Q. My wife was diagnosed as bipolar II. The psychiatrist said bipolar II people experience periods of “hypomania,” and I guess he thought we knew what that meant. Please explain what hypomania is? I’m really not sure he has the right diagnosis. I thought people who were bipolar had psychotic experiences.
A. Bipolar disorders are divided into bipolar I and bipolar II. Although they are similar, bipolar I is the more serious of the two. In bipolar I, the mood disturbances, often including hallucinations or delusions, are sufficiently severe to impair social and occupational functioning. Frequently, the symptoms require hospitalization.
Bipolar II patients fluctuate between major depressive episodes and hypomania. The Diagnostic and Statistical Manual (DSM -5), used by mental health professionals to make a diagnosis, defines hypomania as “a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four consecutive days and present most of the day, nearly every day.” During this period, three or more of the following symptoms must be present:
• Inflated sense of self-esteem. Does your wife often feel that she is entitled to special treatment? Does she often feel more intelligent than others?
• Decreased need for sleep. Can she get by with three or four hours of sleep?
• Racing thoughts. Does she go quickly from one subject to another?
• More talkative than usual. Does she talk so much that it is disturbing to others?
• Distractibility. Is she easily distracted by irrelevant external stimuli?
• Increase in goal activity. Does she come up with original ideas that could be impractical? Does she work excessively long hours?
• Excessive involvement in activities that can cause harm. Does she go on spending sprees, make foolish investments or engage in physically or emotionally dangerous activities?
• The disturbance and change in mood is observed by others. Do people other than you notice the changes?
I suggest that you and your wife speak to the psychiatrist again to receive more information about her condition. Additionally, there are many websites that present accurate information on mental health issue. I recommend the sites for the Mayo Clinic and webMD.
Q. Is it true that most children cannot be diagnosed as bipolar? My son was diagnosed at 9. Could he have something else?
A. In the past few years, an increasing number of children have been diagnosed with pediatric bipolar disorder. In reality, bipolarity in children under 12 is rare. To make a diagnosis, a qualified psychiatrist should document four distinct episodes of mania and depression in a 12-month period. If the doctor cannot document these occurrences, then the diagnosis could be incorrect.
Since you are concerned, ask your son’s psychiatrist about Disruptive Mood Dysregulation Disorder (DMDD). It was added to the DSM-5 to address the issue of chronically irritable children who often receive an incorrect bipolar diagnosis. Because children with DMDD often have low frustration tolerance levels, they generally have difficulty succeeding in school and establishing positive relationships with peers. Since they become frustrated easily, family life can be disrupted by their outbursts. They often have difficulty obeying parents and displaying empathy for their siblings.
Although a DMDD diagnosis does not sound as serious as a bipolar disorder, it can cause many of the same problems. If a child has DMDD, parents must be cognizant of dangerous behaviors and severe aggression that often accompany this diagnosis.
Be certain that your child is seeing a psychiatrist who takes time with him and with you. Be certain that the diagnosis is explained and a treatment plan is made clear. Since your son will likely be prescribed medications, be certain that you ask about each one and the possible side effects. You cannot be too informed.
Nancy Ryburn holds a doctorate degree in psychology from Yeshiva University in New York City. She teaches psychology at Southeast Arkansas College. E-mail your questions to firstname.lastname@example.org or send them to Dr. Ryburn, SEARK, 1900 Hazel Street, Pine Bluff, AR 71603. The questions could appear in a future column. There will be no identifying information and all correspondence remains confidential.