Young people at risk of bipolar often have co-occurring common mental health problems, including self-harm
Submitted by Sue Fen Tan
Bipolar disorder is diagnosed when someone has such elated mood that it affects their function and relationships. They may or may not also have depression. We know that up to two in 100 young people around the world have bipolar disorder, more so in later teen years. Young people with mental health difficulties are sometimes referred to NHS Child and Adolescent Mental Health Services (CAMHS) for support. If we understand the characteristics of young people at risk of bipolar disorder who gets referred to CAMHS, we may be able to identify bipolar disorder and start treatment earlier.
We studied 305 young people between the ages of 11-17 years in England who had mood difficulties and were referred to CAMHS as part of the STADIA trial. These young people and/or their parents/carers had to complete the bipolar disorder section of the Development and Wellbeing Assessment questionnaire.
We found that three in 100 of these young people had possible bipolar disorder, and that they also typically scored highly for depression, social phobia, and generalised anxiety disorder. However, none of these young people were diagnosed with bipolar disorder by CAMHS. Despite this, their referrals were more likely to be accepted by CAMHS and they were more likely to be offered or start treatment for other mood disorders within a year compared to those not at-risk. All young people with possible bipolar disorder thought about harming themselves within the last half of the year, and these thoughts lasted for another year. Seven in 10 of these young people harmed themselves after a year.
I’m a young person – what does this mean for me?
You may not always recognise elated mood, especially if you are struggling with your mental health. Sometimes instead of elated mood, young people with bipolar disorder may complain of irritability and rapid mood swings. Rapid mood swings may also be present in other conditions like ADHD and emotional dysregulation. Therefore, it is important that you seek help from professionals if you have concerns about your mood to get the right diagnosis and support.
I’m a parent – what does this mean for me?
Most of the symptoms of bipolar disorder are obvious, but young people may not always share about their mood. If you notice rapid mood changes or elated mood lasting for more than a week, please seek help from a professional. Even if they don't have bipolar disorder, they may have other mental health conditions and higher risk of self-harm.
I’m a clinician – what does this mean for me?
Young people at risk of bipolar disorder usually have other mood and neurodevelopmental mental health conditions, persistent difficulties, and high self-harm thoughts and behaviours. The onset of bipolar disorder is often in late adolescence, and there is an opportunity for timely diagnosis and treatment in CAMHS. However, young people sometimes do not present with classical mania symptoms, so it is important to be aware of other potential presentations. Although bipolar disorder is uncommon in young people, it should not be overlooked as a possible differential diagnosis in CAMHS.