Recognizing Bipolar Disorder in Your Loved One

By David H. Averbach, MD, MSIA

Bipolar Disorder, or Manic Depressive Disorder, can have a devastating impact on the individual with the disorder, as well as on the families who have to deal with the individual on a daily basis. Coming from a family with a long history of Bipolar Disorder, I can say that identification of Bipolar Disorder in the individual is the key step in understanding and treating this illness.

Bipolar Disorder is characterized by episodes of manic behaviors, which may be short lived for a portion of a day, to long episodes lasting weeks or even months. The individual’s behaviors during these episodes are devastating to the family unit. Mood swings, irritability, needing little sleep, impulsivity, compulsions such as gambling or higher than normal sexual interest, and paranoia may be present during these manic episodes. These episodes may become so severe that the individual is at high risk of hurting themselves or others. Their intention may be rational, but the behaviors and interaction with others are usually irrational and bizarre.

Depression is usually a component of Bipolar Disorder. Episodes of depression may consist of crying, sadness, hopelessness, excess sleep or poor sleep, overeating or not eating enough, isolation from others, and losing interest in things that they used to find enjoyable. Feeling that life is not worth living and thoughts of suicide may also be present during the depressive episodes. Episodes of depression may last hours, days, weeks, or months, and often occur after a period of mania.

Identification of bipolar symptoms or behaviors is crucial in helping the individual and family cope with the disorder and begin to heal. The earlier the person is identified with Bipolar Disorder, the better the prognosis for managing the illness effectively. Individual and family education, support of the individual by their families, and compliance with treatment are crucial in managing the illness effectively.

It is easiest to illustrate Bipolar Disorder in men by using a common but fictitious case example. John S. is a 37 year old married man with three children. His wife has periodically expressed concern over his behaviors throughout their 10 years of marriage. There were times of mania when he would be impractical and impulsive, such as deciding to paint the outside of their house without the proper thought or tools. He would go through friends rather quickly because of his lack of tact and social awareness. He undertook extensive projects that would keep him up for several nights in a row. He would be irritable, loud, and argumentative for periods of time, and at other times he would appear to be happy and passive. He would also mismanage money and was a disaster to the family when he would do banking. During these episodes, he truly believed that he was right, reasonable, and rational when defending his ideas and impulsivity.

However, when he recovered from an episode, he would usually become depressed and isolated himself from his family and friends. He slept for 80 percent of the day, and during the other 20 percent he was tired and lethargic. His memory would be poor, he felt slowed down, and he lost interest in his hobbies and going out with his friends. At times during these episodes of depression, he had wishes of not being around and thought that his death would be the only option for preserving his family. During one episode, he talked to his wife about a plan he had for suicide, but he said that he did not have any intent to pursue the plan.

Needless to say, the family was always walking on “pins and needles” when they were around him, not knowing what his mood was like that minute, and not knowing when he would flip into a manic or depressive state. The frequency and intensity of his episodes caused chaos in the family. His wife would take the children to her parent’s house when his behaviors begin to get out of hand. Divorce was mentioned but not pursued, in part due to his wife feeling that it was her job to keep him under control. At times he seemed to be sorry for his behaviors that occurred during an episode, but he usually tried to rationalize them and blamed others for causing the behaviors. He also has no history of therapy, psychiatric intervention, or medication use for his behaviors.

This case example shows us the devastating impact that Bipolar Disorder has on the individual and family. It can be seen that the intensity and frequency of the episodes would most likely be much more manageable with early diagnosis, education, and treatment. Even if the person with the disorder refuses to seek help, education and therapy for the family by a trained professional skilled in Bipolar Disorder will help keep the family intact and help with their understanding of the illness and behaviors. Many times, the family member with the disorder will accept help when they are not in an episode, but maintaining therapy or medications during an episode is a significant challenge for the family and professionals dealing with this individual.

In summary, Bipolar Disorder can be well managed if identified accurately and prudently. Always seek professional help by a psychiatrist who can diagnose, educate, and provide treatment options for the individual and family. Remember that the earlier an accurate diagnosis is made the sooner the individual and family can begin to heal.

Dr. David Averbach is board certified in psychiatry and neurology.  He received his medical degree from University of Pittsburgh School of Medicine, and completed his M.S.I.A. in business from Carnegie Mellon University, Graduate School of Industrial Administration.  He is a member of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry.

Unmask Bipolar Disorder in Your Child

By David H. Averbach, MD, MSIA and Audra Ann Averbach, MSW of Oakland Behavioral Health

Bipolar Disorder, also known as Manic Depressive Disorder, is a chronic condition effecting 1 to 2 percent of adults. Very often, symptoms begin in childhood and can cause significant problems with social, developmental, and academic functioning. Children who display symptoms such as irritability, agitation, hyperactivity, sleep disturbance, and mood swings may fit criteria for a bipolar spectrum condition. However, the diagnosis is difficult and many other conditions in children have symptoms that mimic bipolar symptoms. Therefore, it is very important that an evaluation by a child psychiatrist trained in Bipolar Disorder be undertaken in order to arrive at the correct diagnosis.

It is very common for children to be irritable, emotional, and irrational. However, when these symptoms begin to cause problems with functioning, the parents should consider seeking a trained professional’s opinion. Many conditions, such as Attention Deficit Hyperactivity Disorder, depression, and substance abuse, may also be present or may be the primary condition affecting the child. All possibilities need to be explored before the diagnosis of Bipolar Disorder is made.

Bipolar Disorder is displayed differently in various age groups. In younger children, moods cycling from irritability to anger, followed by normal moods may be present in Bipolar Disorder. These children usually overreact to minute issues and carry on for an extended period of time. Parents note this as a “Jekyll and Hyde” personality. In adolescents, moods are more classically either depressive or “manic.” Mania is a state of hyperactivity, racing thoughts, irrational thinking or actions, and a distinct change in personality. This more closely resembles the adult form of Bipolar Disorder.

Many children are misdiagnosed with other conditions when in fact they are more closely on the bipolar spectrum. One of the most difficult conditions to sort out is Attention Deficit Hyperactivity Disorder (ADHD) and Bipolar Disorder. ADHD does not come and go, although symptoms may be worse or lessened depending on the environment or treatment. Children with ADHD usually do not exhibit rapid cycling mood swings and usually do not get irritable and angry to the point where they become out of control and explosive. They do become frustrated, bored, and impatient, but it is not to the degree of Bipolar Disorder.

In addition, children and adolescents with Bipolar Disorder tend to exhibit moods that are more unpredictable and dysfunctional than children with ADHD. Parents know their children best – when in doubt, an evaluation by a child psychiatrist who will look at the symptoms and come up with a reasonable diagnosis and comprehensive plan is imperative.

A comprehensive evaluation consists of input from the parents and the child or adolescent. It is important that this be in their own words describing their problems. Interviewing the family about symptoms present in the child, as well as getting a detailed family history, is also very important. Many families seek out a child psychiatrist after their child has been diagnosed with multiple conditions by doctors or therapists with varying levels of expertise. Sorting out past diagnoses is usually very difficult and takes a trained child psychiatrist who has extensive experience in children with Bipolar Disorder and has seen their share of kids with bipolar and other conditions. They also can determine if the child’s current treatment is adequate and appropriate.

Other families present to the child psychiatrist with no history of evaluation or treatment. As with all evaluations, making the family feel comfortable and able to talk about difficult topics is of the utmost importance. There is usually one chance to develop a trusting relationship between the psychiatrist and the family, and this opportunity should not be wasted. The importance of ensuring the family that every effort will be made to interview, diagnose, and educate cannot be understated.

Bipolar Disorder is treatable. Depending on the functioning issues and the severity of the illness, treatment may take the form of therapy, medication, or both. Psychotherapy focusing on the importance of regular and quality sleep, good nutrition and meal planning, the need for exercise and being active, and exposure to sunlight, is essential for all families effected by Bipolar Disorder. Therapy also must involve the different parts of the family unit – the parents, extended family members, the siblings, the child/adolescent, and possibly friends. The child’s academic setting should also be considered at an evaluation. Without the help of these people, it is impossible to determine when a child is cycling and in a bad state versus when they are stable and functional.

A comprehensive review of medication for Bipolar Disorder is outside the scope of this article. However, if medication is needed, the classic family of medications used to treat this condition is the mood stabilizers. A good child psychiatrist skilled in the medication treatment of Bipolar Disorder in children and adolescents is invaluable and can save years of misdiagnosis, functioning decline, and suboptimal treatment.

Seek out resources that provide information about Bipolar Disorder in children and adolescents. Going to your local bookstore and browsing is one way to familiarize yourself with this condition. Going online to sites sponsored by the National Institute of Mental Health (NIMH) or specialty sites such as www.bpkids.org provide information from a research and health administration perspective, and from a member-driven foundation consisting of family members and concerned individuals, respectively. Choose your favorite method of educating yourself on Bipolar Disorder in kids. Make sure the information you gather is reputable. If you are concerned about you or your child, pursue an evaluation from a highly skilled and reputable child psychiatrist.

Dr. David Averbach is board certified in psychiatry and neurology. He received his medical degree from University of Pittsburgh School of Medicine, and completed his M.S.I.A. in business from Carnegie Mellon University, Graduate School of Industrial Administration. He is a member of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry.

Audra Ann Averbach, M.S.W., received her Master’s in Social Work from the University of Pittsburgh. She is a member of the National Association of Social Workers. She completed her undergraduate work in psychology at the University of Michigan, and completed her College of Education, MAT candidate at Wayne State University, Detroit, MI.