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In the last section, we discussed Helping Parents Understand their child’s condition. : developing a family history; understanding a child’s symptoms; the "Knowing Your Child" exercise; and the "Mood Chart" exercise.

In adults, this type of mood disorder presents itself normally. However, in children, the disorder may make its presence known in symptoms unique to children.

In this section, we will present three common manifestations of bipolar disorder that seem to only appear in children with the disorder: separation anxiety; night terrors; and rage.

3 Common Manifestations of BPD

♦ 1. Separation Anxiety
The first characteristic is separation anxiety. Those children who are diagnosed with early onset bipolar disorder have been reported to have an exceptionally difficult time in being away from one parent or both parents, especially in infancy. This separation anxiety occurs to such an extent in bipolar children that the mother is unable to even put her child on the ground. Many mothers report doing household chores with their infants in slings around their torso.

Colleen, mother of Sanford, age 11, stated, "I remember being mauled with his nails scraping down my chest as he struggled against being withdrawn by his father, who was trying to take him from me so that I could take a shower." Obviously, in infants, techniques are usually ineffective because they are at a stage in which they are able to understand very little besides their own emotions and panic. However, for children beyond the age of reason, who have separation anxiety, I recommend a number of techniques to parents in order to help reduce a child’s separation anxiety:

7 Tools for Dealing with Separation Anxiety

1. Listen to the child's feelings. The simple experience of being listened to empathically, without receiving advice, may have a powerful and helpful effect.
2. Keep calm when a child is upset about separating .
3. Gently remind the child that he or she survived the last separation . Reassurance goes a long way and may help reduce the child's anxiety.
4. Anticipate transition points that can cause apprehension, such as going to school or meeting friends for play. If a child tolerates separation from one parent more easily than from the other parent, arrange school drop-off, bedtime, and other transitions to be handled where possible by the parent from whom it is easier to separate.
5. Firmly, consistently, and caringly set limits .
6. Teach relaxation techniques. Teaching children or adolescents how to relax will empower them to develop mastery over symptoms and improve a sense of control over their body.
7. Praise the child's efforts to address symptoms. Young people often feel that they only hear about their mistakes. Even if improvements are small, every good effort deserves to be praised

These tips used consistently have been found to reduce separation anxiety in children with bipolar disorder.

♦ 2. Night Terrors
The second characteristic found in bipolar children is frequent night terrors. These night terrors usually result in the child screaming and sometimes being unable to awaken from their dreams. This leaves the child in a semiconscious state in which they are still experiencing frightening circumstances. These nightmares are vivid, seemingly life-threatening in which the child witnesses unthinkable gore.

Dr. Charles Popper, author of the article "On Diagnostic in Child’s Nightmares", states, "Dreams of fighting are quite common. In the fighting dreams of children or adults with mere anxiety, a knife may be pulled out and brought into attack, but the dreamer wakes up just before the knife enters the skin or rips the clothing. For bipolar children, the knife goes in, the blood is seen, and the dream may continue at considerable length and with explicit visualization of gore."

These night terrors may explain the sadistic remarks that bipolar children say during the day. Zachary, age 7, once stated to his teacher, "I’m going to put a rope around your neck and pull it till you bleed and your face goes white and your shirt is soaked with blood."

Obviously, these comments greatly upset parents who believe that their children may have potential for violence. I find that reassuring these parents that these remarks are most likely the product of night terrors often relieves them of any anxiety. I also find it useful to emphasize the importance of reassuring the child when he or she awakens from these night terrors. Saying such statements as, "You’re safe in your bed" and "There are no bad men to hurt you" can reduce a child’s own anxiety.

♦ 3. Rage
In addition to separation anxiety and night terrors, I find that many bipolar child clients are characterized by rage. These sporadic rages go far and beyond the normal tantrums common in young children. These rages can include hitting, biting, punching, breaking things, and shouting foul language. Often, these tantrums are incited by a simple "no" from a parent and can last up to three hours.

Parents have described children going into a trance-like state in which the child’s pupils dilate and his or her eyes become "wild-looking". Stacey, mother of Charlie, age 8, describes, "I finally came up with a word that fits. It’s feral. He looks feral when he rages. Almost like a wild animal that is fighting for its life, territory, whatever. There is a certain shine in his eyes that is almost metallic. He just exudes this primal rage."

Many times, the child does not exhibit this behavior outside of the home, which makes it difficult for teachers and family friends to understand why the child needs therapy at all. Often this rage calms with mild mood stabilizing medications and therapeutic treatment. I emphasize to parents that it is not surviving the rage that is important, but keeping a close relationship with the child after the rage has subsided. Without a loving relationship, there is a higher chance of acting out from the child to gain attention.

In this section, we presented three common manifestations of bipolar disorder that seem to appear only in children, not adults, with the disorder. These three manifestations are: separation anxiety; night terrors; and rage.

- Bystritsky, A., Khalsa, S. S., Cameron, M. E., and Schiffman, J. Current Diagnosis and Treatment of Anxiety Disorders. P&T, January 2013, 38(1). p 30-57.
Reviewed 2023

Peer-Reviewed Journal Article References:
DuPont-Reyes, M. J., Villatoro, A. P., Phelan, J. C., Painter, K., & Link, B. G. (2020). Adolescent views of mental illness stigma: An intersectional lens. American Journal of Orthopsychiatry, 90(2), 201–211.

Forehand, R., Thigpen, J. C., Parent, J., Hardcastle, E. J., Bettis, A., & Compas, B. E. (2012). The role of parent depressive symptoms in positive and negative parenting in a preventive intervention. Journal of Family Psychology, 26(4), 532–541.

Fortney, J. C., Pyne, J. M., Ward-Jones, S., Bennett, I. M., Diehl, J., Farris, K., Cerimele, J. M., & Curran, G. M. (2018). Implementation of evidence-based practices for complex mood disorders in primary care safety net clinics. Families, Systems, & Health, 36(3), 267–280.

Greenberg, J., Hilton, E. C., Li, J. J., Lu, Q., & Mailick, M. R. (2021). The impact of parenting a child with serious mental illness: Accounting for the parent’s genetic vulnerability to mental illness. Journal of Family Psychology, 35(3), 417–422.

Milos, M. E., & Reiss, S. (1982). Effects of three play conditions on separation anxiety in young children. Journal of Consulting and Clinical Psychology, 50(3), 389–395.

QUESTION 2
What are three common manifestations of bipolar disorder that seem to appear in children, and not adults, with the disorder? To select and enter your answer go to Test.

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