My friend has all symptoms of BPD, including those of psychosis. She hallucinates and has psychotic episodes of extreme paranoia, delusion, certain movements (such as shaking) which she cannot control or rocking which she says helps her. She also has very strong compulsions to hurt herself in such episodes and is not able to think rationally. On the less psychotic side however, she has mood swings as well and her feelings constantly change about the people she loves. She also has a very low self esteem and low self worth. Like I said, she experiences every symptom of BPD even those that I have not listed here. As a child she has been taken to a professional due to excessive aggression and (yet another symptom of BPD) which I thought I would mention as well since it could be a symptom of something else. She also has symptoms of OCD such as inability to touch things that are ‘dirty’ excessive hand washing, certain compulsions, and obsession with the ‘orders’ that her mind gives her and more. However, as I have read that children cannot be diagnosed with BPD I don’t know if that is in fact what she has. For all I know she could also be schizophrenic or have depressive psychosis as she also depressed and suicidal. Please help!

A. I am assuming that when you write BPD you mean bipolar disorder. BPD can also stand for borderline personality disorder, but the symptoms listed seem more in line with bipolar than borderline. Thus my response will refer to bipolar disorder.

Research suggests that while potentially controversial, bipolar disorder can be diagnosed in children and adolescents. It affects approximately 1 to 3% of the youth population. Studies have indicated that 60% of adults experienced bipolar onset before the age of 20; 10 to 20% before the age of 10. The World Health Organization considers bipolar disorder the fourth leading cause of disability among adolescents worldwide.

Mental health professionals are trained to diagnose youth and are aware that developmentally, there may be differences in how bipolar disorder presents among youth versus adults. Best practices would suggest that a diagnosis of bipolar disorder only be given after performing a comprehensive evaluation of symptoms over time.

It’s also important to keep in mind that diagnoses can sometimes be incorrect and symptoms can overlap other mental illnesses. Bipolar disorder often co-occurs with other disorders in youth including depression, substance abuse and attention deficit disorders. Misdiagnosis is possible, but ultimately it’s treatment that matters most.

What’s most important is that she is in treatment. Consider focusing less on diagnosis and more on symptom improvement. Early treatment by competent mental health professionals significantly increases the likelihood of a positive outcome. Please take care.

Dr. Kristina Randle