Questions and Answers about Children with Parents with Bipolar Disorder (BD).

Q: I heard bipolar is genetic. Will my kids get it? Bipolar does have some genetic elements and it is possible to inherit it from family on either side. Some parents may carry a marker for it that they pass onto kids without having the condition themselves. It is not always clear what it means to say that a person has gene markers for bipolar, and it’s not necessarily the case that children will get the condition even if they have markers for it. Being able to detect the condition by genetics alone isn’t possible, as yet. What has been found in studies are a lot of different numbers that don’t always make sense. Some say children of parents with bipolar disorders are 2.7 times more likely to develop the condition. Other studies have looked at all mental health disorders and see children with parents with BD have a 50% chance of developing a mental illness of any kind over the course of their lifetime. Most of the time, bipolar disorder does not occur in childhood and average age of onset is about 25, though there are certainly a small group of teens and children that show signs of it earlier. These answers are changing all the time as we understand genetics more, but it is at least possible to say that there is an increased risk, but many researchers see this as not that high. Q: Do children and teens with parents with BD have different obstacles? From a physical standpoint, children born to bipolar moms on certain medications may have a higher risk for birth defects like heart anomalies, spinal defects, and cranio-facial defects. Risk can be reduced by planning a pregnancy with additional care from a psychiatrist and a high-risk obstetrician. The subgroup of children/teens who do develop mental health disorders will also mean these children need regular assistance, surveillance, and treatment, and there does seem to be a higher number of children with ADHD who have a parent with BD, so parents should look for learning and behavioral issues. The main obstacles that kids with parents with bipolar disorder face are based on the stability of the parents. Children and teens respond and form their life view and behaviors based on their environment. If a parent with BD is frequently unstable, the environment is less stable for rearing children. From statistics we know that 50% of individuals with BD are divorced or unmarried, which means some children will either have experienced divorce of their parents in their lifetime or will have been single parented. Divorce is an adverse childhood event (ACE) and so is being parenting by someone with a chronic illness, so these do have impact on child and teen behavior and future health and wellness. In some cases, single parenting, or even in our area of California, parenting together, may come with certain income difficulties. Chronic illnesses are challenging to work around and may lead to lower socioeconomic states. Without sufficient assistance from government programs and laws protecting those with chronic illnesses, some children with parents with BD may experience food and housing insecurity, and these are ACEs as well.

Q: I’m bipolar and love my kids. What can do to intervene and help them with some of these obstacles? Intervention is two-fold, partly directed at you and partly directed at your kids. The first part is making sure that you are taking care of yourself. The APA guideline for treating Bipolar Disorder is medication and psychiatric care, plus regular therapeutic care. My general recommendation is that individuals with this condition always be supported by a therapist. The second part is figuring out how to make sure your condition least affects your children. This means you have to know what you are like when you are bipolar. If you tend to be highly irritable, prone to risk-taking or unable to take care of yourself for long periods of time, then you know you need to find support around you that can help when you have an episode. Look to reliable friends and family who can pitch in during these times and also consider help from community agencies or your spiritual community. People also become better at managing mood states and may need less assistance as they grow accustomed to working with their illness. Additionally, if your children do experience or have been emotionally touched by your bipolar states, consider either individual or family therapy. Children are often protective of their parents and they may not be too honest with parents about how they have felt fearful or upset with mom or dad while an episode was going on. They don’t want to tell because they don’t want to risk that more upset could cause more instability, and their hearts are invested in the parent with BD staying stable. Individual and/or family therapy can help unwind this process and take away from children the mistaken sense that they have to shoulder your disease. This can be tremendously protective for them as they grow and individuate. Q: How do I help children develop normally if they have these interruptions caused by my moods? Even people managing their condition well can’t prevent their kids from seeing the suffering or difficulty that BD can sometimes cause. Most of the studies done on kids and teens with bipolar parents are those where the parents have been in treatment for a long time or they are on bipolar teens with bipolar parents. With bipolar teens, there does seem to be decreases in socialization caused by missed time from school to deal with illness, but then we are seeing such a change in social media and how it limits socialization in normal children, that it's hard to make sense of previous data. Kids with parents that are frequently in manic or depressive states may express this in different ways, either through immature or overly precocious (the child seems years older or more capable that she should) behavior. Teens may also feel worried when it is time to leave and want to protect a parent who has relied on them too often for assistance. They could delay development forward into adulthood by expressing disinterest in college or a career. Regular conversation in the home with therapeutic help can build resiliency instead and as well as developing “along normal lines” children with parents with a chronic illness can development and harness very powerful boundaried empathy, which can serve them through life. Q: Anything else I should know about my child and my bipolar disorder? Chances are, your child is very creative. A high percentage of children of adults with BD are. This is great because chances are, you are pretty creative too. Playing together and allowing opportunity to express feelings through play, art, and music are terrific ways to handle the many feelings both child and adult have about this condition. Consulting a play therapist skilled in filial therapy can help bring parent and child closer together in this regard, too. Bipolar Disorder will always be a factor in the family’s life, but it doesn’t have to be the dominant factor. Adults of parents with BD who develop the condition themselves may be encouraged by what they learned in childhood from their or their family’s therapist. There is so much help and hope, and this condition can be managed personally and within the context of the family. It is no bar to parenthood when people are committed to getting good care for themselves and family, as needed. . References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. (4th ed. Text revision). Washington, DC: American Psychiatric Association. Boucher, R. C. (1999). Students in Discord: Adolescents with Emotional and Behavioral Disorders. Westport, Connecticut: Greenwood Press. Castaneda, X. (2010). Mental health and latinos in the US. (Fact Sheet) Health Initiative of the Americas. University of California, Berkeley: School of Public Health. Chang, K. D., Blasey, C. M., Ketter, T. A., & Steiner, H. (2003). Temperament characteristics of child and adolescent bipolar offspring. Journal of Affective Disorders, 77 (1), 11-19. Retrieved from www.elsevier.com/locate/jad Chang, K., Steiner, H., Dienes, K., Adleman, N., & Ketter, T. (2003). Bipolar offspring: A window into bipolar disorder evolution. Biological Psychiatry 53, 945-951. doi:10.1016/S0006-3223(03)00061-1 Duffy, A., Alda, M., Trinneer, A., Demidenko, N., Grof, P., & Goodyer, I. M. (2007). Temperament, life events, and psychopathology among the offspring of bipolar parents. European Child and Adolescent Psychiatry, 16, 222-228. doi:10.1007/s00787-006-0592-x Ellenbogen, M. A. & Hodgins, S. (2009). Structure provided by parents in middle childhood predicts cortisol reactivity in adolescence among the offspring of parents with bipolar disorder. Psychoneuroendocrinology, 34, 773-785. doi:10.1016/j.psyneuen.2008.12.011 Engel, L. & Ferguson, T. (1990). Imaginary crimes: Why we punish ourselves and how to stop. Boston: Houghton Mifflin Company. Ernst, C. L. & Goldberg, J. F. (2002). The reproductive safety profile of mood stabilizers, atypical antipsychotics, and broad-spectrum psychotropics. Journal of Clinical Psychiatry, 4 (Suppl. 2), 42-55. Retrieved from http://www.psychiatrist.com/pcc/pccpdf/v04s02/v63s0407.pdf Hinshaw, S. P. (2010). Growing up in a family With bipolar disorder: personal experience, developmental lessons, and overcoming stigma. In Miklowitz, D. J. & Cicchetti, D. (Eds.) Understanding bipolar disorder: A developmental psychopathology perspective. (pps. 525-556). New York: The Guilford Press. Hirschfeld, R. M.A., Bowden, C. L., Gitlin, M. J., Keck, P. E., Suppes, T., Thase, M. E., Wagner, K. D., & Perlis, R. H. (2003). Practice guidelines for the treatment of patients with bipolar disorder (Revision). FOCUS, 1, 64-110. Retrieved from http://focus.psychiatryonline.org/cgi/content/full/1/1/64 Jones, S. H., Tai, S., Evershed, K., Knowles, R., & Bentall, R. (2006). Early detection of Bipolar Disorder: a pilot familial high-risk study of parents with Bipolar Disorder and their adolescent children. Bipolar Disorders, 8, 362-372. Retrieved from EBSCOhost. Kirmayer, Laurence J. (2001). Cultural Variations in the Clinical Presentations of Depression and Anxiety: Implications for Diagnosis and Treatment. Journal of Clinical Psychiatry, 62, (Supplement 13). 22-30. Retrieved from http://www.mcgill.ca/files/tcpsych/LJK- depanx.pdf Knutsson-Medin, L., Edlund, B., & Ramklint, M. (2007). Experiences in a Group of Grown-Up Children of Mentally Ill Parents. Journal of Psychiatric and Mental Health Nursing, 14, 744-752. Linnen, Anne-Marie, Rot, Marije aan het, Ellenbogen, Mark A., & Young, Simon N. (2009). Interpersonal Functioning in Adolescent Offspring of Parents with Bipolar Disorder. Journal of Affective Disorders, 114, 122-130. Retrieved from www.elsevier.com/locate/jad Meadus R. J. & Johnson B. (2000). The Experience of Being an Adolescent Child of a Parent who Has a Mood Disorder. Journal of Psychiatric and Mental Health Nursing, 7, 383-390. Miklowitz, David J. & Goldstein, Michael J. (1997). Bipolar Disorder: A Family- Focused Treatment Approach. New York: The Guilford Press. Papolos, Demitri, Mattis, Steven, Golshan, Shahrokh, & Molay, Francine. (2009). Fear of Harm, A Possible Phenotype of Pediatric Bipolar Disorder: A Dimensional Approach to Diagnosis for Genotyping Psychiatric Symptoms. Journal of Affective Disorders, 118, 28- 38. doi: 10.1016/j.ad2009.06.016 Reupert, Andrea E. & Maybery, Darryl. (2010). “Knowledge is Power”: Educating Children about Their Parent’s Mental Illness. Social Work in Health Care, 49, 630- 646. doi: 10.1080/00981380903364791 Simeonova, Diana I., Chang, Kiki D., Strong, Connie, & Ketter, Terrence A. (2005). Creativity in Familial Bipolar Disorder. Journal of Psychiatric Research, 39, 623-631. Retrieved from www.elsevier.com/locate/jpsychires Zastrow, Charles H. & Kirst-Ashman, Karen, K. (2010). Understanding Human Behavior and the Social Environment. Belmont, CA: Brooks/Cole, Cengage Learning. All information in this article is for informational purposes only. Please seek individual professional advice for help and care on an ongoing basis. If you are a California resident and would like to work with me, you can reach out to Patricia at tricia@santarosatherapist.org or call me at 707-974-4982 to discuss treatment. Written By Patricia Ellis Christensen 6/22/2021. All rights reserved @.