Until recently bipolar disorder or manic-depressive illness – a brain disorder causing severe changes in mood and energy level – was considered rare in adolescents. Consequently, research into diagnostic criteria and treatment focused on adult manifestations of the disease. In the past several decades, however, research that includes prevalence and age-of-onset data has indicated that at least half of all bipolar disorder cases start before age 25, and some people have their first symptoms during childhood.¹

The characteristics of bipolar disorder in adolescents, notably mania and depression symptoms, are typically defined by how they diverge from the norm for the patient’s age. Age, personal energy level, social environment, and manner of self-expression are assessed, as well as the classic “textbook symptoms” – for example, irritability, grandiosity, impulsivity – that are characteristic of an adult bipolar behavior pattern. However, determining an accurate diagnosis of bipolar disorder in youth can be challenging.

There are three types of bipolar disorder: bipolar I, bipolar II, and cyclothymia. Bipolar I is a recurrent disorder that is characterized by at least one manic or mixed episode, often with one or more episodes of major depression. Bipolar II disorder is characterized by the occurrence of at least one episode of major depression accompanied by one or more episodes of hypomania, a less extreme form of mania. Cyclothymia is a mild form of bipolar that involves less severe episodes of mild depression and hypomania.

The basic diagnostic component of adult bipolar disorder is the distinct separation and duration of episodes of manic and depressive mood episodes. Yet in young people, bipolar symptoms more often include rapid changes in mood, energy level, and behavior. The difference that doctors see in adolescent symptoms is reflected in the terminology they use. For example, “rapid cycling” for adolescents can refer to mood changes within an episode, rather than alternating episodes. “Ultrarapid cycling” refers to brief, frequent manic episodes lasting hours to days (but less than four days), as opposed to the 4-day minimum duration to diagnose adults. And “ultradian cycling” refers to repeated brief (minutes to hours) mood cycles that occur daily. It is important to recognize the nature of adolescent bipolar symptoms, as well as the psychosocial factors that can complicate a diagnosis.² In addition, symptoms of adolescent bipolar disorder can be confused with other mental disorders, including attention-deficit hyperactivity disorder (ADHD) or schizophrenia.³