Guidance for doctors in the recognition of bipolar disorder in teens comes mainly from the treatment of adults. Yet, when bipolar symptoms begin before or soon after puberty they are frequently in the form of rapid-cycling moods and disruptive behavior. It is only in later adolescence that onset tends to begin with a manic episode and is interspersed by more stable periods between episodes, a pattern more similar to adults.
The National Institute of Mental Health points to some differences between bipolar symptoms seen in teens to those of adults. For example, during a manic episode, young people are more likely to be destructive rather than creative or speculative in their behavior. When depressed, they are more likely to complain about headaches, stomach pains, fatigue and other physical symptoms. Young people may also have problems in making and retaining friends and seem to have an extreme sensitivity to perceived rejection or failure.
Even if diagnosed, many teens fear the stigma that may result with both their treatment and the signs they are taking medication. Many resist treatment altogether because they dislike the side effects of medication and often the weight gain that comes with taking them. Drugs and alcohol may be turned to as more acceptable ways of trying to keep the symptoms under control.
Various experts have suggested that modern living contributes to the onset of bipolar disorder in teens who might previously have avoided it. A teen with a genetic predisposition to bipolar does not need much in the way of stress or the use of alcohol or recreational drugs to tip them towards bipolar, or so the argument goes. Structure and routine do appear to help with the symptoms of bipolar and for this reason parents of teens with suspected or diagnosed bipolar disorder are encouraged to set firm boundaries when it comes to routines such as bedtime and getting up for breakfast. Unfortunately these routines are fairly vulnerable when, for example, teens leave home for college or are strongly influenced by peers to participate in late night parties involving alcohol and possible drug use.
It can take a long time before a diagnosis of bipolar disorder is reached. If it is suspected then support in the form of counseling, cognitive behavioral therapy, family therapy or other methods may be helpful to provide meaning and structure. From what is known, a predictable and stable lifestyle appears to be a critical feature in reducing the frequency and severity of bipolar episodes or possibly even preventing their onset.