There are no easy answers.

But what I try to do in these columns about therapy is to at least raise the questions. To build awareness. So that readers can make educated choices instead of experiencing panicked reactions.

Sometimes, parents bring a teen into therapy with symptoms like decreased need for sleep, risk-taking behaviors, and racing thoughts. It is important, when a teen's behavior changes drastically—or appears to change drastically (often a teen will tell me how this has been happening over many years, but only now is she unable to hide it any longer), to always rule out physical illness before jumping to conclusions about a clients mental health. So a visit to a pediatrician is always in order before beginning therapy. (Yes, I absolutely believe PANDA exists. And it must be treated with anti-biotics to address first the illness and then incorporate therapy to deal with the behavioral changes this disease effects).

Once physical causes for these behavioral changes has been ruled out, a psychiatric evaluation may be necessary to rule out a mood disorder that can have its onset in the teen years such as bipolar disorder, depression, dysthymia; or a mental illness like schizophrenia.

With teens, it's hard to always know if their behavior is the normally abnormal behavior we expect from adolescents or if there is an underlying problem. It's also hard to know if the acting-out behavior is a symptoms of a mood disorder or if it's a symptom of trauma or abuse—even if the abuse had occurred many years prior (often, with teens, the acting-out symptoms of abuse occurs years after the abuse may have occurred, usually coinciding with a teen's beginning of the coming-into-adulthood stage).

So, it's disturbing to me as a therapist, when one of two things occur: Parents jump to medicate children, glad to pin the child with a diagnosis of a mood disorder rather than deal with the underlying issues that may be causing these abnormal behaviors; or, when parents refuse to accept their child's mood disorder and fight the medications that can help their child function optimally, instead blaming the behaviors on external factors that may or may not be significant at all.

And worst of all, I will admit that diagnosing a teen with a mood disorder is difficult. Especially with one severe as Bipolar I, because the symptoms may mimic those of ADHD or PTSD, and it may take many months, even over a year to uncover abuse and trauma that may have precipitated these behaviors. If it is unknown if abuse has occurred, it may take a client over a year to feel safe enough to disclose; in the meantime, Bipolar I Disorder may be suspected. What to do?

Like I said at the start of this column, there are no easy answers only questions to develop awareness.

So what is Bipolar I Disorder? First of all, it is not a personality disorder.

Personality Disorders are mental illnesses that constant in a person's life. They manifest themselves in every aspect of a person's life such as interpersonal functioning, emotions, thoughts, and impulse control. Mood disorders, such as depression and bipolar are mood disorders with distinct mood episodes. There is no such thing as a bipolar personality disorder, although there are personality disorders like obsessive personality disorder, borderline personality disorder, paranoid and narcissistic personality disorders. You can understand this distinction by comparing a personality disorder to an actual limb of a person, an intrinsic part of a person, if it is handicapped limb versus a mood disorder that is a virus or infection that is within a person, but it is apart from the person at the same time.

(And I also want to note that apart from Bipolar I, there are three lesser forms of Bipolar identified as Bipolar II, Bipolar NOS, and Cyclothymia that have less severe symptoms.)

So Bipolar I is a mood disorder. Oftentimes Bipolar I is diagnosed by the manic—or highs—of the disorder because otherwise the depressive manifestations—or lows—can be mistaken for a depressive disorder. And these are the common manic symptoms: Feelings of grandiosity (unrealistic/overwhelming sense of self or self esteem), a decreased need for sleep (sometimes as little as 2-3 hours), incessant talking, racing thoughts and rapidly changing ideas, high distractibility while paradoxically an laser focused activity to the exclusion of all else at home or work, and excessive pleasurable activity usually with negative consequences (i.e. shopping, gambling).

Bipolar I always must be paired with depression, which would include the common symptoms such as significant weight loss or gain, feelings of lack of self worth or guilt, inability to concentrate, fatigue or loss of energy, lethargy, sleeping too much or insomnia, and even suicide ideation.

Originally, this illness was called Manic-Depressive because of the two parts of the mania and depression. We call in Bipolar today.

People with Bipolar I disorder are often hospitalized when their grandiosity or reckless behavior in the manic episodes create a danger to themselves or others. For example, their feelings of godlike power can cause them to speed dangerously, or go without sleep for days or hours that can create an unsustainable situation in which they will inevitably crash.

It is unsure what causes Bipolar I disorder, but research does point to a biochemical imbalance in which there are deficiencies in hormones and neurotransmitters in the brain like seratonin which has a calming function. There is also evidence of an oversecretion of cortisol, a stress hormone, in people diagnosed with this disorder. What is always linked to this disorder is the sleep abnormalities, which may be triggered by a person's biological clock that may be super-fast, thereby disrupting the normal sleep-wake cycle.

What is certain is that Bipolar I has strong genetic tendencies, in which a person who has a parent or twin with this disorder have a very high likelihood of having this disorder as well.

The good news is that treatment for Bipolar Disorder is very effective and enables those diagnosed with it to lead healthy, productive lives. Treatment consists of medication and ongoing therapy—probably for the rest of a person's life. But so as not to scare anybody, when I refer to therapy for the rest of a person's life, once a person is stabilized, and stable, maintenance therapy can be monthly, bi-monthly, or even as needed. It doesn't mean the once-a-week commitment forever.

Bipolar is not a death sentence. On the contrary, the mania of Bipolar has the potential to be very creative and successful. Many famous historical figures like Mozart, Van Gogh, Mark Twain, and Winston Churchill are suspected of having Bipolar Disorder. Which is why medication is often resisted by those diagnosed. They feel their creativity is stifled and smothered by the effects of the medication and that becomes a challenge. Without medication, their system goes haywire and they can't function normally in society and in relationships; with medication, the side effects may dampen the aspects of themselves that are creative and feels happy.

What to do when someone you love is acting erratically and you suspect Bipolar?

Begin to ask questions. Build awareness. Seek help. Love them even more.

NOTE: THIS WAS ORIGINALLY PUBLISHED IN BINAH MAGAZINE

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