Fad diagnosis in Psychiatry: Bipolar Disorder in children

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Thursday, August 4. 2011

Fad diagnosis in Psychiatry: Bipolar Disorder in children

The last fad diagnosis was ADHD: every little boy who didn't act like a good little girl had it. Now, it is Bipolar Disorder for all kids with unruly emotions. In Newsweek, Mommy, Am I Really Bipolar?

A quote from the article:

I believe... that there is no scientific evidence to support the belief that bipolar disorder surfaces in childhood. In fact, the opposite seems to be the case: the evidence against the existence of pediatric bipolar disorder is so strong that it’s difficult to imagine how it has gained the endorsement of anyone in the scientific community. And the effect of this trendy thinking can have devastating consequences. Such children are regularly prescribed medications that are not effective in kids and have unwelcome side effects.

Diagnostic faddishness is rampant in Psychiatry, and an embarassment to the field. Why does it occur? It occurs because our descriptive diagnostic categories are so elastic, and so fundamentally unvalidated, that there is room for much mischief. Not to mention that the drug companies always welcome new opportunities to sell their wares.

Posted by Dr. Joy Bliss in Our Essays, Psychology, and Dr. Bliss at 16:43 | Comments (15) | Trackbacks (0)

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I'm not a psychiatrist, but I would disagree with you on one point - that ADHD was the latest fad diagnosis. It may be the most widespread, but I think the Autism diagnosis is a more recent fad. Kids are being diagnosed with it earlier and on a broader range of symptoms and it seems to be getting worse. It appears that the field has been taken over by a bunch of political types who want to turn everything into something to be treated and then subsidized.

Keep up the fight, Dr. Bliss!

#1 mudbug on 2011-08-04 18:06 (Reply)

Unfortunately, child psychiatry is as trendy as fashion, education, dentistry, etc. Equally as unfortunate, these are Real Children and their parents and it involves powerful drugs that will be used in children that have NOT be tested in children!

#2 lbillman on 2011-08-04 18:06 (Reply)

Doesn't "fad diagnosis" imply incorrect diagnosis?

If so, why would anyone seek treatment? I would think an incorrect diagnosis would lead to ineffective treatment.

Sounds like psychiatry is just a scam.

#3 feeblemind on 2011-08-04 19:17 (Reply)

Some do have issues and need assistance, I do know, but I'm not all prepared to go $cientologist to reject it either.

#3.1 Fred Zeppelin on 2011-08-05 08:08 (Reply)

yes, it implies overdiagnosis which itself implies an often incorrect diagnosis.

Unless you have a sound explanation for as to WHY all of a sudden there are 100 times more kids coming up with bipolar disorder (or ADHD or autism) than just a few months or years ago, that's the only conclusion you can draw.

It's almost the same as my previous family doctor diagnosing everything as a head cold and prescribing penicilin automatically.
Only if that didn't help after 3-4 weeks would he consider anything else.
Difference is that in his case (and in the case of many old doctors I think) it's narrowmindedness, in case of shrinks making such diagnosis it's the easy money.
There's nothing wrong with these kids, they're just active, normal children in a world that expects them to be couch potatoes so parents expect there to be something wrong with them. Give them some drugs to turn them into couch potatoes and you're set for years of repeat consults and prescriptions, and later for more consults with the kids who now have to deal with the very real mental issues that result from their decade long drug use on the orders of their trusted psychiatrist.
Can you say pyramid scheme?

#3.2 J.T. Wenting on 2011-08-07 01:49 (Reply)

I think "fad diagnosis" is the symptom. Parents trying to explain away johnny's little temper tantrums that in the past would have been solved through behavior modification: swat on the seat, belt from daddy when he get's home, withholding of dessert, sitting in the corner, and other painful applications of discipline control. All these options now have been taken away from the parents to the point they can no longer exercise discipline on their child for fear that some nanny will call "CHILD ABUSE" and the government will come and take the child out of the subject home and place into foster care where the government can exercise control.... and we see how all that is working out. The things I did and my parents did and their parents did are no longer options for the modern parent due to that fear. Creative options that cause "embarrassment" to the child are now even child abuse, damaging to the psyche and to be dissuaded via laws and regulation and educated doctors explaining that johnny's poor behavior needs a diagnosis, what to call it?

#4 JoeC on 2011-08-04 19:47 (Reply)

I think you are correct. It's not only fear of the child abuse hotlines. Parents today are alot less willing to subordinate their own interests to those of their children. Reasons could be later parenting and longer adolescence, meaning many more years satisfying one's own needs and developing the habit of putting oneself first. Also could be two working parents with less time to spend on child rearing.

Raising a child and providing proper discipline takes work. It's easy for many parents to say - aha, my child has behavior problems, must be some sort of illness and here is a ready medication to "treat" it! Problem becomes something outside of the parent and child for which the parent has no responsibility.

#4.1 LHF on 2011-08-05 07:56 (Reply)

This is absolutely spot on.

I would like to add that schools also don't want to do the "hard work" of disciplining AT ALL. I have been told by school administrators (for a preschool program for three-year-olds!) that they do not, EVER, say "No" to a student as policy. Forget disciplining them!

It's easier for them to push Ritalin and the parents seem to agree.

#4.1.1 BlackOrchid on 2011-08-05 10:57 (Reply)

There was no greater or more destructive diagnostic fad than the recovered memories/ child abuse scandal of the 80s. That mostly involved clinical psychologists and other therapists but it was a disaster.

#5 Mike K (Link) on 2011-08-04 23:09 (Reply)

Then there's isostatic monopolarity, formally called hypo-bipolarity.
I suppose psychiatry will have to suffice until the mind is actually understood.

#6 PacRim Jim (Link) on 2011-08-05 06:06 (Reply)

A part of the problem is that the government rewards the diagnoses of these diseases. Schools get more employees and money if they have students with these "golden" illnesses. Parents get financial and social aid if their children are diagnosed. If you want to see some serious decreases in these diagnoses then tax them! That's right, tax them. We tax employers more and more and thus they ship the jobs overseas. Taxes deter while welfare encourages. So tax parents of children with ADHD, bipolar and autism. Provide less money and employees to schools with students with these illnesses. Overnight the problem will disappear. Children will be magically cured.

#7 GoneWithTheWind on 2011-08-05 11:31 (Reply)

Thanks for the

I think Bipolar Disorder in children is still considered pretty rare at my hospital. I'll ask the psychiatrists what their opinion is. I will say that I haven't been seeing an increase in 18 year-olds (the age at which they switch to adult services) arriving with that diagnosis already in place. Perhaps there is some regional or national trend I am unaware of.

I agree that there are fad diagnoses, but here's the thing: reading the comments above, I mostly saw people who had made up their minds about psychiatry and had to trot out the same reflexive statement they've been saying for years, because they know just because of their great wisdom in the world or whatever, and don't need to be the least troubled by the scientific data or what anyone else says. They just know. Yeah, I'm talkin' to you. When you download this crap about what's happening in the country - not like the good old days - and from that draw conclusions about psychiatric diagnoses, how are you in any way better than the people with the fad diagnoses?

On both education and mental health, this has been an ongoing problem at Maggie's. Folks just bloviating with nothing to support their ideas but a particular narrative.

Coming from the POV of doing this for a living and trying to get it right, because individual people are tormented and don't all fall into some stereotype.

Kids are tough to diagnose, because their possible responses to problems are much more limited than adults. "Anxiety" is a symptom of everything, so it doesn't narrow things down much. Secondly, the first-order treatments for bipolar disorder, lithium and depakote, tend to reduce mood extremity in just about everyone. So the administration of those medications is likely to stabilise mood somewhat, even if BPAD wasn't the problem. There is also an ongoing bending of the diagnostic curve because of billing - especially at private hospitals and clinics. If you think depakote will help and you want to get reimbursed, you had better put down a diagnosis for which depakote is a possible solution. It sucks, and it has long-term consequences, but it happens.

#8 Assistant VIllage Idiot (Link) on 2011-08-05 17:50 (Reply)

I never finished the thanks. Thanks for setting up the link, Doctor. Kaplan had published articles on this before he wrote the book, and I tend strongly to agree with him on this. Haven't read the book itself, though.

#9 Assistant VIllage Idiot (Link) on 2011-08-05 18:03 (Reply)

I find all these comments very frustrating. My 10 year old son has a real mental illness. We are not bad parents. I have a college degree yet chose to stay home to raise my kids. We are loving parents that use consistent discipline in our home. We have tried many things to help our son get better, but it wasn't until we tried medication that we started to see a positive change in his life.

My son knew at the age of 7 that he had a problem in his brain, after wanting to kill himself he cried that he wanted to see the doctor so they could fix his brain. My son has suffered depression, rapid mood swings (he would cry, then laugh, then cry, then laugh until he would slam his head into the ground begging through tears to help make his brain stop changing moods all in a matter of 1 minute). He has seen monsters for episodes that has lasted up to 30 minutes, ending with him vomiting. He has heard voices and seen shadowed men coming at him when having panic attacks and has punched himself in the face to stop the images in his brain. He has trouble sleeping, feels too much energy and has violent rages attacking his family, sometimes up to several hours. He suffers from great anxiety that keeps him from playing with other kids and his sensory issues that keep him from enjoying family outings and fun experiences.

He says he feels worthless and that he's God's mistake.

He has seen professional therapists and psychiatrists and to this day we don't have an official diagnosis other than "mood disorder". My son is being treated with bipolar medication and with the recent addition of Lithium, we've seen a tremendous change in our son. My husband and I both feel like we have our old son back, (he has had these problems since he was 7). But I think our son can share the remarkable change in his own words:

"I feel happiness for the first time in a long time”

”I no longer feel anger inside”

”I feel great Mommy”

My son's story is one of many. We are parents that love our children deeply, we recognized that our children need help that no diet, religion, parenting methods, exercise, fish oils, etc. can fix alone. We know because we tried. You mention that all my kid needs is a good spanking, you have no idea what you're talking about. Believe me, we tried many parenting methods including spanking in the beginning for unruly behavior. It only resulted in him spitting in my face and him saying, "spank me again!". His brain is not wired correctly so he doesn't respond like a typical child would to discipline.

Most parents are terrified of putting their child on medication and from experience I would say that most wait too long. We resisted it because of the bad press and judgments of society. Parents need support, not judgement.

You have no idea the hell my son has lived through. Please withhold your judgement.

As for Kaplan's book, he's trying to make money like everyone else. He tries to show that our kids have ADHD only with ODD, yet my son has no attention problems and opposition only comes with instability, normally he is a sweet child. And Kaplan completely ignores cases like my son who have cycling moods, psychosis, clear depression and suicidal thoughts. If you think doctors are diagnosing left and right, you're wrong. Doctor's are afraid to diagnosis, so they treat the symptoms. Right now my son "looks" bipolar, but they are waiting until he's older for a formal diagnosis. No one is rushing to label my son with this "fad diagnosis"!

I don’t know what will be my son’s final diagnosis, but I do know that I am thankful that he has an opportunity to have a life worth living thanks to medication and a mental health community that is trying to help our son in a time where answers are still outside our reach. We hope that within his lifetime we will have better solutions with less side effects, in the meantime, we will treat the symptoms and embrace the beautiful smile that has returned to my son's face.

You can learn more about our story at:
mysonhas2brains.blogspot.com

#10 Mama Bear (Link) on 2011-08-05 22:17 (Reply)

yes, some kids really do need those meds. BUT the vast majority of those who get them do not.
And that means that your kid (if he indeed really needs them, and something else wouldn't do better that doesn't bring as much money for your shrink) is getting a raw deal, as do you, because the world is starting to wake up to the massive amount of abuse of these meds and questions every diagnosis, paints every parent who has it made as being a bad parent who should have their children taken away because they're abusing them (and yes, drugging your children with whom nothing's wrong just to keep them quiet, which is the main use of these drugs and diagnoses, is child abuse and should be dealt with very harshly).

I know people who have children that were wrongly diagnosed with ADHD, bipolar, and autism. Or rather their schools and even kindergartens and daycare centers (one was barely 3 years old when the daycare center wanted to have him diagnosed with ADHD AND autism so they could drug an active child into a stupor) tried to get them drugged up but the parents refused, the kids were perfectly fine.

#10.1 J.T. Wenting on 2011-08-07 03:09 (Reply)

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Thursday, August 4. 2011

Fad diagnosis in Psychiatry: Bipolar Disorder in children