Bipolar Disorder in Children

Bipolar Disorder

Mental illness is a widespread and multicultural issue that ranges from childhood into adulthood. Many of these illnesses are either not reported, nor diagnosed, but also are not treated. Triggers such as depression, prolonged stress, environment, substance abuse, and home life can have lasting effects on those that have underline issues. Some mental disorders can be observed and are easier to pin point, where others may take more time to manifest and have no outward physical indicators. Extremes on the continuum in behaviors can help professionals narrow down symptoms in order to diagnose a patient. Bipolar Disorder is one that many professionals wait until symptoms have not only manifested, but have also become stable. Bipolar disorder can also mimic many symptoms that a person with Autism or other mental illnesses might deal with and vice versa. To understand Bipolar Disorder more, this paper will describe the physical aspects, neurological and emotional aspects, as well as spiritual and religious aspects of someone living with Bipolar Disorder.

Physical Aspects

Patients living with Bipolar Disorder do not necessarily show outward physical symptoms on its own. The majority of the physical symptoms are typically a result of emotional or mental disturbances as well as treatment side effects such as drowsiness, rapid heartbeat, and weight gain. Patient outcomes are further exacerbated by poor physical health, as the presence of medical comorbidities is significantly negatively associated with functioning, treatment response, and course of bipolar illness, including more frequent and persistent episodes (Journal of Affective Disorders, 2016, para. 7). Many patients that believe they have poor health, report less physical activities in their daily lives as well as low occupational functioning. Among these issues were more bodily pain, depression and manic or hypomanic symptoms. Some chronic conditions that have been linked to those suffering from Bipolar Disorder are hypertension, obesity, and diabetes, previous head injuries, migraines, epilepsy, multiple sclerosis and asthma. (Journal of Affective Disorders, 2016). These are just a few to mention. Childhood trauma can be a risk factor for developing Bipolar illness and can present more clinical symptoms over time. Substance abuse and suicide attempts are increased concerns as the trauma from childhood can lead to alterations of affect regulation, impulse control, and cognitive functioning that might decrease the ability to cope with later stressors (International Journal of Bipolar Disorder, 2016, para. 1). Children that have experienced childhood trauma may also experience chronic inflammation and sleep disturbances as well as conditions mentioned above. Patients with unstable moods can become more irritable and have unpredictable behavior and poor judgment as well as increased reckless activities, all of which can have negative consequences to their physical and mental wellbeing.

Neurological Aspects

Bipolar Disorder can be broken up into four subgroups; Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder (Cyclothymia), and Bipolar Disorder other specified and unspecified. Bipolar I Disorder is an illness in which people experience both mania and depression and have had at least one or more manic episodes lasting a specific time period or has had to be hospitalized. Bipolar II Disorder is characterized by depressive episodes that fluctuate over time, but never form into full mania. Those with Cyclothymic Disorder have little if no periods of normal moods. They have chronic unstable moods that combine depression and hypomania for two years or more. People that have been diagnosed with unspecified or other specified Bipolar Disorder typically do not meet the typical standards for I or II, but have periods of clinically significant elevations of abnormal moods. Most often professionals will distinguish between the two major Bipolar Disorders (I and II) before reaching a conclusion of the alternatives. Full mania causes severe functional impairment, can include symptoms of psychosis, and often requires hospitalization; hypomania, by contrast, is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization (American Health and Drug Benefits, 2014, para. 7). Bipolar I and II have similar brain structures that are effected. Though there have been many discussions and questions related to the neurological aspects of those with Bipolar illness, it is thought that it is a multifactorial disease resulting from a combination of gene abnormalities, chronic stressors, traumatic experiences and environmental influences. One report states, Many researchers believe that BPD arises from modulation of synaptic and neural plasticity in critical circuits mediating affective and cognitive function (Journal of Clinical Investigation, 2009, para. 5). Other research articles conclude that, Childhood trauma interacts with several genes belonging to several different biological pathways such as Hypothalamic-pituitary“adrenal (HPA) axis, serotonergic transmission, neuroplasticity, immunity, calcium signaling, and circadian rhythms (International Journal of Bipolar Disorder, 2016, para.1). Yet, another article gives details of brain imaging to support roles for alterations of serotonergic neurotransmission in major depressive episodes. Their studies have reported decreases in radioligand binding to the serotonin transporter in platelets and in the midbrain as well as decreases in hydroxytryptamine receptor binding in the hippocampus and amygdala, increasing cortisol secretion (Official Journal of the World Psychiatric Association, 2003, para. 8). Note that the amygdala is important for regulating fear and emotions and changes in emotional or affect regulation may be seen in the limbic system. There is no concrete evidence of one specific factor resulting in BPD however it is argued that it may be a result of the altered synapses and circuits rather than imbalances in specific neurotransmitters. The research on Bipolar Disorder is ongoing and with the help of fMRI brain imaging, professionals have begun narrowing down many areas of interest that have been helpful in determining different treatment options.

Emotional Aspects

Due to the concern of long term and fluctuations of moods, depressive episodes, and trauma, the emotional aspects of those suffering from Bipolar Disorder are detrimental. Research indicates that childhood trauma can elevate risk for alcohol/drug dependency as well as suicide attempts. It is stated that females are more likely to report sexual abuse where males typically will report physical abuse if present. patients with a history of emotional abuse have higher severity scores on all symptoms, including depression, hopelessness, suicidal ideation, anxiety, and impulsivity. These data may suggest emotional abuse as a specific risk factor for certain psychiatric disorders possibly with anxious, depressive, and emotional core features (International Journal of Bipolar Disorders, 2016, para. 11). The core features that are important to be aware of with a patient having suffered trauma are as follows: emotional neglect, emotional abuse, physical neglect, physical abuse, and sexual abuse. Patients suffering these types of trauma tend to show deficits in cognitive functioning, working memory, attention and processing speed, and executive functioning. In adults, high levels of stress can predict recurring depressive episodes. Adults are also less likely to have social support and secure attachments which can lead to increased vulnerability to long term negative effects (International Journal of Bipolar Disorders, 2016, para. 19). Those suffering Bipolar I tend to have more severe symptoms of anxiety, irritability, and agitation and experience extremes of mania and depression as well as mixed states. Patients dealing with mixed states are harder to treat because they are more dissatisfied with the treatments and are more likely to have at least one suicide attempt during their life (International Journal of Bipolar Disorders, 2017, para. 7 & 8). Research indicates that Bipolar I is the fifth leading cause of medical disability among people ages 15-44. Bipolar I is most concerning in the fact that they have low well being and quality of life due to increased interpersonal conflicts and high unemployment rates, even for those in remission (Journal of Affective Disorders, 2013, para. 1). This article also states deficits in social cognitive functioning such as ability to encode, store and retrieve, as well as apply social information with social context, ability to recognize and respond to emotions of others and self (para. 3). For those living with Bipolar illness, the overwhelming instability of emotions can be triggered with even the slightest stressors. Adolescents in school, especially during times of maturation and puberty, are prone to bouts of insecurities and peer pressures. With a good support system in place and the right treatments, these children can deal with negative stress in a positive way. As adults, the challenge comes with their willingness to seek or sustain treatments available and are more likely to refuse medicine and/or treatment if the side effects seem to outweigh their needs.

Spiritual/Religious Aspects

In any type of scenario, there is bound to be consequences for our behaviors. Whether the consequences are rewarding or they are the result of a negative event, as humans, we want to share our experiences with others. Having a support system, relationships with others, and a social life, is important for most people. However, there are still many people that choose to go through life on their own, dealing with their storms internally. Spirituality is about emotions and connecting socially. It enhances our outlook and helps a person to build and expand their thoughts in a more positive way. Hymns and Psalms in the Bible are focused on trusting the Lords guidance, made for inspiration and worship. Scriptures can enhance positive emotions and give a person a sense of peace, as well as taking the focus off of their problems. George Vaillant states, When I use the term spirituality, I am suggesting that spirituality is all about positive emotions. These emotions includelove, hope, joy, forgiveness, compassion, trust, gratitudeandawe. Of enormous importance is the fact that none of the eight are all about me. They epitomize what Charles Darwin called social emotions; they all help us to break out of the ego cage of I and mine (Mens Sann Monographs, 2008, para. 7). Many times when a person is dealing with uncertainty, when the future looks dim, and they feel alone, it is easy to withdraw and lean on bad habits that negatively effect not only our relationships, but also our well being. Being able to find purpose in life is one of human being's main objectives. Whether through a spiritual connection in nature or through a religious connection with our Creator, the individual has a higher chance of recovery, sustained well being, a positive outlook on life and a desire to persevere.

Conclusion

In conclusion, Bipolar is a disorder that causes dramatic shifts in moods, can drain a person's energy and can create unclear thinking. Mental illness effects 1 in 5 people in a given year. Bipolar Disorder is among the mental illnesses reported. For those living with this disorder, it can wreak havoc on their ability to hold down a job, maintain social supports and can lead to erratic and dangerous behaviors. Depression is one of the leading symptoms in BP and can cause a person to feel insecure and isolated. Unfortunately, there have been reports of thoughts or attempted suicides relating to this disorder. With the right treatments, counseling, and a spiritual or a religious connection, a person can live a full and happy life. Those with family support or social support, have an increased desire to have positive outcomes as well. Bipolar Disorder does not have to be considered a death sentence. Instead, it can be seen as a daily challenge with many opportunities of survival.

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