Child's Behavior: BP Disorder or Learned Behavior?
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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;
b) learned;
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 that.
 

Dr. Phelps



Published December, 2003

 

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