Misdiagnosis of Bipolar Disorder or How I Came to Work with Bipolar Children

There are many reasons for misdiagnosis of bipolar disorder. Mostly though it’s just a hard diagnosis to make. It is a serious diagnosis and for this reason people are hesitant to make it. Even in adults it frequently can masquerade as depression. Unless the client is a very good reporter and the diagnostician very thorough, it is easily missed. In fact it is misdiagnosed more often than correctly diagnosed, And most clients go many years before receiving a correct diagnosis. Misdiagnosis of bipolar disorder costs a lot of money and costs patience the quality of their life.

MY STORY ABOUT MISDIAGNOSIS OF BIPOLAR DISORDER

My first job was at The Family Center, a facility in Charlotte that specialized in the treatment of abused children. What does this have to do with bipolar disorder, you ask?

Trauma and bipolar disorder cause some similar symptoms in children. Trauma is emotionally deregulating, it causes anger and rage and depression. So does early onset bipolar disorder. Another Reason for misdiagnosis of bipolar disorder are these kinds of overlaps among categories.

Initially 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. I think was another contributing factor in this case of misdiagnosis of bipolar disorder.

Carlos

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 point 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 came every night at 700 pm, my last client on Fridays.

Carlos was challenging. I didn’t understand him. He was incredibly self destructive. At times he would stay up all night destroying his house, his clothes, writing on walls. I have to confess at times I didn’t believe his grandfather the stories were so outrageous. It must have something to do with parenting, I thought.

Carlos was angry and hateful and then sometimes………..so loving and sweet. One week he would follow the rules and comply with therapy happily, the next he was defiant and aggressive. What the hell 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 he was 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.

When I left my job I had to transfer Carlos to another therapist. It was a very tearful goodbye. We had gotten very close. I thought about him often. I kept tabs on how he was doing.

It wasn’t until years later when I first attended training on 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. I should have too. His Aunt committed suicide. His mother was a drug addict, and his grandfather had several major depressive episodes while I was working with him. How did I miss that??

Although much less was known about Childhood Bipolar Disorder then, I couldn't let myself off the hook. I did hear he had been correctly diagnosed, about eight years after I first worked with him.

I felt guilty and responsible for not correctly diagnosing him. So I made it my mission to learn everything I could about Bipolar Disorder in children.

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 seen two children diagnosed with bipolar incorrectly. More often than not the misdiagnosis of bipolar disorder is in the other direction.