Bipolar disorder across the lifespan

Although bipolar disorder is often thought to be an adult disease, studies indicate that bipolar disorder is just as likely to appear in childhood or early adolescence. The disease may be different – and possibly even more severe – in young people.  

More research is needed to improve our understanding of how to diagnose and treat bipolar disorder in children and youth. Recognizing the disease in young people is especially challenging because its symptoms often appear similar to more common childhood conditions, including attention deficit hyperactivity disorder (ADHD), anxiety disorders, or conduct disorders. With this said, a professional evaluation and diagnosis is very important.

What are the symptoms of bipolar disorder in young people?

Patients with bipolar disorder experience extreme variations in mood, commonly referred to as “mood swings,” ranging from episodes of depression (extreme lows) to episodes of mania (extreme highs) or hypomania (a less intense form of mania).
In adults who develop the illness, mania is often characterized as someone feeling “up” or “high” and depression is generally indicated by increased sadness, inability to feel pleasure, social isolation, and changes in appetite/sleep. In youth, symptoms of mania and depression often present themselves in different ways, including:

• Disruptive/aggressive behaviors
• Increased irritability
• Destructive outbursts

Symptoms of bipolar disorder also differ in young people based on their developmental stage.

Younger children’s symptoms may include:

• Physical complaints
• Irritability
• Crying spells
• Significant difficulty with relationships
• Extreme sensitivity to negative reactions from others

Older pre-adolescents and adolescents are more likely to experience mixed symptoms and symptoms that cycle more rapidly between depressive and manic states than what is observed in adults.

The number of college students diagnosed with bipolar disorder has increased steadily in recent years. The onset of bipolar disorder tends to peak between the ages of 15 and 24 – just as many students are adjusting to the challenges of college. Bipolar disorder among college-age students often remains untreated, and many students may attempt to ignore or hide their symptoms due to social or academic pressures.

Advice for college students

With a good treatment plan, a strong support system, and a commitment to keeping stress in check, students can succeed in college and manage their bipolar disorder at the same time.

A few tips for doing so include:

• Try to establish and maintain consistent sleep habits, avoiding disruptions such as all-night study sessions
• Maintain a regular and consistent schedule weekly (ex: waking up/going to bed, meals, classes, study/homework time, medication)
• Get plenty of regular exercise
• Eat a healthy diet
• Avoid using alcohol or drugs
• Develop a support system of friends, family, and campus professionals.
• Keep stress in check. Practice time management skills, seek academic help when needed, and don’t hesitate to seek guidance for roommate, relationship or financial concerns.
• Adjust your expectations and be flexible with your goals. Recognize that attending college while managing bipolar disorder may mean it takes you longer to fulfill your academic requirements.
• If you have been receiving treatment back home, make it a priority to make referral arrangements with a healthcare provider and pharmacy near campus before school starts.

In rare cases, bipolar disorder can begin in old age. Some irritability and moodiness in old age are common as people face the aches, pains, and reduced mobility that come with growing older. However, when emotions, thoughts and actions become extreme, they may signal the onset of bipolar disorder.

How common is bipolar disorder in older adults?

An estimated 25% of people with bipolar disorder are considered to have older-age bipolar disorder, meaning they are at least 50 years of age. Studies report that types I and II bipolar disorder affect 0.5–1.0% of older adults, meaning the condition is approximately three times more common in young people. Women may be more than twice as likely as men to develop the illness late in life. Studies in North America report that as many as 3% of nursing home residents and 17% of elderly in psychiatric emergency rooms have bipolar disorder.

Diagnosing bipolar disorder in older adults

Healthcare professionals have a special challenge when it comes to identifying bipolar disorder in seniors. Many conditions impacting people later in life, such as depression, dementia, stroke or other neurological conditions, share symptoms with bipolar disorder. Side effects of certain medications can also mimic bipolar disorder’s symptoms. Some research also suggests that when bipolar disorder strikes later in life, its symptoms may be less severe. As a result, doctors may fail to diagnose the disease.

Birmaher, B. (2013), Bipolar disorder in children and adolescents. Child Adolesc Ment Health, 18: 140–148. doi:10.1111/camh.12021.

Pedrelli, P., Nyer, M., Yeung, A., Zulauf, C., & Wilens, T. (2015). College students: mental health problems and treatment considerations. Academic Psychiatry, 39(5), 503-511.

Sajatovic, M., Strejilevich, S. A., Gildengers, A. G., Dols, A., Al Jurdi, R. K., Forester, B. P., ... & Rosa, A. R. (2015). A report on older-age bipolar disorder from the International Society for Bipolar Disorders Task Force. Bipolar Disorders (english Edition, Online), 17(7), 689-704.