Affiliation: 180 Massachusetts Ave, Suite 301, Arlington, MA 02474, USA.
The diagnosis of juvenile bipolar disorder (JBD) has been the subject of much controversy and confusion. There have been well documented increases in the application of this diagnosis, at least in the United States. This has led to concerns about overdiagnosis. At the same time, juvenile bipolar disorder presenting in adolescents can be difficult to detect, with symptoms being perceived as normal, if exaggerated, adolescent behavior. Two cases, one mistakenly diagnosed as JBD and the other in which the diagnosis was missed, illustrate the difficulty in making an accurate diagnosis. Recent refinements in diagnosis have the potential to clarify and improve clinical diagnosis and treatment. The three main diagnostic approaches to JBD (the so-called “narrow phenotype” approach, the “cardinal symptoms” and brief frequent cycles approach, and finally the persistent, impairing irritability approach) are reviewed. The author then reviews the longitudinal data examining continuity between juvenile and adult bipolar disorder. Returning to the cases, the author reviews her treatment decisions, and how they could have been improved with better diagnostic precision. Finally, some thoughts are shared about why the diagnosis of JBD has become both so much more frequent and controversial, and what practicing clinicians should focus on.