Bipolar disorder, previously called manic-depressive psychosis, is a disease that lasts a lifetime and is often misunderstood. Until the mid-1990s it was commonly undiagnosed and rarely included as part of the training for pediatric clinicians or adolescent psychiatrists since it was not considered part of a diagnosable condition for a moody child or adolescent (Parker, Zuckerman, & Augustyn, 2005). However, this perspective is changing as the information and research on this disorder evolve.
New research and clinical practice as well as family experiences demonstrate that bipolar disorder does occur in children and adolescents—and at a higher incidence than previously thought. At least half of all cases are now diagnosed before the age of 25, yet the disease remains difficult to diagnose in this particular age group because it does not neatly fit the adult criteria for diagnosis and because many pediatric practitioners lack training in this complex disorder.
BACKGROUND
Mental disorders are common in the United States and internationally. An estimated 26% of Americans (about one in four adults) suffer from a diagnosable mental disorder in any given year, and mental disorders are the leading cause of disability in the United States and Canada.
There are several categories of mental disorders including mood disorders, schizophrenia, anxiety disorders, eating disorders, attention deficit hyperactivity disorders, autism, and personality disorders (National Institute of Mental Health [NIMH], 2013).
There are three types of mood disorders (NIMH, 2013):
- Major depressive disorder
- Dysthymic disorder
- Bipolar disorder
Bipolar disorder is defined as a mood disorder in which feelings, thoughts, behaviors, and perceptions are altered in the context of episodes of mania and depression. One of the most severe, most common, and most persistent of all mental illnesses, bipolar disorder affects approximately 4% of the adult population. When atypical types and children are added to that the number, it increases to approximately 6.5% of the total population (Colom & Vieta, 2006; NIMH, 2015).
Up to one-third of the 3.4 million children and adolescents with depression in the United States may actually be experiencing the early onset of bipolar disorder, according to the American Academy of Child and Adolescent Psychiatry (2015). Due to more extensive training, physicians and other health care providers now recognize this as a “real” disorder in young people, but it still remains under-recognized and therefore undertreated.