Bipolar disorder is one of several mental health conditions known as mood disorders. These conditions are characterized by problems with mood regulation, usually involving low mood (depression). While it’s normal to feel blue sometimes, a person with a mood disorder will feel a sudden and drastic dip in emotion.
For bipolar disorder in teens, symptoms of low mood are also paired with periods of mania, wherein the individual experiences irrational happiness and elevated mood, high irritability, high energy levels, restlessness, and a heavily inflated self-esteem. These two states cycle off one another, usually once or twice a year.
While bipolar is more often diagnosed in adults, it may be underdiagnosed in teens. This is a condition that is not as well understood as some other mood disorders such as major depressive disorder, but we have come to learn much about it over the last few decades.
Understanding Bipolar Disorder
Previously known as manic depressive disorder, bipolar disorder is a condition characterized primarily by symptoms of mania alongside periods of depression. We generally understand that it occurs in the brain and is partially hereditary, but researchers are still identifying how and why it occurs.
Many functions in the brain are related to mood regulation, and any one of them may play a contributing role in the development of a bipolar disorder. Some teens experience full-blown mania and depression, with symptoms ranging from excessively risky behavior and delusions of grandeur to suicidal tendencies, while others experience milder symptoms, known as hypomania.
External factors may also play a role – stress, trauma, and even diet can contribute to mood changes. Bipolar disorder is a lifelong condition, and can be generally split into two types:
Bipolar 1, also referred to as bipolar I disorder, refers to any type of bipolar disorder with “full” mania, usually referring to the severity of the manic symptoms. Symptoms of depression in patients with bipolar 1 may range from mild to severe, and some cases of unipolar mania (mania without depression) are often also categorized under bipolar 1 (at an estimated rate of 1-3 percent among bipolar 1 patients).
Bipolar 2, also referred to as bipolar II disorder, refers to cases of bipolar disorder with severe depression but mild mania (hypomania).
Other key forms of bipolar disorder include cyclothymia, which refers to milder symptoms of mania and depression, as well as rapid cycling bipolar disorder, wherein episodes of mania and depression occur more than four times in a single year. Anyone with bipolar disorder may also have “mixed” episodes, wherein an overwhelmingly depressive episode may have some periods of mania, and an overwhelmingly manic episode may feature depressive thoughts.
Identifying bipolar disorder in teens can be a challenge. The symptoms are more obvious in adults, as most people generally learn to regulate their mood and emotions over the years, while teens are expected to be more impulsive and whimsical. This can mean that a teen’s chaotic tendencies and sulking mood may mask symptoms of a mood disorder like bipolar.
While there are no physical tests to determine a positive diagnosis for a mood disorder, certain hallmark symptoms can help set bipolar disorder apart from “normal” teen behavior. If a teen is suspected to be struggling with a mental health condition, they can work with a licensed psychiatrist to determine whether an accurate diagnosis can be made, and whether treatment is needed.
Early Symptoms and Warning Signs of Bipolar Disorder in Teens
Teens can get moody and irritable, and there will be moments when they sulk or become sad over matters adults might not find as important. But normal adolescent behavior can be distinguished from symptoms of bipolar disorder in teens by the severity and pattern of these mood changes and behaviors. Symptoms of depression and mania are unprovoked, often severe, and debilitating. During episodes of depression, teens may exhibit signs of:
- Suicidal ideation and self-harm.
- Wanting to die (not necessarily suicidal).
- Extremely low self-esteem and frequent self-deprecation.
- Long periods of sadness.
- Despair and helplessness.
- Feeling lonely or unwanted.
- Trouble sleeping, or sleeping in.
- Sudden changes in appetite, and rapid weight gain/loss.
- No longer showing interest in old hobbies.
- Unexplained aches, mostly headaches and stomach aches.
During episodes of mania, teens may exhibit signs of:
- Extremely inflated ego and sense of self.
- Heightened irritability.
- Short or no sleep, unrealistically high energy levels.
- Speaking much faster than usual, switching topics and interests frequently.
- Delusional thinking (believing things to be true when they aren’t).
- Lowered inhibition, much more risk taking than usual.
- Racing thoughts, unable to slow down.
- Anxious energy (feeling uncomfortable with one’s own overactivity).
- Other signs of psychosis (a break from reality) including mild hallucinations.
Cases of cyclothymia may be harder to recognize, but if your teen is suddenly acting strange and experiencing unprovoked signs of low mood or excitability, talk to them and ask them about how they have been feeling. Their emotions and mood might be tied to stress at school, the loss of a friendship, or a budding relationship suddenly breaking off.
But if symptoms persist or worsen or are unrelated to what’s going on in their life, it may be worth talking to your teen about visiting a mental health provider – especially if symptoms are interfering with school and everyday life. Only a licensed psychiatrist can make a professional diagnosis of your teen’s condition, should anything be wrong.
Bipolar Disorder and Co-Occurring Issues
Bipolar disorder in teens can be difficult to spot and diagnose, as it may co-occur with the use of mood- and perception-altering substances, as well as other co-occurring mental health conditions. Some common co-occurring mental health issues include:
- Anxiety disorders
- Conduct disorders
- Personality disorders
- Developmental disorders (ADHD)
What Does Teen Bipolar Disorder Treatment Look Like?
While there is no cure, bipolar disorder can be managed via a combination of therapy and medication. Mood stabilizers, including lithium, can be used to help teens reduce the severity of their symptoms and lead healthier lives.
Therapy is critically important as the other half of the equation, helping teens recognize their symptoms and identify aberrant thoughts, and manage stressors and situations that might aggravate their mental health.
Support is also an important part of long-term treatment. Friends and family play a role in helping a teen when they can’t help themselves and learning more about their loved one’s condition so they can differentiate between an episode and normal behavior and call the right people in emergency situations.
Depending on the severity of the condition, treating bipolar disorder in teens can be incredibly challenging. But with the right support and diligent treatment, the worst can be avoided, and a teen’s quality of life can be dramatically improved.