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A Case Against the Diagnosis of Bipolar Depressive Disorder in Pediatrics

A Case Against the Diagnosis of Bipolar Depressive Disorder in Pediatrics
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The current paper is a discussion on the controversy of pediatric bipolar depressive
disorder diagnosis. The current controversies around the issue will be outlined. The
consequences of diagnosing or failing to diagnose this childhood disorder will also be discussed.
The paper will give a view against bipolar depressive disorder diagnosis.
The current Controversy.
There is a general controversy over the label of bipolar depressive disorder in children.
The controversy began in 2007 when a subset of researchers reported a forty-fold increase in
bipolar disorder diagnosis in pediatrics (Birmaher, 2013). The increase arose due to the
redefinition of mania by the American Psychiatrists Association which is required for diagnosis
of bipolar (Wakefield, 2013).
According to the American Psychiatric Association, (2013), mania is present in a
patient who has elevated or expansive mood with a least three of: grandiosity, pressured speech,
reduced need for sleep, easy distractibility, increased goal-directed activity, reckless and overinvolvement in pleasurable activities and flight of ideas. The redefinition of mania needs at least
four of the seven when they present with irritability. Most other childhood psychiatric disorders
present with irritability including ADHD and severe mood dysregulation (SMD) Dvir, Ford, Hill,
M & Frazier, 2014). Children also have difficulty articulating symptoms and are more prone to
effects of social stressors such as attachment loss hence a true picture of mania may be
misinterpreted leading to misdiagnosis with bipolar (Zeanah, Chesher, & Boris, 2016).
Consequences of diagnosis.
The diagnosis of bipolar disorder in children does more harm than good (Birmaher,
2013). First of all, it is most likely a misdiagnosis of more common childhood disorders
including ADHD, ODD and SMD. Although this condition does occur in children it is rare and
does not warrant such overdiagnosis. Secondly, the diagnosis carries social and cultural
consequences. Bipolar has a strong genetic component and such a label might lead to family
disharmony. A bipolar diagnosis also comes with its treatment, usually using mood stabilizers,
lithium, and antipsychotics (Sadock, Sadock, & Ruiz, 2014). These medications have major side
effects and toxicity profiles causing real harm to the child when the disorder could have been
treated with less invasive techniques. Finally, such a diagnosis leads to a missed opportunity to
treat the true presentation of the child, a major treatment delay.
A diagnosis of bipolar depressive disorder in children is not necessary. Although it is a
likely condition in children presenting with irritability, a more common condition should be
excluded to avoid the consequences of labeling and harmful pharmacotherapy.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: American Psychiatric Association.
Birmaher, B. (2013). Bipolar disorder in children and adolescents. Child and adolescent mental
health, 18(3), 140-148.
Dvir, Y., Ford, J. D., Hill, M., & Frazier, J. A. (2014). Childhood maltreatment, emotional
dysregulation, and psychiatric comorbidities. Harvard review of psychiatry, 22(3), 149.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Wakefield, J. C. (2013). DSM-5: An overview of changes and controversies. Clinical Social
Work Journal, 41(2), 139-154.
Zeanah, C. H., Chesher, T., & Boris, N. W. (2016). Practice parameter for the assessment and
treatment of children and adolescents with reactive attachment disorder and
disinhibited social engagement disorder. Journal of the American Academy of Child &
Adolescent Psychiatry, 55(11), 990–103. Retrieved from