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Demystifying bipolar disorder (and why it needs to be demystified)

Teenage girl
Dr. Ben Goldstein

You may be wondering, why does bipolar disorder need to be demystified? Well, misconceptions about this condition can be harmful. If one thinks bipolar disorder in teens doesn’t exist, or is ultra rare, one won’t recognize the symptoms as such. 

At the Centre for Youth Bipolar Disorder at Sunnybrook, we often see teens with relatively longstanding and/or severe symptoms who have never been treated, often because their symptoms have been misattributed to the angst, stress, hormones, or parent-child tensions of adolescence. Whereas these issues affect most everyone, 19 out of 20 teens don’t have bipolar disorder. 

Bipolar disorder vs. “teen-itis”

So what’s the difference between bipolar disorder and a bad case of “teen-itis?” Briefly, a diagnosis of bipolar disorder requires that someone has had “episodes” of mania or milder hypomania, usually alternating with depression episodes. These mood episodes are defined by a cluster of symptoms that cause a change in day-to-day functioning, generally lasting days to weeks for mania/hypomania and weeks to months or even years for depression. Many teens have “great days” with very happy mood, lots of productivity, and perhaps boosted energy. But on those days do they also make uncharacteristic, risky decisions? Lose their need for sleep? Talk so much and so fast that they can’t be interrupted? When these symptoms cluster, persist, and change behaviour, it’s time to carefully consider diagnoses other than “teen-itis.”

Bipolar disorder as a mental illness

Another theme that needs to be demystified is the concept of bipolar disorder as a “mental” illness. Bipolar disorder is a mental illness, of course, but only because we define it that way. In fact, the symptoms are the end result of environmental factors interacting with genetic factors to produce biological disturbances that cause these symptoms. The same is true for most complex diseases. There are clinically useful objective tests for arthritis, cancer, and diabetes, which make these diseases “real.” There are no tests for bipolar disorder. So is it “real”? Of course it is. Bipolar disorder runs in families, responds to specific treatments, and is different from other disorders (despite some overlapping symptoms, which is a topic for another day). But there are no tests for bipolar disorder, only tests to rule out other medical conditions. Why does this matter? Without tests or “biomarkers,” it is hard to predict the course of bipolar disorder, predict and measure treatment response, or predict who is going to develop bipolar disorder in the future.

But perhaps the biggest problem caused by the lack of tests for bipolar disorder is stigma. Although bipolar disorder is the fourth most disabling condition among teens worldwide, and despite Canada’s national health care system, most teens with bipolar disorder have never been treated for bipolar disorder. Lack of recognition of bipolar disorder in teens, and reluctance to seek care as a result of stigma, are two major barriers to receiving care. Our hope is that demystifying bipolar disorder through education and research will help pave a smoother road for teens and families.

About the author

Dr. Ben Goldstein

Dr. Ben Goldstein

Dr. Ben Goldstein is a psychiatrist and Director of the Centre for Youth Bipolar Disorder at Sunnybrook.

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