Childhood Bipolar Disorder and DMDD

A child's mental illness diagnosis can take years to get right, especially when both disruptive mood dysregulation disorder (DMDD) and a childhood bipolar disorder diagnoses are possible. One diagnosis can look similar to another. It takes a skilled provider to tease it out and, let’s face it, as parents, we don’t always know if our providers are the skilled ones. It took three years to get to my son’s diagnosis of DMDD. Prior to that, they briefly considered childhood bipolar disorder. I still sometimes wonder if it’s not.

What Is Childhood Bipolar Disorder?

Bipolar disorder is one of those “famous” mental illnesses that most people think they understand but really don't. It used to be called "manic depression" and there are two types: bipolar I and bipolar II.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM5, bipolar I criteria requires that a person experiences a manic episode at least once. That manic episode has to be preceded or followed by a hypomanic or major depressive episode. A person may then cycle in and out of these moods over time. Bipolar II is similar, but there’s no manic episode. Instead, a person may experience hypomania, a less severe form of mania.

This is a deeply oversimplified description of an often debilitating disorder. See Bipolar Symptoms: What are the Symptoms of Bipolar Disorder? for a more thorough description.

Childhood Bipolar vs ADHD and DMDD

If your child has ADHD, you’ll immediately notice similarities between hyperactivity and mania. The difference between ADHD and bipolar disorder, though, is that ADHD symptoms are persistent. They don't cycle in and out.

If your child, like mine, also has DMDD, it's more complicated. In theory, DMDD lacks mania or cycling moods, so it's not typical bipolar. However, my son seems to cycle in and out of moods. DMDD includes constant irritability with regular destructive outbursts. When a kid's constant irritability is intense, happy cycles are noticeable. While my son always has the hyperactivity associated with ADHD, the symptoms intensify during these happy times.

Is There Really a Childhood Bipolar Disorder Diagnosis?

This is controversial. One problem is there is no real definition of “childhood” bipolar disorder. The same criteria are used for adults and children (Bipolar Disorder in Children: Signs, Symptoms, Treatment). Yet, the illness can look very different in children. Children are more likely to be irritable and have intense, angry outbursts, for instance. Adolescence is so rocky that a typical kid can exhibit bipolar symptoms and not even have bipolar disorder. The main difference is that children with bipolar disorder are unable to function at school or interpersonally.

DMDD was developed partly to deal with this controversy. ¹ It describes children with bipolar-like symptoms, minus the mania. In the past, some children diagnosed with bipolar disorder grew out of it, so DMDD also describes those kids. Because it’s new, treatment is similar for both. Rather than putting kids with DMDD on medication like Lithium, though, they're put on antipsychotics. That’s what they did for my son, and it’s worked.

Should Parents Worry About Childhood Bipolar Disorder?

I don't know the answer to this. I'm worried. I feel lucky that my child appears to be properly diagnosed. The treatments work well for him. Will he grow out of it, though, or will it turn into bipolar disorder? DMDD is so new that there’s not much research on outcomes.

Childhood mental illness already leaves little room for hope. It lowers our expectations and intensifies our worries. It's hard to accept success because you constantly feel the other shoe will drop. My son is doing fantastic, and I need to rest through it.

I'll try to worry about bipolar disorder later.

Resources

¹ The Newest Rage Disruptive Mood Dysregulation Disorder