Bipolar Symptoms in Teens: Early Signs and Diagnosis - University of Utah Health Care

Feb 16, 2022 8:00 AM

Author: University of Utah Health Communications

It's common for teenagers go through emotional ups and downs and do things that don't seem rational. As a parent, it can be frustrating to figure out how to help and support your child through the teen years. But sometimes, a teenager's behavior is so erratic it leaves you wondering: Is this just typical teen behavior? Or could the behavior resemble bipolar symptoms in teens?

The Difference Between Teen Mood Swings and Bipolar Disorder

Parents often say a teen's mood changes from minute to minute. But mood changes are normal in adolescents. They're still developing effective ways to manage their feelings, says Kristin Francis, MD, child and adolescent psychiatrist at Huntsman Mental Health Institute. "Adolescents can have intense mood shifts and responses. So, it's hard for parents to distinguish if it's typical teen behavior or something more serious."

The best way to tell the difference is to determine if your teen's mood changes are in response to a specific, definable situation, says Francis. For example, it's common for teens to:

• Act irritable after being asked to do chores, get off their phone, or stop playing a video game.
• Express anger during a conflict with parents about grades.
• Seem moody and retreat to their room after a fight with a friend or significant other.

"Bipolar mood changes don't usually have a trigger, which is different than mood changes you may see in your teen from stressors at school, rules at home, or from conflicts with parents," Francis says. She discusses what bipolar symptoms in teens look like and what to do if you're worried about your child.

What Is Bipolar Disorder?

Bipolar disorder (BD) is a mental health condition marked by intense ups and downs in emotions and energy. People with the condition may also exhibit unusual thoughts and behaviors. While health care providers don't know the exact cause, risk factors include:

• Having a close family member with bipolar disorder or another mood disorder.
• Experiencing stressful life events and trauma.
• Having differences in brain structure and function.

What Are the Symptoms of Bipolar Disorder in Teens?

Teens with bipolar disorder experience extreme highs (manic episodes) and lows (depression) and sometimes a mix of both simultaneously. Their symptoms can last several days or weeks and come out of the blue. "As the illness progresses, teens can also experience psychosis," Francis says.

People that experience psychotic symptoms have trouble distinguishing what's real and what's not. Signs of psychosis include:

• Hallucinations—Hearing voices that aren't there is the most common type of hallucination, says Francis. Seeing things that aren't there is rarer.
• Delusions—People with psychosis may have strong, irrational beliefs that they can't be talked out of. These thoughts aren't consistent with facts. For example, they may believe they have superpowers or are special or chosen. They may also experience paranoia (unfounded distrust of others).

Francis says, "A parent of a teen with bipolar disorder will report, 'My child hasn't been sleeping. They're talking about how they found a solution for free energy. And, they're rearranging the furniture in their room all night. They're not understanding that they have to go to school or comply with expectations at home.'"

Early Warning Signs of Bipolar Disorder

An early red flag for bipolar disorder in teens is a significant decrease in sleep. "It's not just a teen who stays up all night and sleeps all day," Francis says. "A teen with bipolar stays up most of the night and then goes about their day normally. It can also be someone who has always been a poor sleeper. A low amount of sleep coupled with increased emotional intensity and goal directed activity are a few things I look for as early signs of the disorder."

Other classic symptoms of bipolar disorder include:

• Depression—Periods of depression usually emerge in early adolescence and are present before an episode of mania occurs.
• Changes in conversation—Teens with bipolar disorder may talk fast and quickly switch from topic to topic during manic episodes. They aren't easily interrupted, but they may abruptly lose their train of thought.
• Increased energy—A sudden and overzealous focus on a new project can be a sign of a manic episode. For example, your teen may obsessively work on an art or science project, cleaning, or reorganizing.
• Impulsiveness—People in a manic state take action without thinking it through. They engage in risky behavior and may not consider their physical limitations. For example, they may walk out of the house in the middle of a frigid night without a coat. They may also feel as if they have endless energy and don't need to eat or drink.
• Hypersexuality—A teen with bipolar disorder may begin dressing more provocatively, become more flirtatious, and seek sexual partners.
• Irritability—Increased anger and aggression can be symptoms of bipolar disorder.

Bipolar Diagnosis

You can develop BD at any age, but it's more frequent when people are in their 20s. Research indicates one-percent of kids ages 14 to 18 also meet the criteria. However, psychiatrists are cautious about making the diagnosis in teens for two reasons:

First, doctors have to rule out other mental health conditions. "We always tell parents that a bipolar diagnosis shows up over time because kids are developing. Their symptoms aren't as severe and notable as they are in adults," Francis says. "Early signs can be confusing because they can overlap with a lot of different diagnoses."

Second, mood stabilizers such as lithium are the primary treatment. According to Francis, these drugs can impact an adolescent's growth and weight and affect the thyroid and kidneys. Additionally, antipsychotic medications are often used and can increase a teen's risk of diabetes, and cause weight gain and long-term neurologic side effects.

Mental health conditions that share some of the same symptoms as BD include: 

Next Steps

If you're worried that your child has BD or another mental illness, see a child and adolescent psychiatrist, Francis says. Psychiatrists have completed medical school, and those who specialize in kids have additional years of training. "They're physicians who can make a BD diagnosis, prescribe medications, and refer you to a therapist." 

Your teen may need inpatient hospital services if they have psychosis or you're not able to keep them safe. The hospital is a secure environment with around-the-clock monitoring by professionals who can assess your teen's symptoms.

It's not unusual for teens to have some emotional outbursts and moodiness. But if it's affecting your child's ability to do everyday activities, it could be a mental health problem. The only way to know is to seek professional help to get the support you and your family need.

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