My phone buzzed with a panicked text from Lisa, the mother of Ariana, an eight-year-old girl I am treating for anxiety and school phobia. Ariana’s terror at the idea of going to school has often led to explosive outbursts when parents have pushed her to go. The treatment has been stop and go, but Ariana is making some very slow progress with a lot of support.
Lisa has experienced a roller coaster of emotions in the last year, trying to help Ariana. She sought out a parent support group and had gone to her first meeting the night before this frantic text. When I called Lisa back she explained to me that several parents at the group had told her that her daughter must really have bipolar disorder. Specifically, she was told “Anxiety and angry outbursts are really code for bipolar disorder.” Lisa was frantic to know if I really thought Ariana had bipolar disorder—if I had not been clear about the “actual” diagnosis.
We spoke for a while and I reassured Lisa that anxiety was the diagnosis; there were no hidden or coded conditions that I had not spoken about with her. We discussed how anxiety can cause extreme emotional outbursts. Lisa cried—a mixture of relief and ongoing despair. We hung up, but I was concerned about the “common knowledge” that had been shared with this already exhausted mom. Why does this myth persist—this notion that children who have extreme outbursts and tantrums have bipolar disorder?
The bottom line is that a pattern of chronic and severe explosive meltdowns is a symptom, not a diagnosis. It is like fever. An elevated body temperature tells us that something is wrong in the body. But there can be a range of causes. The job of the health care provider is to use the tools at their disposal to determine the cause of the fever so that she can treat it effectively.
A pattern of chronic and severe explosive meltdowns is a symptom, not a diagnosis.
Severe emotional/behavioral dysregulation—another way of describing these patterns of meltdowns and outbursts—can be caused by many things. Sleep disorders, for example, cause fatigue, which is associated with irritability and anger outbursts. Anxiety can cause fight or flight reactions that dysregulate a child emotionally and behaviorally. Language problems, autism spectrum disorder, trauma, obsessive compulsive disorder, and fetal alcohol effects are some of the other possible causes.
Bipolar disorder is in the list of possibilities, but the diagnosis requires much more than dysregulation. An accurate diagnosis is essential for obtaining the right care. If it isn’t bipolar disorder, we need to treat what we find. If it is bipolar disorder, an early diagnosis will be the key to the right care. But sorting it out is the essential first step.
The parents in Lisa’s support group were trying to be helpful. Unfortunately they were sharing a commonly held misconception about childhood bipolar disorder. It has become a one size fits all diagnosis that can drive a treatment dangerously off track and a parent into unnecessary despair.
Angry young girl photo available from Shutterstock