The number of children diagnosed with bipolar disorder has risen dramatically. A study of mentally ill children in community hospitals, published recently in the Archives of General Psychiatry, found the proportion of children diagnosed as bipolar shot up from less than 3 percent in 1990 to 15 percent in 2000 and this rate is still climbing.
Before 1995 we believed that bipolar disorder was exceedingly rare in children. Then psychiatrists at the Massachusetts General Hospital published research that showed 16 percent of the children referred to their psychopharmacology clinic fit the diagnosis. That observation suggested that perhaps 1 percent of all children might be affected. Recent studies document a steep increase in prescriptions of antipsychotic drugs to children of all ages and this is probably due to the increasing diagnosis of bipolar disorder. Many psychiatrists question whether the disorder really affects so many children and whether the benefits of the diagnosis outweigh the risks of the drugs in many cases.
One factor in the increased use of the diagnosis is the availability of new, potentially effective drugs, particularly antipsychotic and mood stabilizers. As the bipolar diagnosis gained popularity in recent years, so did prescriptions for powerful antipsychotic drugs such as Risperdal and Zyprexa, which have been approved for use in adults, but are also prescribed for children. A concern is that if you have kids on these medications for long periods of time they may develop major medical problems as adults.
Unfortunately the bipolar diagnosis is being applied to children and adults whose condition arises from serious childhood trauma that results in symptoms very similar to the depression and mood swings of bipolar disorder. Therapists estimate that about one-third of dissociative patients referred to the specialty clinics of the Trauma Recovery Institute and the Intensive Trauma Therapy Inc. center
- They have an emotion (e.g., fear, sadness, anger, happiness) that feels like it is not their own.
- They hear the voice of a child in their head.
- They have another personality that sometimes takes over.
- They experience blank spells or blackouts in their memory.
- They feel like they are only partially 'there' (or not really 'there' at all).
- They feel strong impulses to do something - but the impulses don't feel like they belong to them.
- They feel like they are often different from themselves.
- They feel that pieces from their past are missing.
- They feel like some of their behavior isn't really theirs.
- They feel distant and removed from their thoughts and actions.
- They feel that they have multiple personalities.
- They feel that they have another part inside that has different memories, behaviors, and feelings
Sometimes people with bipolar disorder experience some of these symptoms but at a much lower degree than those with dissociative disorder. I recommend that parents of children who demonstrate any dissociative symptoms find a psychiatrist or therapist who will at least consider childhood trauma and therapy for it as a possibility. If the diagnosis of childhood bipolar disorder is made I recommend seeking another opinion before agreeing to medication as treatment.
Children and adults with dissociative disorder can respond rapidly to psychotherapy alone, particularly the so-called exposure therapies that focus on childhood traumas.
Louis W. Tinnin, MD,
Psychiatric Consultant to Intensive Trauma Therapy, Inc.
