The Bipolar Child

Jason, an energetic but feisty client of mine, wore the word bipolar on his sleeve. He had virtually every symptom of the disorder and struggled to keep his adolescent life together. One problem that consistently reared its ugly head was significant friction at home. When Jason's symptoms got bad—and they got really bad—the whole family suffered and conflict ensued between Jason, his parents, and sisters. Navigating the impact of his illness on his family was critical in his treatment because I wanted to reduce his stress—not add to it at home.

Given the challenges Jason and other sufferers face, a study in the Archives of General Psychiatry arrives like a beacon of hope. It found that a specific type of therapy, Family-Focused Treatment (FFT), drastically reduces the symptoms for adolescents who suffer from bipolar disorder. The study followed 58 adolescents over a two-year period. In a nutshell, FFT involves the whole family with the idea that the family's reaction to the disorder is critical.

Bipolar disorder is a juggernaut. It is one of the most severe mental disorders a person could have and it severely impacts the lives of those suffering from it. While other disorders, such as depression and anxiety, may dissipate or even disappear later, bipolar disorder is often a life-long illness that requires constant, vigilant management.

The trademark symptom of bipolar is a major mood imbalance. The person may go from depressed lows to euphoric highs, or may experience other shifts in mood that severely affect the person's ability to function. For example, people who have this disorder often have great difficulty keeping a regular sleep schedule. It's not unusual for sufferers, who are not medicated, to be up for two or three days straight because mind and body simply won't let them sleep.

When we're talking about adolescent sufferers, the associated issues are in a league of their own. The impact of the disorder on the adolescents' lives and families isn't pretty—as a rule adolescents are sometimes already difficult to manage without the added complexities of this disorder.

The situation is often difficult for family members because they experience the sufferer's moment-to-moment symptoms first-hand. Because the bipolar adolescent goes through major mood spells and typically feels a loss of control, the mood shifts often set the tone for the entire household. Parents and siblings often walk on eggshells because they never know what to expect next.

In addition, when the sufferer goes into a manic cycle, the inability to sleep can disrupt everyone. The sufferer can be making noise all hours of the night, and it can be difficult for others in the household to sleep. If your husband had the disorder, you would wake up at 4 a.m. and find him absent. This would cause concern even under normal circumstances. The concern jumps to a whole new level if you're dealing with a bipolar adolescent.

Every parent worries about their kids—say they fall into the wrong social group or experiment with drugs. But a parent who has a bipolar adolescent has additional worries. Such parents must consider whether their adolescent is rebelling and not taking her meds; whether the adolescent will suffer long-term damage to his schooling; and whether normal teen angst could morph into suicidal thoughts. A manic cycle exacerbates parents' worries a thousand fold because the adolescent with bipolar has so much energy—the sky's the limit, unfortunately. If the sufferer is your brother or sister, you may feel afraid or worried, as well. On the other hand, you may get wrapped up in your own stuff and react impatiently to the sufferer and her symptoms. Simply put, the outbreaks of severe symptoms may not jive with your expectations or your schedule for the day, so you might snap and lash out at the sufferer. The cold reality is that young siblings may feel bitterness toward the sufferer, and may consider him a 'freak.'

Because the whole family is severely impacted by the tidal wave that is bipolar, the family needs attention when it comes to conceptualizing the best treatment for the adolescent sufferer. If the family knows about the disorder and is supportive, the adolescent sufferer will often benefit. According to the recent research about FFT, a family's proper management of the disorder can improve the child's prognosis. The ultimate benefit for the family is indirect: When family members help sufferers like Jason, symptoms will lessen and life inside the household will endure fewer interruptions.