October 11, 2021
- What is Bipolar Disorder?
- Causes of Bipolar Disorder in children and young adults.
- Symptoms of Bipolar Disorder.
- Treating Bipolar Disorder
- What types of professionals are involved?
- The journey of treating Bipolar Disorder
- How to support someone with Bipolar disorder
- How can I support my child with Bipolar disorder?
- Useful resources
What is Bipolar Disorder?
Bipolar disorder also known as manic depression, is a serious and long-term mental illness that causes a person’s mood to swing between two extremes. This includes:
- Mania/Hypomania – Experiencing high moods, irritability and a big increase in activity.
- Depression – Feeling sad, having low mood, irritability or loss of interest. Bipolar disorder is more common in younger age groups between 16-24 years old. It is not like the common mood swing. Bipolar disorder is severe. It can cause problems in the everyday life of a child or young person and can sometimes lead to hospitalisation.
During an episode of depression, people with bipolar disorder can be overwhelmed by feelings of worthlessness. Because of this, people with this disorder can often have thoughts about suicide. It is important to pay attention to these signs so that the right support can be given early on to prevent serious harm.
Symptoms also disrupt daily lifestyles in that children aren’t able to perform well in school, get along with family members and may get negative thoughts of hurting themselves.
Bipolar disorder differs from other mood disorders such as depression in that with bipolar disorder you also experience durations of great highs. Depression is more focused on feelings of hopelessness and emptiness whereas bipolar disorder revolves more around manic episodes or hypomania and depression.
Bipolar I disorder is a mental condition which was also defined as manic depression, whereby an individual experiences at minimum one manic episode in their life. A manic episode can be described as a period of irritable mood and high elevated energy that disrupts lifestyle. Individuals may also experience depressive episodes, but not all of them do.
Bipolar II disorder is defined by a pattern of depressive and hypomanic episodes, however, the episodes are less extreme than manic episodes of bipolar I disorder. During hypomania, mood and behaviour are greater than what the majority of people experience. An individual diagnosed with bipolar II disorder will have at least one depressive and hypomania episode. The severity of the time length of the episodes varies from person to person.
Causes of Bipolar Disorder in children and young adults.
While the exact cause of bipolar disorder is unknown, we are aware that there is a combination of physical, environmental and social factors that contribute to the likelihood of an individual developing the disorder.
Biological abnormalities in the brain
Chemical imbalances have shown links to developing symptoms of bipolar disorder. Neurotransmitters such as noradrenaline, serotonin and dopamine are the body’s chemical messengers and without them, the body can’t function. Hence in cases of abnormalities and imbalances, an individual may develop symptoms of bipolar disorder (e.g. manic episodes due to high levels of noradrenaline)
While there is no specific gene that is responsible for bipolar disorder, it is recognized to run in families. Having a family member diagnosed with bipolar disorder increases the likelihood of developing it.
There are also environmental factors that increase the likelihood of bipolar disorder symptoms such as:
- Death of a loved one
- Relationship breakdown
- Physical, emotional or sexual abuse
- Sleep problems
- Stressful life events (e.g. money, work pressure)
- Change and uncertainty
Symptoms of Bipolar Disorder
It is likely that a person has bipolar disorder if they experience episodes of mania/hypomania and depression or a rapid mixture of these two states. It is common for people with bipolar disorder to start off with a period of depression.
The symptoms of mania can include:
- Elevated mood, extreme irritability or aggression
- Having lots of energy, being highly active
- Speech that cannot be understood
- Not feeling the need to sleep for long or at all
- Having lots of racing thoughts and ideas
- Difficulty to concentrate
- Having extraordinary ideas or unrealistic plans (e.g. financial investments)
- Increased desire to engage in sexual activity
- Having psychotic symptoms (e.g. delusions or hearing voices)
Hypomania is the term used for the milder form of mania. These milder symptoms can include:
- Mild elevated mood or irritability
- Mild increase in energy or activity (e.g. in work performance social life or school)
- Feelings of intense satisfaction with life, mental efficiency
- Increased talkativeness, being overly friendly
The symptoms of depression include:
- Feelings of sadness and low mood
- Lack of interest or pleasure in usual activities
- Difficulty to concentrate
- Feelings of worthlessness or guilt
- Lack of appetite
- Problems with sleep
- Thoughts/acts of suicide or self-harm
The episodes experienced in bipolar disorder can cause more problems in everyday life and can sometimes pose real dangers to safety.
These problems can include:
- Financial issues (e.g. due to overspending, investing, buying lottery tickets)
- Injuries or accidents (e.g. from driving at high speeds or engaging in reckless activities)
- Neglect of own hygiene
- Sexually transmitted infections
- Behaving inappropriately at school or at work
- Dehydration or feeling exhausted (e.g. from not sleeping for many days)
- Can be taken advantage of by others (e.g. to spend money or to take part in sexual acts)
- Misuse of alcohol and other substances
“Dave is 19-years-old. He suffered from an intense period of depression a few months ago. Since starting college, he switched from history to philosophy and is convinced that he is going to revolutionise the field. There have been weeks where Dave hardly slept, spending hours online looking up new ideas. Dave has also had many sexual relations in the last few weeks, which his close friends say is not like him. Dave recently used his parent’s emergency credit card to purchase expensive courses, saying that he is going to change the world with his new knowledge. His parents have noticed these extreme behaviours and believe that it will be good for Dave to speak to a mental health expert.”
Treating Bipolar Disorder
The treatment and management of bipolar disorder are lifelong. It helps the episodes of mania/hypomania and depression to be less intense. This usually involves a comprehensive treatment plan that aims to help people achieve goals for their recovery. The doctor or psychiatrist will take the time to come up with a plan that is right for each person.
Medication is usually the first treatment that is given for bipolar disorder. It helps the brain to balance certain chemicals that cause the episodes. Mood stabilisers are prescribed for mania/hypomania and anti-depressant medication for depression. Different people respond to each medication differently. The doctor or psychiatrist will adjust the medication in a way that works for each person.
Cognitive behavioural therapy (CBT) is a type of talk therapy that focuses on how we think and act and how this affects how we feel. Research shows that CBT is effective in helping people with bipolar disorder to have less severe episodes.
The idea behind CBT for bipolar disorder is to help the young person monitor and manage the thoughts, actions and feelings that might make the depressive symptoms worse.
During the sessions, the young person will learn about bipolar disorder and how it works. They will also learn to spot certain warning signs for changes in mood. The young person will learn to make changes to the way they think about certain situations, as well as learn to problem-solve and develop social skills.
Eventually, the young person will develop their personal toolbox for coping with depression in a healthier way.
Interpersonal psychotherapy (IPT) is a type of talk therapy that focuses on the young person and their relationships, as a way to manage depressive episodes. Research shows that IPT is helpful in reducing depressive symptoms in bipolar disorder.
The idea behind IPT is that relationships are always involved in the course of depression. So by helping relationships to get better, depression will also get better.
The young person will develop an understanding of how their relationships affect the way they feel. They will learn the skills that will help their relationships to improve. These might include communication skills, conflict resolution, problem-solving and other relational skills.
There is also a variation of IPT that involves focusing on the social rhythms in the person’s life. The therapist might also help them to adopt a regular daily routine that encourages discipline in areas such as taking medications, having a good bedtime routine, going to work and making social contact.
Eventually, the young person will have improved their relationships and daily routine, which will reduce the symptoms of depression.
Family therapy is a type of therapy that focuses on the family as a whole, as a way to support the young person in coping with bipolar disorder.
The idea behind family therapy for bipolar disorder is to strengthen family relationships and the ability to work together to manage the disorder. This can help the person to recover from episodes quicker and experience less severe symptoms.
The family will learn how to resolve conflict and improve communication and emotional bonds. By working together, they will learn to take helpful actions that will help to support the young person when they are having difficulties.
Eventually, the family will build a strong support network that will be responsible for spotting warning signs and encouraging the person to get the most out of their treatment.
A crisis plan is also important to have as sometimes people with bipolar disorder can feel like they are not able to cope and can have thoughts about self-harm or suicide. The doctor, psychiatrist or mental health expert might propose certain actions that can be taken in these situations. This might include encouraging the person to contact crisis services. A list of these can be accessed on the NHS website. Crisis teams are made up of mental health professionals who are there to offer urgent help on a 24-hour basis.
Lifestyle changes can help when coping with bipolar disorder.
- Keeping active and eating healthy: Staying active can be very helpful for fighting against depression by helping the brain release natural “feel-good” chemicals. Exercise and healthy eating can also help to keep off excess weight, which can be the side effect of certain medications for bipolar disorder.
- Getting more sleep: Having a good sleep routine can be very helpful for concentration and to be able to cope with emotions better throughout the day.
- Talking about the condition with loved ones: Sharing feelings with loved ones can stop you from feeling isolated and alone. Loved ones can also spot when there are changes in mood and can take the necessary actions to make sure that you are taken care of.
- Engaging in support groups: There are many support groups with others recovering from bipolar disorder that are available online and in different local areas. This is also a great source of support that can help you to know that you are not alone.
What types of professionals are involved?
There are different professionals that may or may not be involved throughout the treatment process of bipolar disorder in young people. These might include counsellors, psychotherapists and doctors/psychiatrists, mental health nurses, support workers and social workers. These terms might be confusing, but the main difference is in the training that each of these professionals has received.
In the UK, there is not much of a distinction made between counsellor and psychotherapist. Both of these professionals provide therapy. However, there are some slight differences between these two professional terms. These are outlined below.
Compared to psychotherapists, counsellors tend to have had shorter training and they help people deal with their issues on a more short-term basis. There may be school-based counsellors available that children and young people can approach at their own school if they feel they need support with their difficulties. Here at Mindsum, we have counsellors who are available to provide support.
Psychotherapy training tends to be longer. Psychotherapists can also give counselling but their approach to talking therapy is more in-depth, exploring the history and causes of certain behaviours and emotional issues. The psychotherapist will work with bipolar disorder in this specialised way. Here at Mindsum, we have psychotherapists who are available to provide support.
There are also doctors and psychiatrists who are involved in the treatment of bipolar disorder. There are more obvious differences between these two professional terms.
These are professionals who are trained in medicine. This will likely be the family GP, who might find it necessary to prescribe certain medications that might help the person cope.
These are professionals who are also trained in medicine. However, they also specialised in the field of psychiatry. Psychiatrists will prescribe certain medications that will help with the episodes of bipolar disorder.
Mental health nurses
Nurses trained in mental health might also be involved. If the young person is in a hospital setting or is seen by a crisis team due to self-harm or suicide, a mental health nurse might help to give treatment by administering medication.
Workers trained in helping vulnerable people to live better lives might also be involved with the young person. This might be within a community setting or a crisis situation. Their role is to provide emotional and practical support (e.g. helping parents to cope, helping with paperwork, and making child-care arrangements).
Workers trained in protecting vulnerable individuals might also be involved. This might be within a community or a crisis situation. Social workers will problem-solve and organise the right support for the young person to ensure their protection.
The journey of treating Bipolar Disorder
When it comes to bipolar disorder, it is about management as opposed to recovery. This is because bipolar disorder is a life-long condition. The way bipolar disorder is managed can look different for each young person. However, there are some things that are expected when going through therapy for bipolar disorder.
This is an important phase, where the psychiatrist or doctor will first assess the young person. They will ask many questions, including certain questions about mania, depression and the possibility of self-harm or suicide. This will help to create a full picture of what is going on and to know what type of treatment will be most helpful. From there, the doctor might decide on a treatment plan that includes medication, psychological therapy and a crisis plan for the person.
These sessions will take place on a more long-term basis. An important aspect of the therapy session is the relationship the counsellor or psychotherapist will build with the young person and the family. This will create a safe space to encourage them to explore their difficulties. The sessions will equip the young person and the family to understand and manage the episodes of bipolar disorder.
This can be an important part of treatment. The therapist might get the young person and family members to practice certain tasks at home. Homework tasks will help the young person and the family to develop a sense of achievement and mastery in coping with bipolar disorder.
The psychiatrist or therapist may have made agreements with the person on what to do if they experience sudden desires to self-harm or commit suicide, due to intense depressive episodes. For this reason, it may happen that other mental health staff will need to see them at their home or at the hospital to provide support.
Progress and setbacks
When having treatment for bipolar disorder, there will be progress and setbacks. Even with successful therapy, the person might still experience some extremes in their mood. It is important not to feel discouraged when this happens, as this is normal when dealing with bipolar disorder.
These situations provide opportunities to discover new ways to move forward together with the mental health experts involved in the treatment.
The counsellor or psychotherapist will eventually prepare the young person and the family for the end of therapy. The end of therapy will take place once the young person and the family have made a lot of progress and have reached their treatment goals. The young person and the family will leave therapy with many skills that they can use without the help of the therapist.
The young person will continue to see their psychiatrist throughout their lives. The counsellor or psychotherapist might schedule follow-up meetings to check how the young person copes. If they are doing well, there will be no need for more support. But if they continue to have challenges, this will be an opportunity to have extra support.
How to support someone with Bipolar disorder
It can be challenging when you have a loved one who has been diagnosed with bipolar disorder. Especially, since it is a condition that affects many areas of the person’s life. Fortunately, there are some things that you can do to help. These are discussed below.
Understand bipolar disorder
It is a good idea to read as much information about bipolar disorder as you can. Understanding this disorder and how it works will help you to recognise the signs that your loved one needs help.
Help them to feel supported
A loved one with bipolar disorder can feel isolated sometimes because they struggle with a condition that can be difficult for others to understand. Your attitude towards them can make a big difference.
Show acceptance: They might be struggling with very negative thoughts or they might feel embarrassed after certain episodes. For this reason, it is important to show acceptance and remind them that they are loved and valued no matter what.
Give validation: Their episodes might be something that is difficult for you to understand, but it is a real problem for them. Avoid saying things like “Just snap out of it”. Acknowledge that this is a real problem for them with an attitude that is non-judgmental and non-critical.
Be patient: During certain episodes, the person might be impulsive, aggressive or rude towards you. Do not feel discouraged if this happens. Learn to separate the person from the disorder, stay calm and continue to show your support.
Help them to find the right support
Encourage them to find support through a GP, psychiatrist or therapist. If this involves your child who is under the age of consent, you can contact these services. You might:
- Help them to book an appointment with a GP, psychiatrist or therapist
- Offer support when they attend appointments (e.g. waiting in the waiting room or attending some sessions if you need to)
- Help them search for support groups or self-help resources
- Encourage them to keep attending sessions and to not give up
- Learn about their medication
- Give them reminders to take their medication
Know when to get urgent support
When your loved one is experiencing an extremely low mood, it is good to keep an eye out for signs of self-harm or suicide. If you suspect that your loved one is at risk of hurting themselves, you should get immediate support.
You should contact a GP or the NHS urgent helpline.
Know the warning signs
Most people will have some warning signs before they experience an episode of depression or mania. It will be helpful for you to pay attention to the behaviours that you usually notice before an episode.
For example, you might observe increased energy and more restlessness before an episode of mania. Knowing the warning signs will allow you to talk about it with your loved one, and to be prepared to take action.
Ask them what they need
They may or may not be able to tell you what they need, but it is always good to ask. They might let you know other ways that you can help. This way you won’t have to figure it out on your own.
Plan support in advance
Have a conversation with your loved one and plan out what you and others can do during an episode. You might want to consider the following:
- Make sure you have a list of emergency contact services
- Taking hold of bank cards, vehicles or any other important assets
- Be ready to prepare meals that are easy to eat, especially when they are unwell
- Think about helping them with their usual tasks that they won’t be able to get done
- Talk with your loved one and their healthcare provider on what to do if they refuse to take their medication
Help them to reduce stress
You can find different ways to reduce the chances of an episode being triggered by helping them avoid stress. For example, you might:
- Try to keep a positive atmosphere at home
- Volunteer to help them with work or other deadlines
- Encourage them to do activities that relieve stress (e.g. light exercise, deep breathing)
- Keep the environment quiet with few stimulations
Talk about challenging behaviours
Sometimes when your loved one is unwell, they might do or say things that are offensive, cruel or embarrassing. It is reasonable for you to feel upset by this. For this reason, it is good to talk to your loved one about these behaviours in a calm way.
You might be able to gain a better understanding of these difficulties from their point of view. By having open conversations, you can avoid feeling resentful towards your loved one. This will put you in a better position to continue to support them.
Look after yourself too
It is extremely important for you to look after yourself. Whether you are a parent, family member or a friend, you will be in a better position to give help, as long as you are taking care of your own well-being too. To do this you might:
- Get other family members involved in supporting your loved one
- Schedule some time off for yourself
- See a professional that can support your mental health
How can I support my child with Bipolar disorder?
In order to support your child with bipolar disorder, it’s vital to seek advice from a medical professional to ensure the right diagnosis and treatment.
The following is a list of things parents/guardians can take into account to do on their behalf in supporting your child:
- Having patience
- Make sure your child has fun, do things that they enjoy
- Stay on board with the treatment plan and medication schedule – inform others around them e.g. teachers and school nurse about medication needed to be taken at school
- Communicate with teachers about your child’s bipolar disorder so they can adjust on their side to support the child during difficult times, e.g. less homework/extra breaks
- Reassure your child that treatment takes time and eventually will make life better
- Family therapy – communicate and educate all members of the family of how to deal with any such disruptive situations that may appear due to having a child with bipolar disorder
- Monitor side effects of medication – follow up with health care provider if any unusual side effects appear and negatively affect symptoms
To read information about helping someone with bipolar disorder on the Bipolar UK website.
To read information about helping someone with bipolar disorder on the MIND website.
For urgent support
The British Association for the Counselling Professions (BACP) have a useful document on different aspects of therapy.
You can get more information about bipolar disorder on the NHS website. NHS also offers access to a list of crisis helplines. Click here to access the link.
Provides resource information for parents/carers about symptoms and support.