If your child has been diagnosed with Bipolar Disorder within the last fifteen years, get a second opinion.
This is the advice showing up on more and more mental health information sites. And with good reason.
In the years 1994 to 2003, the diagnosis of childhood bipolar disorder increased 4000 %. Since 2003, no one has done another study. No one even knows what the diagnosis rate is today.
This astonishing pattern has sparked some heated controversy in mental health and medical circles. Bipolar Disorder, (previously called Manic-Depressive Disorder), in considered to be a very serious, relatively permanent, and generally genetically-induced disease. A label of Bipolar Disorder can have a very serious impact on a child’s future. In addition, the medications used to treat bipolar disorder are dangerous and have serious side effects, including death, siezures, numbness, loss of consciousness, weight gain, diabetes, permanent movement disorders, and loss of the ability to feel pleasure, to name a few.
What caused this increase in the diagnosis of Bipolar? At the time that the diagnosis began to multiply, several other important events occurred.
First, several researchers published articles, followed by the release of the book “The Bipolar Child”in 2002 . This book offered a checklist and description that completely redefined the diagnostic criteria for childhood bipolar disease, expanding it to include what other specialists were classifying as “oppositional defiant disorder, Conduct Disorder, Intermittent explosive Disorder, and some non-official diagnoses such as Sensory Integration Disorder, Developmental Trauma Disorder, Attachment Disorders, and family dysfunction symptoms.
“Childhood Bipolar Disorder” became the easy catch-all for a broad variety of problems that manifest themselves through rapid mood swings, sensory dysregulation and anger management problems. (To see how broad the definition for bipolar disorder became, you can view the “checklist” for identifying “Childhood Bipolar Disorder” at http://bpchildresearch.org/cbq/cbq_survey.cfm. )
Its important to note that this was not an official or organizationally endorsed redefinition: It was just a theory proposed in a book, based on the clinical experiences of Dr. Demitri Papolos and his colleagues, and some published papers by other psychiatrists such as Janet Wozniak at Harvard.
Childhood Bipolar Disorder is not presently a diagnosis in the DSM-IV, nor are the 65 items on the checklist considered diagnostic criteria for the existing Bipolar Disorder currently listed in the DSM-IV. In addition, they are not on their way to being accepted in the DSM-V. In fact, in an attempt to curb the accelerating categorization of acting-out children as “bipolar”, the American Psychological Association has announced that the DSM-V will include a new diagnostic category, “Temper Dysregulation Disorder” to allow for a more accurate diagnosis that is not considered a permanent, severe mental illness.
What Wozniak, Papolos and other began calling bipolar disorder had certainly been noticed and studied by other psychiatrists, other medical schools, other treatment centers. There is a good argument that more and more children were displaying these symptoms. But other clinicians were making very different assumptions, and assigning very different names (and causes) to the disorders they studied.
Why was it that “Childhood Bipolar Disorder,” an unofficial and unapproved diagnosis, seized the reins of child psychiatry for over a decade?
The answer is likely related to advertising tactics and business profits. Other diagnostic categories that could have been used, such as conduct disorder or developmental trauma or oppositional defiant disorder, were not considered to be particularly responsive to medication. Bipolar Disorder, on the other hand, was viewed as something that should usually be medicated. It didn’t take the pharmaceutical companies very long to catch on. Soon doctors were being inundated with flyers from pharmaceutical companies stating that “you are missing Childhood Bipolar Disorder”, and suggesting medications that should be used to help. All this was done without any research to show that these clusters of symptoms were actually helped by these medications, that these symptoms actually turned into true Bipolar Disorder in adults, or that these medications were safe for children.
This aggressive marketing to doctors was part of an overall campaign by the pharmaceutical companies to push atypcial antipsychotic and other psychotropic medications for use in children.
A large number of psychiatrists and general practitioners received the marketing information with little question. Unfortunately, research show that the bipolar diagnosis was most often being made by primary care physicians. Unfortunately, most general practitioners cannot keep track of the legitimate research in a multitude of specialties and literally hundreds of medical journals, and have generally assumed in the past that pharmaceutical companies were quoting legitimate research when the stated that a specific drug was an effective, safe treatment for a given disorder.
This trust was not well-placed. In the last few years the major drug manufacturers in the US have collectively been fined the largest fines in medical history for illegally pushing antypical antipsychotics to doctors for use in children for which these drugs have not been approved or proven effective, and for downplaying the risks of those medications (many of which have serious side-effects. Eli Lilly paid out 1.42 billion in 2009 for selling Zyprexa to doctors for use in children. ($615 million of this amount was to settle criminal charges). Bristol Myers Squibb paid $515 million in 2007 for promoting the drug Abilify to child psychiatrists. Pfizer paid out 301 million for abuses relating to the drug Geodon. Astra Zeneca paid out 520 million to mismarketing and misrepresentations over the drug Seroquel. Most recently on April 11 this year Johnson and Johnson were fined more than 1.2 billion for minimizing or concealing the dangers associated with using Risperdal, and this judgement was only the most recent in a series of 4 recent judgments against Johnson and Johnson and its subsidiaries over Risperdal that have currently come to a total of 1.94 billion dollars.
In an attempt to curb the child bipolar disasters, the American Psychological Association has announced that a new diagnosis will be included in the DSM-V, “Temper Dysregulation Disorder”, which is not to be regarded as having the permanence or the genetic underpinnings associated with Bipolar Disorder. A body of the nation’s top trauma therapists led by Bessel VanderKolk is also pushing for the inclusion of “Developmental Trauma Disorder”, a diagnostic category that encompasses many of the symptoms attributed to Childhood Bipolar Disorder, but which directs treatment towards rebuilding and repairing regulatory systems in the brain, rather than medicating long- term.
These trends and developments strongly suggest that an individual diagnosed with bipolar disorder within the last fifteen years should get a second opinion, and it should be from a up-to-date specialist in mental health.
To learn more about childhood bipolar disorder, the other childhood disorders that have been mistaken for it, and the medications that are currently being used for it, watch the program.
Sources used in this program include:
Risk of strokes increases 50% in individuals taking Risperdal or zyprexa:
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American Psychological Association announces new diagnosis “Temper Dysregulation Disorder to reduce use of “Childhood Bipolar Disorder”
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