By W. Douglas Tynan, senior health psychologist at Nemours Health & Prevention Services in Newark, Del., is a contributor to the Healthy Kids blog.
The statistic seems alarming. Hospital stays for bipolar disorder among children ages 1 to 17 soared 434 percent from 1997 to 2010, the government has reported.
The number of hospital stays rose from 10.3 million to 57.3 million over that period. The rise in diagnoses began in the mid-'90s when bipolar disorder for children was heavily promoted in the psychiatric community. Now there's evidence that the diagnosis was overused and is falling.
A classic bipolar adult. I saw my first bipolar patient almost 35 years ago. A wealthy executive, he became energized one week with new ideas on how to revolutionize his company. This led to a Manhattan trip where he charged a limo rental and hotel to his account. Married with kids, he picked up a young man and they flew to a tropical island for a few days. He wrote all his ideas in a journal later judged incoherent. Finally after a week, he began to realize what he had done and fell into depression. He was fired and his wife wanted him out. Here he was in my tiny basement office at the county mental health office seeking help.
A bipolar child. Twenty years later, I saw my first child bipolar case, an 11-year-old who in our first session assured me that she could make the family court judge do what she wanted, and she could. With a very high IQ and the ability to manipulate people, she convinced those around her that her mother, an executive with a government contractor, led a life of unusual debauchery, and she demanded to be put in foster care.
The mother noted that the father had been diagnosed with bipolar disorder. He also had bouts of grandiosity, and had vanished at one point to start a new career and family far away. Repeat probes yielded no verification of this child's claims, yet she got what she wanted. Over the next two years, she repeated the abuse claims in every home she was put in, and then would have bouts of severe depression. This cycle went on for years, but no one called it bipolar. Finally, she became an emancipated minor after getting pregnant at 17 and vanished.
Bipolar diagnosing in the last 20 years. What has been labeled child bipolar for the last 20 years is something else entirely. While it encompasses these cases with cycling mood swings and extreme behavior, it has also included all cases of children expressing intense emotional distress. A 2-year-old with intense rage, a strong emotional reaction to a parental separation, intense frustration due to a learning disability can all be easily and incorrectly labeled bipolar. Childhood bipolar is often treated with fairly strong drugs.
I have seen children who are truly suffering from post-traumatic stress problems labeled as bipolar. A middle school student watched the suicide of a parent, and seven years later, due to the bipolar diagnosis he got, could not enlist in the Navy. A bipolar diagnosis implies a lifelong disability.
The end of bipolar disorder in children? The American Psychiatric Association is proposing a new diagnostic category "Disruptive Mood Dysregulation Disorder," which is more simply a child who is having out-of-control emotional outbursts, not typical for age, several times a week or more. Critics feel this may cause more children to be diagnosed with a disorder when they are having temper tantrums. I think it might help, and at least it will take the bipolar label, with all of its implications, off children who eventually learn to control themselves and no longer fit the diagnosis.