In the late 1990s and continuing on into the past decade, bipolar disorder started being diagnosed more and more in children. This became a problem only because the criteria for bipolar disorder in children have never been firmly established. Researchers developed their own set of criteria which contradicted the official diagnostic criteria for the disorder. The research criteria basically did away with the need for a manic or hypomanic episode, and instead replaced it with irritability and anger.
Coincidentally, a few pharmaceutical companies also released a set of medications — called atypical antipsychotics — which can be used to treat certain symptoms of bipolar disorder.
Doctors started diagnosing bipolar disorder in children with a looser set of criteria, and felt more at ease prescribing a treatment for it because these new medications had become available.
This set of circumstances led to a reported 40-fold increase in the past decade of bipolar disorder diagnoses in children. This suggests a pretty obvious problem in the diagnostic criteria, since nothing has changed so much in the past decade to offer a reasonable explanation for this sort of increase.
This issue has gotten more attention as of late because of the DSM-5 revision process. This is the perfect time, after all, to ensure the research criteria match the official diagnostic criteria. Such an effort can put a halt to too-liberal diagnosing of children’s simple bad behavior as a “disorder.”1
A new proposed diagnosis called “disruptive mood dysregulation disorder.”
Symptoms of Disruptive Mood Dysregulation Disorder
A. The disorder is characterized by severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation.
- The temper outbursts are manifest verbally and/or behaviorally, such as in the form of verbal rages or physical aggression towards people or property.
- The temper outbursts are inconsistent with developmental level.
B. Frequency: The temper outbursts occur, on average, three or more times per week.
C. Mood between temper outbursts:
- Nearly every day, most of the day, the mood between temper outbursts is persistently irritable or angry.
- The irritable or angry mood is observable by others (e.g., parents, teachers, peers).
D. Duration: Criteria A-C have been present for 12 or more months. Throughout that time, the person has not had 3 or more consecutive months when they were without the symptoms of Criteria A-C.
The disorder must also be present in 2 or more settings (just like ADHD), and the symptoms must appear between the ages of 6 and 10 (I guess 2 to 5 year olds simply can’t be diagnosed). The diagnosis cannot be made in adults.
Is this a good step forward, or one step back?
Something needed to be done about the mis-diagnosis and over-diagnosis of bipolar disorder in children. Clinicians, pediatricians and family doctors have simply been ignoring the official DSM-IV criteria, and making up their own to justify most of the increase of childhood bipolar diagnoses. This situation needs to end.
Some fear the new proposed disorder is simply too squishy:
[Janet] Wozniak, who opposes the new mood-disorder diagnosis, said she fears that its focus on temper and irritability may capture too many normal but volatile children or delay what might be an appropriate bipolar diagnosis and treatment. Accepting the proposed disorder, she said, is “misguided and unconscionable.’’
Wozniak is one of the lead researchers and proponents of kids just being diagnosed with a form of bipolar disorder. She, along with Joseph Biederman, believe that a child’s irritability and aggression is just a different form of mania. Talk about stretching the definition of words…
Luckily, reason and logic has won out in the DSM-5 revision committee, and the proposed new diagnosis recognizes that trying to stretch the adult criteria for bipolar disorder simply doesn’t work very well.
Some other local clinicians applauded Leibenluft for challenging what they describe as excessively flexible criteria used to diagnose bipolar disorder in children, leading to an explosion in new cases. They said clinicians should consider other complex causes for severe mood problems, including family trauma or developmental delays.
And that’s the key problem with childhood bipolar disorder diagnoses today — the criteria already are too squishy, and yet are being used to diagnose hundreds of thousands of children.
It’s likely that the proposed diagnosis, disruptive mood dysregulation disorder, would help solve this problem, and bring some much-needed sanity back to this area of childhood mental disorders.
Read the full article: Proposed new diagnosis for bipolar disorder divides psychiatrists
- We don’t much care for the fast-and-loose way some have diagnosed bipolar disorder in children or the disagreements in the research. [↩]