Bipolar Disorder Diagnosis: A Spectrum

In order to understand bipolar disorder diagnosis in children, it helps to understand how we define it in adults.  In adults, according to the Diagnostic and Statistical Manual (DSM) used to diagnose all psychological disorders,  a specific number of symptoms must occur within a specified timeframe.  For bipolar disorder, which includes manic episodes and depressive episodes, there are specific criteria for both types of episode in order for the individual to be diagnosed as bipolar.  The episode(s) must also not be induced by a medical prescription or condition, nor by drug abuse.   The details of the diagnostic criteria and the timeframes are below, however, some of the difficulty in diagnosis of bipolar in children with these adult criteria is that the time frames are not applicable.  Children’s episodes may last minutes and hours instead of days.  The outward expression of depression and mania also look somewhat different in children.

This page will explain some of the basic information necessary for understanding the diagnosis of bipolar disorder. This page is linked to many more pages about bipolar disorder in both children and adults.Scroll down to the bottem and check them all out.

Episodes

To understand how bipolar disorder diagnosis is made, it is important to understand the concept of episodes. Episodes and their length are how psychiatric professionals determine whether someone meets the criteria for bipolar disorder. It is important to note that even with these guidelines in place, mental health professionals make mistakes all the time when diagnosing bipolar disorder. Sometimes they diagnose it when it’s not there, and sometimes they don’t see it when it is there. Other pages on the site will go into more detail describing this. The purpose of this page is simply to describe the current system mental health professionals use when diagnosing bipolar disorder.

There are several kinds of bipolar mood disorders described in the Diagnostic and Statistical Manual (DSM), the book used to make a bipolar disorder diagnosis. Each different bipolar disorder diagnosis is distinguished by episodes. Below are some of the definitions we need to understand to differentiate between different types of bipolar disorder ( Bipolar I, II, NOS, and Cyclothymia).

Learn more about types of bipolar here

Types of Bipolar Diagnoses

Bipolar I:  At least one manic episode along with at least one major depressive episode.  This is the classic definition of bipolar as mania is the defining feature.

Bipolar II:  At least one hypomanic episode and at least one major depressive episode.  

Cyclothymia:  Hypomanic symptoms along with mild or moderate depression.

Bipolar Disorder NOS (Not Otherwise Specified):  This diagnosis is used with individuals who have some aspects of bipolar symptoms, but not others.  For example, they may exhibit symptoms of depression or mania, but the episodes may not meet the criteria for duration.

Mood Disorder NOS (Not Otherwise Specified):  This diagnosis is used with individuals with even less clearly defined mood symptoms or issues.  Oftentimes, this will be the diagnosis given to children who have a variety of mixed presentations, but who do not meet the criteria for anything specific.


Bipolar Disorder Diagnosis: What are Episodes  and How to Distinguish Them


Major Depressive Episode

All of the symptoms below must occur most of every day for two weeks.

Symptoms

Either a depressed mood (in children this can be irritability)

or

No pleasure or interest in previously enjoyed activities or any activities

and

4 of the other symptoms below:

  • Weight loss or gain or decrease increase in appetite
  • Not sleeping or sleeping too much
  • Feeling restless or slowed down
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Impaired concentration or difficulty making decisions
  • Recurrent thoughts of death , thinking of suicide with or without a plan or a suicide attempt

Manic Episode

Symptoms are present to a significant degree for a week.  This mood state must cause some kind of an impairment in functioning, a hospitalization or be accompanied by psychosis.

3 or more of the symptoms below accompany a week of elevated or expansive mood

 -or-

4 or more symptoms accompany and irritable mood

Symptoms

  • inflated self-esteem or grandiosity
  • decreased need for sleep
  • more talkative than usual or pressure to keep talking
  • flight of ideas or racing thoughts
  • easily distracted
  • increase in goal-directed activity
  • psycho-motor agitation
  • excessive involvement in pleasurable activities that have a high potential for painful consequences (gambling spending money sexual activity)

Mixed Episode

All the symptoms are met both for a Manic Episode and for a Major Depressive Episode nearly every day for a week.

The mood disturbance is sufficiently severe to cause impairment in functioning,

or

there is psychosis

or

hospitalization is necessary

Hypo manic Episode

At least 4 days of period of elevated, expansive, or irritable mood, which meet the criteria of mania except that the episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

Symptoms Must Cause Impairment

In addition to these symptoms existing, to make a bipolar disorder diagnosis they must also cause impairment in an area of a person’s functioning (i.e. work or social). A person who is having these symptoms but moving along just fine in life would not qualify as having an episode.

Can’t be Caused by a Medical Condition or Drug Use

These symptoms also cannot be related to a medical condition or due to drug abuse or medication. I have seen people receive a bipolar disorder diagnosis, when in fact, they had a medical disorder. Certain medical disorders can mimic the appearance of bipolar disorder as can certain drugs. For example, someone who is on crack may appear manic, but they are not manic, they are high on crack.

Definitions

  • Flight of ideas- rapid speech during which the person speaker rapidly switches from topic to topic
  • Grandiosity-feeling you are more powerful intelligent or important than you are.
  • Psycho- motor agitation pacing moving around being physically agitated
  • Psycho- motor retardation- slowed physical movements, snail like
  • Psychotic features- disconnected from realty hallucinations
  • Elevated or expansive mood- feeling high euphoric or elated

 


Bipolar and Kids


Leave Bipolar Disorder Diagnosis for information on Bipolar In Children

Bipolar or  autism?

Bipolar teens

Homeschooling my bipolar child

Toddlers

Bipolar and school

Bipolar Disorder and creativity

Bipolar and ADHD

Self injury

Parenting

Bipolar and meds

More about bipolar and meds

Parents with  bipolar disorder

More about parents and bipolar disorder

Support groups

Symptoms

Anger

Treatments

Checklist for child diagnosis

School and Kids with Bipolar DIsorder

Misdiagnosis of bipolar

Pages about Bipolar Disorder

Bipolar disorder and memory

Natural treatments for bipolar disorder

Family members with bipolar disorder

Bipolar and diet

Bipolar disorder and relationships

Bipolar disorder and alcoholism

Lithium

Cognitive behavioral therapy for bipolar



Check out our online facebook support community for parents of kids with mood disorder. 

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