“December '07 my son tried to commit suicide twice. Hard to believe, huh? Well, it happened.” The poor boy is seven.
Angela posted this in early March. She reports that she had to hospitalize her son. There, the doctors diagnosed him with depression and anxiety, but one of the meds they put him on raised a red flag with her. The med was low-dose Risperdal (they also had him on the ADD med Adderall). After what must have been pointed questioning from Angela, the psychiatrist came clean. As Angela reports:
“He explained that in layman’s terms my son has bipolar, but they don’t want to give him that diagnosis until he is a bit older.” (Angela later mentions that the boy is also currently diagnosed with ADHD and OCD).
In addition to meds treatment, Angela’s boy is receiving weekly counseling.
Angela notes that whereas her oldest son has no problems, her youngest tries to “harm himself in ways that are unimaginable.”
“I am so hurt and crushed,” she concludes. “I can’t tell my husband his diagnosis cause he will go off on me. He won’t even come to the counseling sessions to help our son. Any advice?”
No one likes to see a kid suffer, and Angela’s call for help attracted 48 replies. The diversity of the responses reveals just how difficult it is to hit on a cause and effect and solution when things go wrong with your kid. One responder asserted the boy is “a different type of normal.” Another, in light of the boy harming himself, raised the possibility of early-onset borderline personality disorder. Another asked about whether sexual abuse may have occurred. A number of people questioned the dad’s role in all this.
There is merit to all these and other responses. Kids simply don’t fit into easy diagnostic categories. And there has been a lot of negative press lately about psychiatrists being too quick to label kids with bipolar disorder. Nevertheless, the response that resonated most with Angela was one from Lynn. Lynn’s boy also suffered in a way similar to Angela’s, but it was age 18 before a psychiatrist finally diagnosed her boy with bipolar. Now on the right meds and able to sleep,, he is now “such a really nice person to be around even the next day. God, how I wish that it could have happened in the beginning.”
A few days ago, in another post, Angela gave us an update. After four months of treatment and therapy, she reports, her son is improving. But in a therapy session, her son’s mood went from cheerful to highly distressed in the space of a nanosecond. Angela’s husband just happened to be there. Both he and the therapist, she reported, “were in shock.”
In reporting on her boy’s extreme mood swing, one senses Angela’s relief. Finally, one feels, her husband gets it. So does the therapist. There is clearly something going on with the boy. She is not making things up. Others believe her now.
Okay, Angela. I think I got it all down. And readers, I think got the gist of your comments. Now let’s establish some ground rules that we can all agree upon:
- Angela, you are the mother. You know way more about your child than anyone on this planet, including your husband, including his teachers, including those who treat your son, including anyone here offering advice, including me.
- Angela, you are also wise enough to solicit advice from other sources, including the people here at BipolarConnect. Even if some disagreement is going on, their goodwill is genuine.
- Readers - and I include myself in this category - it is tempting to come out with blanket “should” statements about treatments and other issues. But we are commenting from a distance concerning very complex circumstances about a boy we never met.
- Everyone, mental illness and related behavior is often a matter of “both-and” rather than “either-or.” We all come pre-loaded with a range of symptoms and behaviors that defy standard diagnostic wisdom.
Okay, Angela, let’s consider the diagnosis issue. What I hear you telling all of us is that the bipolar diagnosis best explains your boy’s behavior. You offer us compelling reasons, but even if you didn’t I’m not about to second-guess your opinion or that of your boy’s clinicians.
But we also know that more is going on, the ADD for one, the OCD for another. And we all have personality issues issues in abundance. When mine flare up, I come across as Attila the Hun, only not nearly so nice.
One reader, citing the boy’s recurring self-harm behavior, raised the possibility of borderline personality disorder. Two points: 1) We’re not talking “either-or,” as in either bipolar OR borderline. 2) We could be talking about the possibility of “a little bit,” as in a little bit of borderline.
Let me explain: I once queried a leading researcher about the “a little bit” phenomenon. She told me that although the presence of one or two symptoms may not qualify as a diagnosis, these symptoms may nevertheless make a huge clinical impact. In the context of your boy, even if he does not have borderline, he clearly has some personality issues. And what we know about borderline may shed some light on what is troubling your boy.
Clearly, in addition to the bipolar and ADD and OCD, the self-harm (and what may be self-loathing) need to be addressed, no matter how we choose to categorize it.
Please let me know if this makes sense to you, so far.
Okay, now a couple of general observations:
Diagnostic categories can be so confusing. What really seems to be going on is that in reaction to stress and underlying vulnerabilities that may include trauma, our brain circuits tend to overload. Thanks to our genes, some of us are sitting ducks. Downstream from the circuit overload, all kinds of things go wrong, totally messing up one’s thinking and behavior.
In your boy, the thinking and behavior may manifest mainly as bipolar, but the circuit overload is also likely to bleed over into other diagnostic categories, perhaps as full-blown co-occurring illness, often as “a little bit” of this, “a little bit” of that.
So, Angela, it’s crunch time. Your boy has been diagnosed as bipolar. I’m sure you were devastated by the news, but you also displayed considerable courage in facing the issue head on. What now?
First, it may be wise to think of your son’s diagnosis as provisional. Certainly, that’s the way his psychiatrist is treating it. One reason is a natural reluctance against diagnostic and treatment overkill. Another is that though there is widespread expert consensus that bipolar disorder does break out in kids, there is not yet total agreement on the precise nature of the illness in its early-onset form. Finally, life is full of surprises - tomorrow a new kink in your boy’s behavior or reaction to treatment may turn up.
And, most important, please be hopeful about your boy’s prospects. You mention that “he has come a long way in the past four months.” No doubt, there will be setbacks together with more heartbreak and frustration, but you should be able to look forward to your boy enjoying his childhood and leading a fulfilling adulthood.
Finally, I detect in your posts a boy who may be different, but different in many good ways. In an increasingly brutish and insensitive world, your boy comes across as gentle and sensitive. No doubt he has other gifts. You may have to nurture him more than his older brother, but don’t rule out the thought that he will be the source of your greatest satisfaction.
I know I’m rambling on a bit, Angela, and, believe it or not, I am not finished. But I will call it a day for now. Think of this post as Part One of my reply. Part Two - which I intend to work on today - will focus on the child bipolar issues. Maybe there will be a Part Three. You have raised some very critical issues, Angela, which deserve a full airing. Please stay tuned ...
Published On: April 05, 2008
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