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Co-Occurring Disorders in Teens: Bipolar Disorder - The Great Imitator

Angry outbursts, erratic sleep patterns, sudden mood swings, and changes in personality. If you’re a parent of a teenager, these behaviors can be the status quo—actually, we often take these behaviors for granted. When teens are in trouble, when they are struggling to cope with issues that are too difficult for them to handle, drinking or getting high makes these behaviors worse often to the point of frightening us.

Symptoms of substance misuse often mimic other behaviors and make it hard to figure out exactly what’s going on in kids who are getting high. We know that kids (and adults) get high to help manage the difficult emotions associated with life’s challenges. And we know that adolescence presents them (and us!) with unique challenges.

Your parental instinct that something is wrong is often correct, but understanding the difference in the root causes of their erratic behavior will help you decide what course to take with your child.

Sometimes the issues are normal external pressures, like arguments with friends, academic expectations, real or perceived rejections by others.

Sometimes the issues are internal, relating to your child’s coping style, temperament, or ability to tolerate frustration. When bipolar disorder is present, however, the internal issues are also related to your child’s brain functioning.

How Substance Misuse Symptoms Can Mimic Bipolar Disorder

It’s important to understand that bipolar disorder is a medical condition of the brain. The person experiences extreme highs (mania) and extreme lows (depression). When I explain below more about what bipolar disorder is, you’ll see how easily it can be misdiagnosed in children and teens as major depression, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder.

During a manic episode, a person’s mood is noticeably euphoric, irritable, or aggressive. It is common for a person who is manic to think that nothing is wrong with their behavior even though it is extremely distressing to family and friends.

During a depressive episode, a person may feel sad or lose interest in previously enjoyable activities. When severe, thoughts of suicide may be present. Someone with bipolar disorder can experience a variety of mood patterns, such as having mostly episodes of mania or mostly episodes of depression. Another person may cycle rapidly between the two. It is also possible for someone to remain symptom-free for extended periods of time.

Bipolar Disorder and Children

Another important thing to know is that bipolar disorder looks different in children and teens than it does in adults. When children or teens have bipolar disorder, they have mood swings with extreme ups and downs. When they are up, they have brief, intense outbursts or feel irritable or extremely happy (mania) several times almost every day. They have a lot of energy and a high activity level. When they are down, they feel depressed and sad.

Children more often experience several severe mood swings in a single day versus the sustained and clearly defined manic episodes that adults have. These intense moods quickly change from one extreme to another without a clear reason. Some children may briefly return to a normal mood between extremes.

Many children change continuously between mania and depression, sometimes several times in the same day. Sometimes children with bipolar disorder have symptoms of both mania and depression at the same time, often showing itself as agitation or extreme irritability.

But because of the “normal” ups and downs of adolescents or for children with sensitive temperaments, times of mania or depression may be less obvious in children and teens than in adults. It’s often difficult to sort out what exactly is going on.

Normal ups and downs of adolescence are exaggerated greatly when kids are drinking or getting high. As with adults, children will resort to getting high in an attempt to feel “normal” or balance out the “feeling crazy” that bipolar contributes to. That’s why when substance abuse is in the picture things get even more confusing.

The good news is that bipolar disorder can be effectively treated usually with a proper combination of medication and counseling. Getting a thorough evaluation by a professional who is experienced with mental illness and addictions is your best bet in determining what course of action to take.

As always, education and support are the best antidotes to the fear and helplessness we feel as parents when our children are suffering from bipolar disorder.

Other excellent resources to learn about bipolar disorder and get support are the Depression and Bipolar Support Alliance and the Child and Adolescent Bipolar Foundation has a great site especially for kids.

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