Bipolar II Disorder and Teenagers: Part Three -- Diagnosis

In the third article of a four-part series, we'll continue to follow Wendy's story and discuss the difficulty of diagnosing bipolar II disorder.

Dr. Smith had been treating Wendy for depression since she was 14, but it wasn't until she was 17 and displaying hypomania symptoms that he considered assessing her for bipolar II. In order to meet the criteria for this condition, a history of depression and at least one episode of hypomania are necessary. Bipolar II often goes undetected because of problems with a clear definition and a lack of understanding of hypomania. Bipolar II is often misdiagnosed because of the overlap with other conditions such as anxiety, depression, oppositional disorder and ADHD.

While most of Wendy's friends were bothered by her constant talking and boastful attitude, they admired her confidence, endless energy, and various talents. These characteristics can make bipolar II even more challenging to diagnose because the hypomania may appear to be a period of successful high productivity and happiness. Because hypomania can cause a person to feel good, it is reported less frequently than a painful depression.

Dr. Smith believed Wendy was experiencing hypomania based on her grandiosity about winning the state championships, her need for little sleep and her rapid talking. Upon questioning from the doctor, Wendy shared that she had been experiencing an increase in her sex drive but figured it was normal for her age. This cluster of symptoms confirmed a bipolar II diagnosis and the need for an adjustment in her medication. Dr. Smith explained bipolar II to Wendy, but she denied that she had it, explaining that she was just buzzed about the upcoming championships.

People with bipolar II typically don't have the severe mood swings of bipolar I patients, but they may be prone to longer depressive episodes. Teenagers with bipolar disorder may often start out with the depressive side of bipolar, and helping professionals may believe that the patient has unipolar depression. If a person has a history of substance abuse, eating disorders, schizophrenia and/or major mood disorders, it's important to realize that these are red flags for bipolar; however, not all people with this background get this disorder.

Of course, there are a percentage of cases where hypomania causes significant distress, and it's important to detect hypomania early on. Some research indicates that teens are more prone to auto accidents and may suffer a decline in grades because of the distractibility caused by racing thoughts. There are many faces of hypomania that can help you differentiate the disorder; however, remember that any one person has a cluster of symptoms and not all of them.

Wendy didn't like the term "hypomania" for the wonderful feelings she was experiencing, and she didn't want to take any additional medication. Dr. Smith was conce
ed when Wendy refused to take the recommended medication because ignoring hypomania can make bipolar II worse and possibly lead to the more severe bipolar I. People with bipolar I can lose touch with reality and become a danger to themselves or to others, so it is crucial to stop the progression of low-end bipolar conditions.

Fortunately, with education, Dr. Smith was able to convince Wendy to take a mood stabilizer to regulate her mood and keep treating her depression. He also referred Wendy to me because I have a specialty with bipolar II in teenagers. I taught Wendy a variety of coping skills that will be discussed in the next article in this series: "Bipolar II Disorder and Teenagers: Part Four -- Positive Coping Skills."