Bipolar Disorder in Youth

The assessment and diagnosis of bipolar disorder in youth is enormously controversial. Depending on whom you listen to, there is either an epidemic or it’s virtually non-existent in young people. Many diagnoses nowadays are made by primary care physicians with little expertise in psychiatry, less time with each child and intolerant of unruly behavior. And there remains no consensus on how to effectively measure symptom severity. These factors have contributed to a “diagnostic rush to judgment” mode and children are often shuffled from one clinician to another.

Clearly, the preponderance of evidence is indicative of gross overdiagnosis. Bipolar diagnosis in children has increased 40-fold in just one decade!

Most kids getting the diagnosis nowadays have temper tantrums and irritability; classic swings between mania and depression are being largely ignored, and this is a major travesty. As such, the boundaries of pediatric bipolar disorder have pushed far into unconventional territory.

Because of its fad status, DSM 5 editors and criteria writers have proposed a new diagnosis – Disruptive Mood Dysregulation Disorder to create a less threatening diagnostic “haven” for kids misdiagnosed as bipolar. Keep in mind, many of these kids shouldn’t have been diagnosed with any disorder in the first place, as they are merely navigating the ups and downs ordinarily displayed by youth who are growing through the developmental life cycle.

The major ramification of all of this is that inappropriately and inaccurately diagnosed children are increasingly being treated with medications – particularly second-generation antipsychotics – that are unnecessary and potentially harmful. Another ramification is that the bipolar label carries significant stigma, hanging around the necks of these youth like an albatross, when they apply for admission to a university, medical school, law school or any of the professions for that matter. Also, an incorrect diagnosis can reduce a young person’s personal responsibility to address the undesirable behavior, leading them to conclude they’re doomed to failure with such a diagnosis so “why even try.”

If you’re a non prescriber and treat bipolar disorder in children and adolescents here are some recommendations:

  1. Question physicians/prescribers about medication side effects and the rationale for polypharmacy.
  2. Have a child’s medication profile evaluated every 4 months.
  3. Above all, stay true to diagnostic basics – don’t ignore standard bipolar criteria during the assessment phase.
Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.

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