Image: DANIEL STOLLE
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The Wisdom of Psychopaths
In this engrossing journey into the lives of psychopaths and their infamously crafty behaviors, the renowned psychologist Kevin Dutton reveals that there is a...
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Imagine an eight-year-old boy whom we will call Eric. He is irritable and talks incessantly. Unable to sit still and concentrate, he does poorly at school. Nevertheless, he claims to be one of the smartest kids in the world and blames his poor academic performance on his “horrible” teachers. There are periods when his mood changes abruptly from euphoria to depression and then swings back again. Eric's symptoms qualify him for a diagnosis of bipolar disorder, which is characterized by episodes of full-blown mania or a less severe form called hypomania. These moods usually alternate with periods of depression [see box on opposite page].
Until about 1980 most mental health professionals believed that bipolar disorder did not occur in children. Although a few still hold this view, the general opinion of the psychiatric community has drastically shifted over the past 30 years, a period in which diagnoses of the disorder in kids have skyrocketed. In a study published in 2007 psychiatrist Carmen Moreno, then at Gregorio Marañón University General Hospital in Madrid, and her colleagues found a 40-fold increase between 1994 and 2003 in the number of visits to a psychiatrist in which a patient younger than 19 was given this diagnosis. By 2003, the researchers reported, the number of office visits resulting in a bipolar diagnosis in these youths had risen from 25 per 100,000 people to 1,003 per 100,000 people, a rate almost as high as that for adults.
Such data have sparked widespread concern that the condition is egregiously overdiagnosed, perhaps contributing to the use of ineffective and even harmful medical treatments. In this column, we discuss controversies regarding the overdiagnosis of bipolar disorder in children and recent attempts to remedy this situation.
Tale of Two Maniacs
In 1980 the American Psychiatric Association came out with a radically revised third edition of its diagnostic bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). This edition debuted the term “bipolar disorder” as a replacement for the earlier term “manic-depressive disorder.” The diagnosis required a full-blown manic episode lasting at least a week, usually alternating with periods of major depression that extended for at least two weeks. The symptoms had to be severe enough to interfere with social or occupational functioning; for children, the latter refers to how well they perform in school.
In the view of many professionals, some children did—and still do—fit these criteria. In 1994, however, with the publication of the DSM-IV, a new category of bipolar disorder appeared. In this volume, the one in use today, the illness is subdivided into bipolar I, essentially equivalent to the DSM-III version of this malady, and bipolar II, which has less stringent diagnostic criteria. A patient can be diagnosed with bipolar II if he or she has hypomania, the less severe form of mania, in which the manic episodes can be shorter—four days instead of a week—and do not impair functioning. The inclusion of this milder form of the disorder enabled many more children (as well as adults) to qualify for a bipolar diagnosis.
It is no coincidence then that the dramatic rise in cases of childhood bipolar disorder began as soon as the revised edition of the DSM landed on psychiatrists' desks. Many critics have raised concerns that this manual's loosened criteria have misclassified many children as bipolar II who had features too mild to really qualify them for any type of bipolar disorder—or who suffer from entirely different ailments.
Bad Diagnosis, Bad Treatment
Indeed, bipolar II overlaps substantially with other common childhood conditions. For example, attention-deficit hyperactivity disorder (ADHD) and bipolar are both characterized by distractibility, fidgeting, restlessness, high activity levels and excessive talking. Bipolar disorder also shares similarities with conduct disorder and oppositional defiant disorder, which are associated with repeated disruptive behaviors. Such overlaps can lead to misdiagnosis.
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14 Comments
Add CommentThe foolishnesss goes on and on. Just go with Bi-polar! There doesn't really need to be a differentiation. It's the same problem, but different degrees, not like Diabetes 1 or 2. Good grief.
Reply | Report Abuse | Link to thisDo they "get" it? I likeyouknow get it too.
Reply | Report Abuse | Link to thisMy cousin once stood too close to two magnets right in a row, and he "got" it - he got bipolar.
OK, you've had your fun, I've had mine, now how about back to reality, and just help the children with their conditions.
I like your humor.
Reply | Report Abuse | Link to thisAs well as diagnosing 'up' to bi-polar, some kids can be diagnosed down. My son suffers from schizophrenia, and manifested the thought disorders, hearing voices, and hallucinations starting at 14. Yet we were told that he couldn't possibly have Schizophrenia at that young age and so it must be bi-polar disorder instead. He therefore was placed on the typical bi-polar medications (listed above), which proved to be ineffective and with devastating side effects, and suffered needlessly.
Reply | Report Abuse | Link to thisOnly when he was given his true diagnosis, and provided with Clozapine has he found any relief.
Bi-polar disorder seems to be somewhat of a catch-all bucket, from my experience. And about as useful as schizoaffective disorder.
Schizoaffective is real and many children have full blown bi-polar with hallucinations. It is a clear category that has been observed.
Reply | Report Abuse | Link to thisBox on opposite page?
Reply | Report Abuse | Link to thisJust so you understand where I'm coming from. I have had Bi-polar as far back as I can remember. When I had an adverse reaction to the oral Polio vaccine in 1962, a hereditary auto immune situation kicked in. I developed Hypothyroidism, as a result, which in recent years developed into Hashimotos Thyroiditis. I spent 40 years seeking help for Hypothyroidism, to no avail, and over 60 years suffering from Bi-Polar. I'm finally getting the help I needed and my health is normalizing. That means the Hashimotos has turned around, into simple Hypothyroidism, which still continues to improve. And the Bi-Polar? That continues to improve too. Drugs did not work in my case, as I'm highly allergic to Pharmaceuticals. Only, a change in diet and supplementation worked.
Reply | Report Abuse | Link to thisMore often than not, those who suffer from Thyroid conditions, OCD, Bi-Polar, etc, have Schizophrenia in their genetics or genetic background. In my case I have 2 great aunts, a great uncle and 2 cousins that were diagnosed and institutionalized with Schizophrenia. There are dozens of cases of Bi-Polar and OCD on both sides of my parents families.
Did you seriously write that? Do you know anything about Bipolar?
Reply | Report Abuse | Link to thisIt's a tough illness overall. Symptoms of psychosis are very similar to schizophrenic symptoms. At the same time, many of the medications for both illnesses are the same.
Reply | Report Abuse | Link to thisYet you STILL do not talk about BP1 or BP2... they are VERY different! Shame that someone who has the illness does not know that there are at least 4 variations of the illness.
Reply | Report Abuse | Link to thisApparently not as much as you do. What is being done on my behalf is having to be met by taking care of a multitude of things, which is slowly addressing everything. The BP1 and BP2 were never brought up. In fact, when I was suspicious that I had BP, they misdiagnosed it because I didn't manifest the PB as "a woman." It manifested itself more like a man, with aggression and anger. How stupid is that on their part? Anyway, when it was diagnosed, properly, they of course, wanted to use Pharmaceuticals. I left and never went back. Apparently, you don't believe that the Thyroid can affect a person's hormones and mental faculties. That is where I'm coming from. I'm more involved in strengthening my immune system and correcting the problem rather than doping myself. Everyone is different in how they handle their health issues. Pharmaceuticals don't work for everyone, in fact 5% of the population can't use them.
Reply | Report Abuse | Link to thisObviously you are more up to date on Bipolar. My diagnosis was 16-18 years ago, in the early mid 90s. After the initial findings, I did not pursue it any further, with the doctors, as they wanted to use Pharmaceuticals, which I was not willing to do. I wanted to get to the root of the problem, which meds would not allow. At that time, I did research online and found a number of herbs that worked well in curbing the extremes of the manic and depression. One of my daughters who suffered greatly from OCD, also took the herbs and was able to turn her life around. Now ow that I have been working with a Naturopath and a DO, for the past 18 months, I'm getting better results.
Reply | Report Abuse | Link to thisS Freud described psychosis as a narcissistic neurosis, libido is blocked to go outside and reverts to the self, and bipolar disorder is a psychotic disease, sharing biological traits with schyzophrenia, however, some point as a lack of enough self-esteem in the origin of bipolar disorder, so opening ways for other approaches in ethiology and therapy. Even decades after J Ajuriaguerra, some pediatricians keep on having doubts on whether depression may exist in childhood. The repeated works about parental affective influences in the origin of severe mental disorders, plus the plasticity of the young brain, can make consider a therapeutic separation of "bipolar" children from a possibly noxious family environment, at least for a while, a choice that may have been also forgotten in the cases of family bond youngs or not too old adults suffering schyzophrenia and other serious mental disorders able to impact well beign, socialization and career for a whole life span.
Reply | Report Abuse | Link to thisI took a class at a state hospital. Frequently the problem a kid had and the diagnosis the psychiatrist wrote down differed. While the kid received treatment for schizophrenia, that was not the diagnosis. The psychiatrist did not want to attach that label to a kid and have him carry it for life. As a result the diagnosis would be something like, "Adjustment reaction to Adolescence."
Reply | Report Abuse | Link to thisAs frequently happens, the kid was not the sickest member of the family. Getting the kid into a healthy environment, eating healthy food, having rotten teeth filled, having chronic diseases treated, and being in a less stressful learning situation helped tremendously.
So, here was a kid that had come to school every day after being beaten up at home. The kid would fidget. The teacher wanted him on drugs to calm him down so she could deal with him. Was he really bipolar?