Q: Child's Behavior: BP Disorder or Learned Behavior?
Is it likely that a child growing up with a diagnosed yet unmedicated Bi-polar parent that was abusive will show signs of BPD but not
truly have the disorder themselves? If a child is surrounded by the behavior
for 15 years can it be a learned behavior that they are acting out rather than
truly carrying the disorder themselves? Can a counselor that does not
specialize in BPD evaluate accurately if this is the case. Can the behavior be
seperated from the true disorder?
Dear R' --
Mmm, tricky, this one. For starters, we could say, as you are suggesting, that
the child's behavior could be:
a) bipolar disorder;
c) (I would add) a reaction to the environment that isn't "bipolar"
but isn't "learned" as such either.
The latter possibility might fall under the
diagnostic label of "post-traumatic stress disorder" (PTSD) and the
symptoms there would include hyperreactions to minor events; insomnia; unexplained
agitation; avoidance of situations and stimuli that might somehow suggest
aspects of the original trauma -- and this one can be a huge
"umbrella" if the term avoidance includes acting out behaviors
such as crying, anger, creating a disturbance, etc., in other words nearly
everything one might expect from a troubled child bipolar or otherwise. In this
model the "trauma" can range from simply having one's own emotional
needs utterly unrecognized and met; to getting hit; to getting sexually abused
-- roughly speaking.
Worse yet, PTSD is very difficult sometimes to
separate out from complex bipolar disorder. So, can a counselor evaluate this
distinction? I'd suggest that even a specialist might find teasing out these
possibilities very difficult. Sometimes it's so difficult we have to just
proceed to treat the symptoms, without being certain about the
"diagnosis". It's a little easier to proceed in this fashion than you
might think, because the medications we use to treat bipolar disorder can help
even when the diagnosis is incorrect: for example, if a better overall
explanation is PTSD, or explosive anger problems, and there's no good response
to non-medication approaches which might generally be tried first especially if
the child is still less than 18 or so, a medication like Depakote can still
help (even though, granted, it has it's risks too).
So, I would hope that anyone attempting to
arrive at a "diagnosis" in a situation like this would strive to keep
their mind open to all possible diagnostic interpretations, as you go along;
and that at each step, the risks and benefits of different treatment options,
including therapy versus medications, would be re-examined. Good luck with
Published December, 2003