Symptoms

Bipolar disorder causes cycles of mania (or hypomania, a less severe form of mania) and depression. The different types of bipolar disorder are based on whether a person has more severe symptoms of mania or depression.

• With bipolar I disorder, moods swing between mania and depression, sometimes with periods of normal mood between extremes. Some children with this disorder have episodes of mania and are hardly ever depressed.
• With bipolar II disorder, depression is more prominent than mania, and manic episodes may be less common and less severe.
• With cyclothymia, the high and low mood swings are not as severe as mania and depression seen in bipolar I or bipolar II disorders.
• Bipolar, NOS (not otherwise specified), is diagnosed when symptoms of mania and depression are not frequent or severe enough for the above diagnoses.

In children and younger teens, bipolar disorder tends to be rapid-cycling or mixed cycling:

• Rapid-cycling means that the shifts between depression and mania occur quickly, sometimes within the same day. Often the mood shifts are continuous, rarely returning to a normal mood between extremes.
• Mixed-cycling means that symptoms of both mania and depression occur at the same time.

Following are some common symptoms of bipolar disorder in children and teens.¹

Depression symptoms

• Continuous sad or irritable mood
• Loss of interest in activities that the child enjoyed in the past, such as hobbies, sports, games, or friends
• Significant changes in appetite or body weight (weight loss or gain)
• Sleeping too much or too little or having trouble falling asleep
• Slowed body movements or restlessness
• No energy, or loss of energy
• Inappropriate feelings of guilt or worthlessness
• Problems concentrating
• Recurrent thoughts or talk of death or suicide
• Headaches, muscle aches, or stomachaches

Manic symptoms

• Severe changes in mood from being extremely irritable to overly silly and elated
• Too much energy, such as the ability to keep going without tiring while the child's peers are tiring
• Decreased need for sleep, such as going for days with very little sleep and not being tired
• Talking too much or too fast, changing topics too quickly, and not allowing interruptions
• Increased distraction and constantly moving from one thing to another
• Grandiosity, such as inflated self-esteem or a belief in unrealistic abilities or powers
• Increased sexual thoughts, feelings, activity, and use of sexual language (hypersexuality)
• Increased obsession with reaching goals or becoming involved in too many activities
• Risky, wild, thrill-seeking behavior

During severe episodes of mania, your child may suffer from symptoms of psychosis, such as having hallucinations or delusions of grandeur (for example, telling people that a rock band is coming to his or her birthday party).

Bipolar disorder frequently occurs along with other conditions, such as conduct disorder. And each condition needs treatment.

Untreated bipolar disorder can lead to suicide. Warning signs of suicide in children and teens may include preoccupation with death or suicide or a recent breakup of a relationship.

People sometimes confuse bipolar disorder in children with other conditions with similar symptoms, such as attention deficit hyperactivity disorder (ADHD). Although there is some evidence of a link between ADHD and bipolar disorder, the conditions have distinct features that you can usually identify.

In young children, the symptoms of mania are more than just being a bother to adults and other children now and then. For example, many children can be silly and giggly to a point that it bothers their parents sometimes. This is not considered to be a sign of mania. But if a child is silly and giggly for several hours, several times almost every day, and this is interrupting the family's usual routine, then it may be a symptom of mania.