead to thoughts of suicide.

The depressive symptoms that obstruct a person's ability to function must be present nearly every day for a period of at least two weeks for a diagnosis. Depression associated with bipolar disorder may be more difficult to treat and require a customized treatment plan.

Causes

Scientists have not yet discovered a single cause of bipolar disorder. Currently, they believe several factors may contribute, including:

Genetics. The chances of developing bipolar disorder are increased if a child's parents or siblings have the disorder. But the role of genetics is not absolute: A child from a family with a history of bipolar disorder may never develop the disorder. Studies of identical twins have found that, even if one twin develops the disorder, the other may not.

Stress. A stressful event such as a death in the family, an illness, a difficult relationship, divorce or financial problems can trigger a manic or depressive episode. Thus, a person's handling of stress may also play a role in the development of the illness.

Brain structure and function. Brain scans cannot diagnose bipolar disorder, yet researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder.

Diagnosis

To diagnose bipolar disorder, a doctor may perform a physical examination, conduct an interview and order lab tests. While bipolar disorder cannot be seen on a blood test or body scan, these tests can help rule out other illnesses that can resemble the disorder, such as hyperthyroidism. If no other illnesses (or medicines such as steroids) are causing the symptoms, the doctor may recommend mental health care.

To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania. Mental health care professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose the "type" of bipolar disorder a person may be experiencing. To determine what type of bipolar disorder a person has, mental health care professionals assess the pattern of symptoms and how impaired the person is during their most severe episodes.

Four Types Of Bipolar Disorder

Bipolar I Disorder is an illness in which people have experienced one or more episodes of mania. Most people diagnosed with bipolar I will have episodes of both mania and depression, though an episode of depression is not necessary for a diagnosis. To be diagnosed with bipolar I, a person's manic episodes must last at least seven days or be so severe that hospitalization is required.

Bipolar II Disorder is a subset of bipolar disorder in which people experience depressive episodes shifting back and forth with hypomanic episodes, but never a "full" manic episode.

Cyclothymic Disorder or Cyclothymia is a chronically unstable mood state in which people experience hypomania and mild depression for at least two years. People with cyclothymia may have brief periods of normal mood, but these periods last less than eight weeks.

Bipolar Disorder, "other specified" and "unspecified" is when a person does not meet the criteria for bipolar I, II or cyclothymia but has still experienced periods of clinically significant abnormal mood elevation.

Treatment

Bipolar disorder is treated and managed in several ways:

Psychotherapy, such as cognitive behavioral therapy and family-focused therapy.

Medications, such as mood stabilizers, antipsychotic medications and, to a lesser extent, antidepressants.

Self-management strategies, like education and recognition of an episode's early symptoms.

Complementary health approaches, such as aerobic exercise meditation, faith and prayer can support, but not replace, treatment.

The largest research project to assess what treatment methods work for people with bipolar disorder is the Systematic Treatment Enhancement for Bipolar Disorder, otherwise known as Step-BD. Step-BD followed over 4,000 people diagnosed with bipolar disorder over time with different treatments.

Related Conditions

People with bipolar disorder can also experience:

People with bipolar disorder and psychotic symptoms can be wrongly diagnosed with schizophrenia. Bipolar disorder can be also misdiagnosed as Borderline Personality Disorder ( BPD).

These other illnesses and misdiagnoses can make it hard to treat bipolar disorder. For example, the antidepressants used to treat OCD and the stimulants used to treat ADHD may worsen symptoms of bipolar disorder and may even trigger a manic episode. If you have more than one condition (called co-occurring disorders), be sure to get a treatment plan that works for you.
Reviewed August 2017

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Bipolar disorder is a mental illness that causes dramatic shifts in a person's mood, energy and ability to think clearly.

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BP Hope focuses on family/caregiver support for children with bipolar disorder. They offer articles, blog posts, videos, and sections for kids all on Bipolar disorder.

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bpHope.com | Hope & Harmony for People with Bipolar

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bphope.com is bp Magazine’s award-winning online community. We strive to increase the awareness of bipolar disorder. We also provide hope, empowerment & support for those living with bipolar & their loved ones.

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Website 3: DBSA (Depression and Bipolar Support Alliance) 

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Website 3: DBSA (Depression and Bipolar Support Alliance) 

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DBSA helps provide support, education, and help to those with depression and or bipolar disorders. They offer educational materials and support groups. Peer-led support groups are offered as long as both online and in person.

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We are calling on our community to help us share brightness this season! Together we can provide empowering resources and services for mental well-being. Visit our toolkit to learn how you can spread awareness and support DBSA during our busiest giving time.

Your support is an investment in fostering hope, healing, and a brighter future for all those living with mood disorders.
Brighten Lives Toolkit!

Treatment Options

Seeking mental health treatment is not a sign of weakness or failure, but rather a show of great strength and compassion for yourself and those you love. Learn more about options to treat mood disorders and how to choose a provider.
See Treatment Options

Daily tools empower your wellness journey

Each person's wellness journey is unique. With that in mind, DBSA has developed tools to help you take the first steps and determine what support you may need along the way.

Start with Strengths

The DBSA Wellness Wheel is an easy-to-use tool that focuses on your strengths in 7 key areas of life.
Wellness Wheel

Keep Daily Logs

Our Wellness Tracker can be an essential resource to understand your moods, symptoms, medications, and lifestyle.
Wellness Tracker

If there's a young child in your life, we think you'll be excited to learn more about the DBSA Mood Crew®
Meet the DBSA Mood Crew!

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DBSA - Depression and Bipolar Support Alliance

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Living with depression or bipolar disorder? Find free support groups, resources, and wellness tools.

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Website 4: IBPF (International Bipolar Foundation) 

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Website 4: IBPF (International Bipolar Foundation) 

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The IBPF offers many resources for parents, guardians, and children struggling with Bipolar Disorder. They have the program HUGS for kids which gives comfort kits to children admitted into psychiatric units. They also offer a Caregiver connections program that schedules meetings and resources for these adults, as long as acknowledge the challenges the caregivers and family face while dealing with loved ones with bipolar disorder.

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UPCOMING WEBINARS

Register for Energy Metabolism and Bipolar Disorder: Where We Are and What is Coming here.

Register for Screen Time, Social Media Use, and Developing Brains here.

Register for Cannabis Use in Teens with Bipolar Disorder here.

Register for Bipolar Disorder and Suicide Risk: Insights from Brain Imaging here.

CONGRATULATIONS TO OUR TEEN CHANGEMAKERS ESSAY WINNERS

Read the winning essays here:
1st Place: Petra Dujmic 2nd Place: Charm Evans 3rd Place: Courtney Hughes
UPCOMING EVENTS

Health Fair of American Medical Student Association

Resource Fair, San Diego | April 11, 2020

For more details email info@ibpf.org

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Register for Energy Metabolism and Bipolar Disorder: Where We Are and What is Coming here. Register for Screen Time, Social Media Use, and Developing Brains here. Register for Cannabis Use in Teens with Bipolar Disorder here. Register for Bipolar Disorder and Suicide Risk: Insights from Brain Imaging here.