Bipolar Disorder in Adolescents: Meaning, Symptoms and Causes

Bipolar disorder, also called manic-depressive illness, is a mental health condition that causes extreme mood swings. People with bipolar disorder experience intense highs, known as manic episodes, and deep lows, called depressive episodes. These mood swings can disrupt daily life and relationships.

The symptoms of bipolar disorder include alternating periods of elevated, manic, or hypomanic episodes characterized by increased energy, impulsivity, and grandiosity, and depressive episodes marked by low mood, loss of interest, and feelings of hopelessness.

The exact causes of bipolar disorder are not fully understood, but it is believed to result from a combination of genetic, biological, and environmental factors that interact to influence its development.

What is Bipolar Disorder?

Bipolar disorder, a complex mental health condition characterized by extreme mood swings, is a challenge that affects individuals of all ages, including adolescents and teenagers. This critical developmental stage is marked by significant physical, emotional, and social changes, making the management of bipolar disorder in this population particularly demanding. 

During manic episodes, individuals may feel very happy or irritable, have lots of energy, talk quickly, need less sleep, and engage in risky behaviors. Depressive episodes involve feeling sad, lacking energy, losing interest in activities, having trouble sleeping or eating, and experiencing negative thoughts.

There are different types of bipolar disorder, and symptoms can vary. Some people have more frequent mood swings, while others have longer periods of stability between episodes.

Bipolar disorders aren’t a common mental health condition. According to research by the National Institute on Mental Health (NIMH), among adolescents in the U.S. aged 13-18, approximately 2.9% had bipolar disorder with 2.6% experiencing severe symptoms such as impairment.

What are the Common Symptoms of Bipolar Disorder in Teens?

The symptoms of bipolar disorder can vary depending on the specific type and individual, but there are several common signs to be aware of. These symptoms typically manifest during manic, hypomanic, or depressive episodes. Here are some key symptoms for each phase:

Manic Episode Symptoms

  • Elevated mood: Feeling extremely happy, euphoric, or irritable.
  • Increased energy and activity: Having a surge of energy, feeling restless, and being highly active.
  • Rapid speech: Talking quickly, jumping between topics, and having racing thoughts.
  • Decreased need for sleep: Feeling little or no need for sleep without feeling tired.
  • Grandiosity: Having an inflated sense of self-importance, feeling invincible, or having unrealistic beliefs about abilities.
  • Impulsivity: Engaging in risky or reckless behaviors, such as excessive spending, substance abuse, or engaging in unsafe sexual activity.

Hypomanic Episode Symptoms

Similar to manic episodes but less severe in intensity and duration.

  • Increased productivity: Feeling highly motivated, creative, and goal-oriented.
  • Heightened sociability: Being more talkative, outgoing, and seeking social interaction.
  • Decreased need for sleep: Feeling well-rested with less sleep than usual.
  • Increased self-confidence: Feeling self-assured and capable.

Depressive Episode Symptoms

  • Persistent sadness
  • Loss of interest
  • Fatigue and low energy
  • Sleep disturbances
  • Changes in appetite
  • Difficulty concentrating
  • Feelings of guilt or worthlessness
  • Thoughts of death or suicide

It’s important to remember that bipolar disorder is a complex condition, and not everyone will experience all of these symptoms. The severity and frequency of mood episodes can also vary. 

What Causes Bipolar Disorder in Teens?

The exact cause of bipolar disorder in teens is not fully understood. However, research suggests that a combination of genetic, biological, and environmental factors contribute to its development. Here are some factors that may play a role:

1. Genetic predisposition

Bipolar disorder tends to run in families, indicating a genetic component. Having a close family member with bipolar disorder increases the likelihood of developing the condition.

2. Brain chemistry and structure

Imbalances in certain neurotransmitters, such as serotonin, dopamine, and norepinephrine, may contribute to the development of bipolar disorder. Additionally, abnormalities in brain structure and function, particularly in areas involved in mood regulation and emotion processing, have been observed in individuals with bipolar disorder.

3. Hormonal changes

Adolescence is a period of significant hormonal changes, which can impact mood and increase vulnerability to mental health disorders, including bipolar disorder.

4. Environmental factors

Stressful life events, such as trauma, loss, or major life changes, can trigger the onset or exacerbation of bipolar symptoms in susceptible individuals. Substance abuse, particularly drug use, can also worsen symptoms or trigger episodes.

While these factors can contribute to the development of bipolar disorder, it’s important to note that not all individuals with these risk factors will develop the condition. Bipolar disorder is a complex interplay of multiple factors, and further research is ongoing to understand its causes fully.

How Can Bipolar Disorder be Diagnosed?

The diagnosis involves a comprehensive assessment that takes into account the individual’s symptoms, medical history, and family history. Here are some key steps and methods used in diagnosing bipolar disorder:

1. Initial evaluation

The mental health professional will conduct an initial evaluation, which may involve a discussion about the individual’s current symptoms, duration, and intensity, as well as any previous episodes of mania or depression. They may also ask about the individual’s medical history, family history of mental health conditions, and any substance use.

2. Mood and symptom assessment

The mental health professional will conduct a thorough assessment of the individual’s mood, emotions, and behavior. They may use standardized questionnaires or rating scales to gather more specific information about the symptoms experienced during manic, hypomanic, or depressive episodes.

3. Medical and psychiatric evaluation

The mental health professional may perform a physical examination and order laboratory tests to rule out any underlying medical conditions that could be causing the symptoms. They may also assess for co-occurring psychiatric disorders that could influence the diagnosis and treatment approach.

4. Diagnostic criteria

The mental health professional will refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which provides criteria for diagnosing mental health conditions. Bipolar disorder has specific criteria for manic, hypomanic, and depressive episodes, and the duration and severity of these episodes are considered.

5. Family history assessment

Since bipolar disorder has a genetic component, the mental health professional may inquire about the family history of bipolar disorder or other mental health conditions to better understand the potential genetic risk factors.

6. Duration and pattern of symptoms

The mental health professional will evaluate the duration, frequency, and pattern of symptoms to determine if they align with the diagnostic criteria for bipolar disorder. They may also assess for the presence of rapid cycling or mixed features, which can impact the diagnosis and treatment approach.

It’s important to note that diagnosing bipolar disorder can be complex, as symptoms can overlap with other mental health conditions.

Are there Mental Health Conditions Similar to Bipolar Disorder in Teenagers?

Yes, several mental health conditions share similarities with bipolar disorder and may have overlapping symptoms. These conditions can sometimes be misdiagnosed or co-occur with bipolar disorder. Here are a few examples:

1. Major Depressive Disorder (MDD)

MDD is characterized by recurrent episodes of depressive symptoms such as persistent sadness, loss of interest, changes in appetite and sleep patterns, low energy, and thoughts of death or suicide. While MDD does not involve manic or hypomanic episodes, it can be challenging to differentiate depressive episodes of bipolar disorder from MDD.

2. Cyclothymic Disorder

Cyclothymic disorder is a milder form of bipolar disorder characterized by numerous periods of hypomanic symptoms and depressive symptoms that do not meet the full criteria for a manic or depressive episode. The mood swings in cyclothymic disorder are generally less intense and shorter in duration compared to bipolar disorder.

3. Borderline Personality Disorder (BPD)

BPD is a personality disorder characterized by unstable mood, self-image, and relationships. People with BPD may experience intense emotional fluctuations, including periods of heightened mood and energy similar to manic episodes. However, these episodes are typically more reactive and short-lived than the sustained and distinct manic episodes seen in bipolar disorder.

4. Substance-Induced Mood Disorder

Substance abuse or certain medications can induce mood disorders that resemble symptoms of bipolar disorder. The use of substances like stimulants, antidepressants, or corticosteroids may trigger manic or hypomanic symptoms, while withdrawal or the comedown from substances may lead to depressive symptoms.

How is Bipolar Disorder in Adolescents Treated?

When it comes to treating bipolar disorder in adolescents, the approach is generally similar to the treatment for adults. However, there are a few additional considerations. Here’s a breakdown of how bipolar disorder is treated in adolescents:

1. Medication

Medication, such as mood stabilizers (e.g., lithium, valproate) or atypical antipsychotics, may be prescribed by a psychiatrist to help stabilize mood and manage symptoms. The dosages and choice of medication may vary based on the individual’s age, weight, and specific symptoms. It’s important to closely monitor medication effects and potential side effects in adolescents.

2. Therapy

Psychotherapy, such as cognitive-behavioral therapy (CBT) or family-focused therapy (FFT), is often recommended for adolescents with bipolar disorder. Therapy can help them understand their condition, develop coping strategies, improve communication within the family, and address any co-occurring issues like substance abuse or difficulties with school. Involving parents or caregivers in therapy can be particularly beneficial for supporting the adolescent’s treatment.

3. Psychoeducation

Providing education about bipolar disorder to the adolescent and their family is crucial. It helps them understand the nature of the condition, recognize early warning signs of episodes, and learn strategies for managing symptoms and preventing relapse. Education can also help reduce stigma and improve treatment adherence.

4. Lifestyle adjustments

Encouraging healthy lifestyle habits is important for managing bipolar disorder in adolescents. This includes promoting regular sleep patterns, engaging in physical activity, maintaining a balanced diet, and minimizing stress. Establishing routines and creating a supportive environment at home and school can also be helpful.

5. School support

Collaboration with school personnel, such as teachers, counselors, or school psychologists, is important to provide necessary support and accommodations for the adolescent’s academic needs. This can include developing an individualized education plan (IEP) or a 504 plan to address any difficulties related to mood fluctuations and academic performance.

6. Ongoing monitoring and support

Regular follow-up appointments with the psychiatrist and therapy sessions are essential for monitoring the adolescent’s progress, adjusting treatment as needed, and providing support. It’s important to maintain open communication between the adolescent, their family, and the treatment team to address any concerns or changes in symptoms.

A multidisciplinary approach involving mental health professionals, teachers, and family support is crucial for the effective management of bipolar disorder in adolescents.

What Results Can Adolescents and Teenagers Expect from Treatment?

Treatment for adolescents and teenagers with bipolar disorder can lead to improved symptom management, stabilization of mood episodes, enhanced quality of life, better academic performance, and prevention of relapse. 

Through a combination of medication, therapy, and lifestyle adjustments, adolescents can experience reduced frequency and intensity of mood swings, gain coping strategies to manage symptoms and achieve better overall emotional well-being. 

Collaboration with school support systems can also contribute to academic success. Adherence to treatment plans, ongoing monitoring, and a supportive environment are essential for maximizing the benefits of treatment.

Can bipolar disorder develop during adolescence?

Yes, bipolar disorder can develop during adolescence. It often emerges during late adolescence or early adulthood, although it can occur at any age. Adolescence is a time of significant physical, emotional, and social changes, which can contribute to the onset of bipolar symptoms. Hormonal changes, genetic predisposition, and environmental factors can all play a role in the development of bipolar disorder during this period.

How is bipolar disorder different in teenagers compared to adults?

Bipolar disorder in teenagers may present with some unique characteristics compared to adults. Adolescents may experience more rapid mood swings, irritable or angry mood states, and behavioral problems. 

It can also be challenging to differentiate bipolar disorder from typical adolescent moodiness or other mental health conditions. Additionally, the impact of bipolar symptoms on academic performance, peer relationships, and family dynamics can be more pronounced in teenagers.

Can bipolar disorder in teenagers coexist with other mental health conditions?

Yes, bipolar disorder in teenagers can coexist with other mental health conditions. It is not uncommon for adolescents with bipolar disorder to experience comorbid conditions such as anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), substance use disorders, or self-harm behaviors. Treatment plans need to address the full range of symptoms and conditions present to ensure comprehensive care.

Can teenagers with bipolar disorder participate in extracurricular activities?

Participation in extracurricular activities for teenagers with bipolar disorder should be assessed on an individual basis. While involvement in activities can benefit socialization, self-esteem, and overall well-being, it is important to consider the potential impact on mood stability. 

Open communication between the teenager, family, mental health professionals, and activity organizers can help determine appropriate levels of participation and provide necessary support.

How can parents and caregivers support teenagers with bipolar disorder?

Parents and caregivers can support teenagers with bipolar disorder by educating themselves about the condition, maintaining open and supportive communication, and actively participating in their treatment. 

Providing a stable and understanding environment, encouraging adherence to medication and therapy, and fostering a balanced lifestyle can significantly contribute to the teenager’s well-being. Seeking support from mental health professionals, support groups, and other families facing similar challenges can also be beneficial for parents and caregivers.

Author: Shantel Sullivan Ed.D., LCSW
Dr. Shantel Sullivan, Ed.D., LCSW, serves as the CEO of Bright Path with a rich background in residential adolescent treatment, adult outpatient services, and academia, leveraging over a decade of licensed social work experience in New York and North Carolina. Her academic credentials include a BA in Sociology, an MSW and a graduate certificate in addictions counseling from the University of New England, culminating in a doctoral degree in Educational Leadership focused on transformational leadership. Beyond her clinical expertise, Dr. Sullivan contributes to the field as a national speaker, educator, and editor of the Bright Path Teen Mental Health Blog, committed to enhancing access to evidence-based mental health care for adolescents and their families.
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