In adolescents, bipolar disorder may resemble any of the following classical adult presentations of the illness, as indicated in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV):

  • Bipolar I. In this form of the disorder, the adolescent experiences alternating episodes of intense and sometimes psychotic mania and depression.

    Symptoms of mania include:

    • elevated, expansive or irritable mood
    • decreased need for sleep
    • racing speech and pressure to keep talking
    • grandiose delusions
    • excessive involvement in pleasurable but risky activities
    • increased physical and mental activity
    • poor judgment
    • in severe cases, hallucinations

    Symptoms of depression include:

    • pervasive sadness and crying spells
    • sleeping too much or inability to sleep
    • agitation and irritability
    • withdrawal from activities formerly enjoyed
    • drop in grades and inability to concentrate
    • thoughts of death and suicide
    • low energy
    • significant change in appetite

    Periods of relative or complete wellness occur between the episodes.

  • Bipolar II. In this form of the disorder, the adolescent experiences episodes of hypomania between recurrent periods of depression. Hypomania is a markedly elevated or irritable mood accompanied by increased physical and mental energy. Hypomania can be a time of great creativity.
  • Cyclothymia. Adolescents with this form of the disorder experience periods of less severe, but definite, mood swings.
  • Bipolar Disorder NOS (Not Otherwise Specified). Doctors make this diagnosis when it is not clear which type of bipolar disorder is emerging.