Both in adult bipolar and early onset bipolar, misdiagnosis of bipolar disorder is a problem.
As discussed on other pages on this website, there are many reasons for misdiagnosis of bipolar disorder- especially in children. The similarity in symptoms of other disorders (even in adults it frequently can masquerade as depression), and the seriousness of the diagnosis itself make it somewhat of a last resort diagnosis. Unless the client is a very good reporter of their symptoms and the diagnostician very thorough, it is easily missed. In fact, it is misdiagnosed more often than it is correctly diagnosed, And most clients go many years before receiving a correct diagnosis. An incorrect diagnosis can wind up costing patients valuable time and money.
MY STORY ABOUT MISDIAGNOSIS OF BIPOLAR DISORDER
My first job after graduating with a Masters degree in Social Work was at The Family Center, a facility in Charlotte that specialized in the treatment of abused children.
Trauma and bipolar disorder share some similar symptoms in children. Trauma is emotionally deregulating, it causes anger and rage and depression. So does early onset bipolar disorder.
Initially, when I started at the Family Center, I focused on learning everything I could about trauma and abuse. I mastered all aspects of treatment and worked with many, many children. Three years later, people began to recognize me as somewhat of an expert in sexual abuse treatment for children. I saw a lot of the work I did through this lens. This can oftentimes be another reason why bipolar disorder does not get diagnosed. Mental healthcare professionals who specialize in specific conditions can sometimes see the symptoms that relate to their specialty much more clearly, and may miss clues that would lead to a different diagnosis.
I first met Carlos during this time; he was seven and was a victim of sexual abuse. We didn’t know all the details, but there were so many possible perpetrators it seemed obvious that something sexually inappropriate had happened. The most significant sign to us that he had been sexually abused was his sexual behavior (which I would later learn can occur in children during mania and is called hypersexuality). He would act out sexually with other children and adults.
At that early point in my career, I believed sexual behavior in a seven year old was a pretty clear sign of some form of abuse, or exposure to pornography.
I worked with Carlos for two more years. He always came in at 7:00 pm, my last client on Fridays.
Carlos was challenging. I didn’t understand him. He was incredibly self destructive. He lived with his grandfather, and at times he would stay up all night destroying his house, his clothes, writing on walls. I have to confess that at times, I didn’t believe his grandfather when he told me what Carlos was doing because the stories were so outrageous. It must have something to do with parenting, I thought.
Carlos was oftentimes angry and hateful- but then, sometimes, he could be so loving and sweet. One week he would follow the rules and comply with therapy happily, the next he was defiant and aggressive. What was going on here?
There was also another side, a sad side. Some days he was sluggish, appeared haggard and had visible circles under his eyes. He didn’t want to play on those days and would sit in the corner or curl up in a ball in my lap. I wasn’t sure if he was dissociating, or if he was still being abused. I couldn’t provide any help to his grandfather regarding parenting, nothing worked. I felt frustrated and incompetent. He wasn’t getting better- rather, he seemed to be getting worse. I wondered if it was the family. I talked with him endlessly about good touch and bad touch. I didn’t know what else to do.
During a change in my work, I had to transfer Carlos to another therapist. It was a very tearful parting. We certainly had become very close. I thought about him often and over the years I kept tabs on how he was doing.
It wasn’t until years later when I first attended training on bipolar disorder by Demitri Papolos that I finally figured out what was going on. It was during this conference I learned about misdiagnosis of bipolar disorder.
I had worked with Carlos for years and never understood him. Perhaps I ought to have. It was only after specialized training in bipolar disorder, however, that I was able to put together the clues that lay beneath the surface, hidden by his history of trauma and sexual abuse. His Aunt had committed suicide. His mother was a drug addict, and his grandfather had several major depressive episodes while I was working with him. Clear signs that point to a genetic mental health issue, not just abuse. Yet, without the new perspectives that training provides, I was unable to see it.
Although much less was known about Childhood Bipolar Disorder then, I couldn't let myself off the hook. I felt responsible for not correctly diagnosing Carlos, so I made it my mission to learn everything I could about Bipolar Disorder in children. Hopefully, this story will help others see some signs and be wary of hidden clues in otherwise chaotic behavior.
I am glad to say that I did hear that Carlos had been correctly diagnosed with bipolar disorder and was getting the help he needed. Unfortunately, it cam about eight years after I first worked with him. Sadly, this story is all too common as bipolar diagnoses tend to take a long time to surface.
Is Bipolar Disorder Over Diagnosed?
There has been a lot of discussion over the past few years about bipolar disorder in children being over diagnosed. I have, in my practice come across only two children diagnosed with bipolar incorrectly. More often than not bipolar disorder is under diagnosed.