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 ...
