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How to deal with a bipolar daughter


Managing Bipolar Disorder in Children and Teens

Written by WebMD Editorial Contributors

In this Article

  • Bipolar Disorder in Young Children
  • How Can I Help my Bipolar Child?
  • Teenagers With Bipolar Disorder

Although bipolar disorder more commonly develops in older teenagers and young adults, it can appear in children as young as 6. In recent years, it's become a controversial diagnosis. Some experts believe it is rare and being overdiagnosed; others think the opposite. At this point, it's hard to be sure just how common it is.

Another diagnosis, called Disruptive Mood Dysregulation Disorder (DMDD) also has been established to describe children ages 6-18 who have severe and persistent irritability and temper outbursts that don't meet conventional definitions of bipolar disorder.

So it's important not to jump to conclusions. If your child is diagnosed with bipolar disorder, you might want to get a second opinion before embarking on a treatment plan. Make sure you're comfortable with your child's health care provider.

Bipolar Disorder in Young Children

Diagnosing bipolar disorder in young children is difficult, because many of the symptoms are similar to those of attention deficit hyperactivity disorder (ADHD) or conduct disorders -- or even just normal, childhood behavior. One problem is that medications used for ADHD are often stimulants, which can potentially trigger mania in children with bipolar disorder.

Young children in a manic phase might be more irritable than adults; they may be more likely to have psychotic symptoms, hearing and seeing things that aren't real. During a depressive episode, they might be more likely to complain of physical symptoms, like aches and pains.

One of the most notable differences is that bipolar disorder in children cycles much more quickly. While manic and depressive periods may be separated by weeks, months, or years in adults, they can happen within a single day in children.

How Can I Help my Bipolar Child?

As the parent of a child with bipolar disorder, there's a lot you can do to keep your child well. Here are some suggestions.

  • Follow the medication schedule. You absolutely must make sure that your child gets the medication they need for bipolar disorder. Use timers, pillboxes, notes, or whatever it takes for you to remember. If your child needs medication at school, talk to their teacher or school nurse -- schools may not allow students to take medication on their own.
  • Monitor side effects. Most drugs used for bipolar disorder (including mood-stabilizers, antipsychotic medications, and even antidepressants) were originally tested in adults, and only a few have been well-studied in children and adolescents. Some children are more prone to side effects from some of these drugs, such as weight gain and changes in blood sugar and cholesterol caused by some atypical antipsychotics. Ask your child's health care provider what symptoms to watch for and you may need to routinely monitor bloodwork. The FDA has issued a warning that using some types of antidepressants or other medicines used to treat depression may increase the risk of suicide in children, adolescents and young adults up to 24 years old.
  • Talk to your child's teachers. In some cases, a child with bipolar disorder may need special allowances at school. They may need extra breaks or less homework during difficult times. So work out an agreement with your child's teachers or the school principal. In some cases, you may need to take your child out of school for a while, at least until their bipolar symptoms stabilize.
  • Keep a routine. Children with bipolar disorder can really benefit from a daily schedule. Help them get up, eat meals, exercise, and go to bed at roughly the same times each day. Do what you can to reduce stress in the household.
  • Consider family therapy. Having a child with bipolar disorder can be disruptive to the whole family. It can put extra stress on your marriage. Your other children may not understand what's wrong with their sibling, or they may be resentful of all the attention they are getting. Going to family therapy can help you all recognize and deal with these issues.
  • Take suicidal threats seriously. No parent wants to think about their children hurting themselves. But unfortunately, it can happen, even with young children. So if your child begins to express a desire to die, or engages in life-threatening behavior, don't ignore it. Remove any weapons or dangerous drugs from the house. And get help right away.

Teenagers With Bipolar Disorder

In older teenagers, the symptoms and treatment of bipolar disorder are much more similar to those seen in adults. But having a teenager with this condition presents a lot of distinct problems.

As they get older, teenagers might be resentful if they feel that you're imposing treatment on them. So let them into the conversation. Talk frankly -- along with your child's doctor or therapist -- about treatment options. Try not to develop an adversarial relationship with your child over their treatment or medication.

As with adults, it's key that teenagers with bipolar disorder avoid alcohol and drugs, which can interact with medications or bring on or worsen mood episodes. The risks of developing a substance abuse problem are much higher in teens with bipolar disorder than in their peers. It's also important to maintain regular routines around sleep and wake times, and to develop effective coping strategies for managing stress and distress.

Bipolar Disorder Guide

  1. Overview
  2. Symptoms & Types
  3. Treatment & Prevention
  4. Living & Support

How to Parent an Adult Child With Bipolar Disorder

by Sarah Ludwig Rausch Health Writer

Medical Reviewer

Stephanie O'Leary, Psy. D., P.C.

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Medical Reviewer

Stephanie O'Leary, Psy.D., P.C.

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Maybe your grown child rarely speaks during family events—or she’s out partying for days without sleep. Moods can swing without warning or explanation, vacillating between debilitating depression and unexplained bursts of energy. And then there’s the drug and alcohol abuse—you haven’t seen it firsthand, but you suspect it’s happening, maybe to self-medicate—and other risky behaviors. If your adult son or daughter has bipolar disorder—newly diagnosed or yet to be—you’re a parent who’s likely worried about their emotional, physical, educational, and professional well-being, especially if they no longer live at home. How can you help?

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Bipolar Often First Appears in Young Adulthood

According to the National Alliance on Mental Illness (NAMI), symptoms of bipolar disorder typically first appear around age 25 (although they can sometimes emerge earlier), which can make navigating this condition’s unknowns extra tricky for parents. You likely no longer have legal authority over your child, yet you’re concerned about how bipolar may affect their life and livelihood. Know this: While they may push back against your efforts, your grown child might need you more than ever during this turbulent time.

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How Much Emotional Space Should I Give My Bipolar Adult Child?

Ideally, you’ve got a supportive, friendly relationship with your grown child that promotes maximum independence, says Robert Hamilton, M.D., a psychiatrist at OSF HealthCare in Normal, IL. How involved you should be depends on how well your son or daughter can function, what their needs are, how well you get along, and what you’re able to handle, Dr. Hamilton says. “The family’s role—parent, partner, sibling, or close friend—is to be a consistent source of support and encouragement through the good and the bad,” says Teri Brister, L.P.C., national director of research and quality assurance at NAMI.

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How Can I Guide My Child While Still Respecting Them as an Adult?

Keep communication with your child open and non-judgmental so they know their well-being is your main concern, and that you’re in it for the long haul, advises Dr. Brister. Ask your child to name you as a personal representative and grant permission to treatment providers for you to communicate with them, ask questions, and share your concerns. (How to get official HIPAA authorization varies, depending on the provider.) If you see worrisome behavior, point it out to your child with compassion, and offer to help discuss it with a professional, says Dr. Hamilton.

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If My Child Wants to Move Out, What Do I Do?

Remember that confrontation, arguing, and criticism usually aren’t helpful in any circumstance with your child, says Gregory Simon, M.D., a psychiatrist and researcher at Kaiser Permanente Washington in Seattle. “We can’t force others to do what we want them to do, but we can provide guidance and encouragement,” Dr. Brister says. Share your concerns with your child and talk about what involvement you’ll have once they’re living independently. If you don’t yet have your child’s permission to talk to their providers, ask for it now—in case you need to step in and help.

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How Can I Help Them at College?

If your child is away at school, open up a direct communication line with staff at the health and counseling centers on campus, says Dr. Brister. Your kid might exhibit behavior at school you don’t see at home, which could be an early sign that symptoms are returning. “Early symptom recognition is important, knowing when things are changing and working with the treatment team to address what’s going on before things get worse,” she adds. “Navigating mental illness involves everyone who loves and cares for the person. It takes a village.”

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What Should I Do if My Child Stops Taking Their Meds?

It’s common for a person with a mental illness to stop their medication, so expect this to happen at some point—and be prepared, advises Dr. Brister. Talk to your child about the consequences of stopping medication and give feedback on the positive changes you see from treatment, Dr. Hamilton suggests. “Remember, this is your child’s life—treatment choices are ultimately theirs to make,” Dr. Brister adds. “Like any other choices our adult children make, we may not always agree. And this doesn’t mean that they aren’t doing ‘well’.”

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What if My Adult Kid Is Exhibiting Unhealthy or Even Dangerous Behaviors?

If there’s a risk of harm to themselves or others, you need to get help immediately. Otherwise, Dr. Brister advises you make a distinction between behavior you disapprove of and behavior that’s actually dangerous for your child. This is where having communication privileges with healthcare providers is helpful so you can share what you’re observing, from violent episodes, to substance use, to erratic sleep patterns. Even if you don’t have permission, Dr. Brister says you can still legally talk to your child’s providers, though you won’t get any information from them.

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Should I Blame Myself if My Adult Child Is Not Doing Well?

While it’s important never to enable unhealthy behaviors—like turning a blind eye to drug use—it’s equally important to remember your son or daughter’s choices are not your fault. It’s can be tough to confront such issues head on but compassionately addressing problems shows love and concern, and may encourage your kid to get help. “We can’t control the behavior of other adults, even if they are our adult children,” Dr. Brister says. “We can be there to help pick them up when they make choices that have negative consequences.”

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What If I Need to Legally Intervene?

If your child’s behavior is truly out-of-control, you might wonder how—or even if—you can step in to help. In cases where the behavior definitely looks like it’s leading to harm, Dr. Hamilton says you can seek involuntary treatment, putting your adult son or daughter in inpatient or outpatient treatment without their consent. (How to do this depends on your state.) Dr. Brister maintains this should only be done as a last resort—and only when your child’s, or other people’s, safety is an issue. You can also seek court-appointed guardianship if your child seems incapable of making competent decisions.

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Where Can I Find More Information About Bipolar Disorder?

The best thing you can do for your child is to learn as much as you can, says Dr. Brister. Check out courses like NAMI Basics or NAMI Family-to-Family, which are led by family members of people with mental illness and teach you everything you need to know. “Most important, they provide support for the family as they navigate this with their loved one,” says Dr. Brister. Dr. Simon and Dr. Hamilton recommend resources from the Depression and Bipolar Support Alliance (DBSA), as well.

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How Can I Take Care of Myself So I Can Be There for My Child?

“Dealing with mental illness is very difficult,” acknowledges Dr. Hamilton. “Parents need to receive support, educate themselves about the illness, and may want to get counseling themselves.” He encourages parents to talk to other parents who’ve shared similar experiences. Don’t be afraid to ask questions and, since a supportive community is essential, consider joining a support group, adds Dr. Brister. “The important thing is not to give up.”

What to do (and what not to do) if a child has bipolar disorder

It is often difficult for parents to understand their child, especially when communication is reduced to formal questions like “how are things at school”. But if a child is diagnosed with a mental disorder, it is even more difficult to understand and help. Blogger Inna Gentle translated the podcast hosted by Dr. Esther Perel. It tells you what to do (and what not to do) if your child has bipolar disorder.

Stop pushing

Crying parents came to the session  —  daughter was diagnosed with bipolar disorder. She sits in her room 22 hours a day, her parents do not understand what to do. The girl is undergoing treatment, but this is not family therapy. During the session, it turns out that the adopted daughter (initially knew about the adoption), was bullied at school. Last year there was a suicide attempt in which the daughter blamed her mother. A typical story: a smart girl was a straight A student, and then everything collapsed.

At the reception, my mother is constantly crying. Like, "how I want my daughter to have a passion for something, she's so talented, she cooks like that, and she sings like that." Dad is mostly silent.

Parents are asked: "Have you discussed the problem with any of your friends?" Of course, the answer is no.

Therapist's note : "You understand that you have two parallel processes of isolation in your house: your daughter is isolating from you, going to Internet friends, and you are isolating from society."

Offer : look for a mutual support group among parents, share it with your friends already. Don't spoil an already complicated dynamic.

Parents put pressure on "find a job, you need hobbies." The daughter cuts her veins in response.

Therapist's note : A depressed person loses control of everything. Everyone around him is bombarding him with phrases like “have you tried [insert generic method 1]? What about [insert generic method 2]?”. The only way to get control of your life again is to say no, go to hell, I don't need your support. No, I'm not getting better. This is not a conscious rational resistance, but simply a natural reaction to pressure.

Offer : stop pushing. It won't help the cause at all.

Dad is stuck in a triangle between wife and daughter. He doesn't understand what to do. As a result, he simply remains silent, taking a detached position

Proposal : you need to clearly distinguish between situations when the daughter wants to talk to him, and when to pass some information on to her mother. The daughter's desire to distance herself from her mother (whom she recently stopped calling "mother"), of course, hurts his beloved woman. But sometimes you need to be closer to the child himself.

What does the daughter herself want? Why do parents come to therapy with the question "how to help her" without bringing her?

Suggestion : family therapy are sessions aimed at restoring the resources of the parents themselves, who clearly need support.

Mom is very worried that she can no longer pretend that everything is in order.

Therapist's note: actually, you're really not all right. In addition, the daughter is really weighed down by the feeling that she has been lying all this time, "pretending" to be normal. As a result, parents' attempts to pretend that everything is under control create another parallel process: both parties feel the growing falsity in the relationship.

The child decides how to get well

Parents are glad that they turned to a specialist. Further efforts will be directed towards building healthy relationships in the family, since helping her daughter cope with the symptoms of bipolar disorder is the task of her personal therapy.

The therapist's general conclusions are:

  • Hearing from a mother "I want my daughter to love something with all her heart" when it comes to a girl with a severe form of bipolar disorder is strange. First of all, we are talking about the treatment of the disease. A person in a state of depression does not fit at all with these standard advice in the style of "follow your dream." But if you explain to a person, he will understand. Mom seems to have heard. Another issue is that sometimes understanding parents is not such an important thing when compared with the amount of resources expended. You don't have to explain.
  • A person in a depression / depressive phase most often and without other people's advice understands that this is not life, but hell, and something needs to be done. Any pressure creates resistance.
  • The question of the general recovery of the child  —  this is very important, but it is decided in personal therapy by the child himself. In the context of working with parents, the most important thing is to restore the overall dynamics of relationships.

Parental Rescue Strategies

I think the idea of ​​creating parent support groups is a very sound one. We are very smart here with our English and access to resources, and our parents are poorly oriented due to lack of information. And yet, here are some other interesting sources on this topic.

1. "15 tips for parents of a child with bipolar disorder on how to deal with their child's outbursts."

2. Here are some more practical tips for parents of children with bipolar disorder.

3. And here is the personal experience of the mother of an adult son, who was first treated for addiction, and only then the correct diagnosis was made.

4. Rescue strategies for parents of a bipolar child.

In a nutshell, these are the rescue strategies.

  • Keep the general structure of the day, as children with BAD are extremely susceptible to changes in the schedule.
  • Keep a mood diary.
  • Plan everything in advance: surprises can serve as a trigger for an aggravation of the condition.
  • Reduce the number of family conflicts: set clear boundaries in the conflict, be as friendly as possible, do not swear in front of the child.
  • Remember the strengths of the child, praise and redirect his energy.
  • Be aware of what is happening outside the walls of the house, talk with the child.
  • Make the transition from one activity to another as painless as possible.
  • Monitor teenager for alcohol and drug use.
  • Make a "contingency plan" in case of increased aggression on the part of the child or the appearance of suicidal thoughts. If possible, remove all sharp objects from the visibility zone, be in touch with the doctor.
  • Be aware of the unrealistic standard expectations. Of course, I really want to compare the child with peers, but if you think that the child should do this, this does not mean that he can.
  • Take care of yourself, take care of your mental health.

Source: Where Should We Begin podcast. Series: S2Ep1 You need help to help her. The author is the therapist Esther Perel.

Photo: Shutterstock (Kamira)

Bipolar disorder: a parent's perspective.

| by Inna Gentle

Podcast: Where Should We Begin (either on Podcasts on IoS or any other app).

Series: S2Ep1 “You need help to help her.”

Author / therapist: Esther Perel (specializes in couples therapy)

Case: Clients' daughters were diagnosed with bipolar disorder several years ago. The girl sits in her room for 22 hours, and her parents do not understand how to react to the situation. My daughter is receiving treatment, but it is slow and difficult. During the session, it turns out that this is an adopted daughter (a girl from South Korea, she initially knew about the adoption), and she was subjected to severe bullying at school. Last year, the girl made a suicide attempt, which she blamed on her mother. This is an unexpected breakdown for others - the high academic performance and general activity of the daughter were replaced by a psycho-emotional abyss and a constant “hang on the Internet” mysterious for parents.

During the reception, the mother weeps non-stop: it is rare to hear a parent's unedited position when a child is ill. Her main reaction is “how I want my daughter to have a passion for life and realize all her endless talents.” Dad is mostly silent.

  1. Therapist asks: “Did you discuss the problem with a friend yourself? ". The answer is no, parents try not to tell others about the trouble.
  • Note therapist: "You must understand that two parallel processes of isolation are going on in your house : the daughter is isolating from you, going to online friends, and you are isolating from society."
  • Offer : look for a support group among parents, share with friends. Don't spoil an already complex dynamic.

It seems to me that the idea of ​​creating parental support groups is a very sound topic: we are very smart here with our English and access to resources, and our parents are poorly oriented due to lack of information.

2. Parents of are actively promoting the “get a job, you need hobbies” strategy . The daughter cuts her veins in response.

  • Therapist's note: depressed people lose control over everything. Surrounding people shower him with the phrases “have you tried abc? What about def?” and the only way to get control back is to say no, go to hell, I don’t need your support. No, I'm not getting better. This is not a conscious resistance, but a natural reaction to pressure.
  • Sentence: stop pushing. It won't help the cause at all.

3. Dad is tied into a triangle between wife and daughter. Doesn't understand what to do => just keeps silent and takes a detached position.

  • Sentence : clearly distinguish between situations when the daughter wants to talk to him personally, and when she wants to convey some information to her mother. The daughter's desire to distance herself from her mother (she recently stopped calling her "mother"), of course, hurts his beloved woman. But sometimes you need to be closer to the child himself.

4. What does the daughter herself want? Why do parents come asking “how to help her” without bringing her?

  • Offer:
    - family therapy
    - sessions aimed at the recovery of the parents themselves, who clearly need support.

5. Mom is very worried that she can no longer pretend that everything is in order.

Therapist's note: actually, you really are not all right. The daughter in conflicts resorts to a frightening argument: "I lied to you all this time, pretending to be normal." Parents' attempts to pretend that everything is under control creates another parallel process: both parties feel a growing fakeness in the relationship.

Parents are glad that they turned to a specialist. Further efforts will be directed towards building healthy relationships in the family, since helping her daughter cope with the symptoms of bipolar disorder is the task of her personal therapy.

  • Parents are the same people. Yes, hearing from a mother “I want my daughter to love something with all her heart” when it comes to a girl with a severe form of bipolar disorder is strange. The standard “Follow your dream” advice doesn’t work at all for a depressed person. But people can change their minds if sound arguments are made: the heroine of this episode accepted the words of a specialist. But sometimes understanding parents requires huge resources on the part of the explainer. Educational work should be carried out by a specialist, and not by a relative in a difficult situation.
  • A person in a depression/depressive phase most often understands, even without other people's advice, that his condition is not life, but survival, and something needs to be done about it. Any pressure creates resistance.
  • The issue of a child's recovery is very important for family relationships, but this is resolved in the course of his personal therapy. In the context of working with parents, the most important thing is to restore the overall dynamics of the relationship.

https://www.bphope.com/kids-children-teens/15-rules-for-parents-to-manage-bipolar-rage-in-their-children/ - 15 tips for parents of a child with bipolar disorder how to Deal with your child's outbursts of anger.

https://blog.oup.com/2008/03/bipolar_children/ - (short: