Without a professional diagnosis, symptoms of bipolar I or bipolar II disorder can be difficult to track and may be invisible except to those who know the person very well. In the early stages of the disorder, manic depression behavior may actually appear as a different problem: substance abuse, changes in sleep patterns, strained relationships, or poor performance at work or school.
To make a bipolar disorder diagnosis, a doctor, usually a psychiatrist, uses the criteria established by the American Psychiatric Association in the Diagnostic and Statistic Manual of Mental Disorders. The mental health professional takes a detailed family history and a history of manic depression behavior over the patient’s lifetime, including age at onset and current symptoms. Some of the symptoms of bipolar disorder recognized by the mental health community are provided on the Symptoms page.
When Does Bipolar Disorder Begin?
Bipolar disorder usually begins in adolescence or early adulthood, although it can sometimes start in early childhood or as late as the 40s or 50s. If bipolar disorder symptoms appear late in life, their occurrence is probably triggered by factors such as excessive stress or substance abuse.
Manic depression behavior typically follows a pattern that cycles—sometimes rapidly—from depression to euphoria or irritability. One person’s symptoms may include more mania (excitability) then depression; another person may suffer primarily from depression with mania occurring infrequently. Symptoms of mania and depression may be mixed together in any combination, but the person’s mood swings from intense lows to extreme highs.
Bipolar Children and Teens
Bipolar children usually have uninterrupted, rapidly cycling and severe mood disturbance producing a chronic irritability with few periods of wellness. Bipolar illness is usually diagnosed in children over the age of twelve.
Unfortunately, for bipolar children under age twelve, behaviors that should be associated with manic depression are often confused with attention deficit/hyperactivity disorder (ADHD). According to the American Academy of Child and Adolescent Psychiatry a significant number of children diagnosed with ADHD may actually be bipolar, or have bipolar disorder along with ADHD.
The onset of puberty is when the symptoms of adolescent bipolar disorder often manifest. Symptoms typically mirror those of adults with manic depression. For some, adolescent bipolar disorder may initially be triggered by a traumatic event, such as the loss of a loved one, or severe stress. Later episodes may occur even in the absence of stress, or may worsen with stress. Hormones may also trigger adolescent bipolar disorder in girls just starting to menstruate and they may notice that their symptoms vary in severity with their cycle.
Because a majority of teens with adolescent bipolar disorder abuse drugs or alcohol, their manic depression behavior is often masked by the substance abuse.
In all cases, an early bipolar disorder diagnosis and start of treatment is vital to establishing mood stability and mental wellness. This is especially true when it occurs in children and teens.
Cyclothymic disorder is characterized by chronic, frequent swings between hypomania and depression that occur over a period of at least two years (or in children and adolescents, at least one year). The periods of hypomania are never severe enough to qualify as full manic episodes, and the depressive periods are too mild to qualify as major depressive episodes. A person with cyclothymia is never symptom-free for longer than two months.
While cyclothymia is considered a form of manic depression, many practitioners who do not specialize in mental health often fail to arrive at a bipolar disorder diagnosis.
Finding a Doctor
Ask trusted friends or your primary care physician, or check your yellow pages and your medical insurance company’s list. The importance of finding a mental health professional who has experience in working with major mood disorders cannot be stressed enough.