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Onset of Bipolar Disorder

Some diseases are diagnosed at specific ages or developmental stages. Bipolar disorder is not. It can be diagnosed at any age, from as young as preschool to any time throughout adulthood. The age at diagnosis---early-onset versus adult-onset---makes a difference in the severity and outcome of the illness.

  1. Facts About All Ages of Onset

    • Bipolar disorder (BPD) affects about 2.6 percent of the U.S. population. More than 90 percent of those who have a single manic episode will have future episodes. On average, it is eight years after initial symptoms before a person with BPD obtains a diagnosis, and 60 percent are untreated or inappropriately treated. This is not surprising, considering that comorbidity---the presence of other diseases in addition to BPD---frequently hides the bipolar symptoms.

    Onset and Symptoms

    • Adult-onset BPD is defined by manic and depressive episodes that have a specific minimum duration. While this varies a little depending on the subtype, mania lasts a minimum of one week, while depression is evident for at least two weeks. Both mania and depression can last much longer---anywhere from four to five months for mania and six months or more for depression. The duration of episodes is different in early-onset BPD. When diagnosed under the age of 18, BPD is marked by rapid mood cycling, sometimes occurring frequently within one day. While adult-onset BPD follows pronounced mood phases, early onset may present as a chronic, persistent irritability or a mixed state in which the two moods exist simultaneously.

    Onset and Outcomes

    • Early onset is consistently associated with a worse outcome. Those diagnosed at an early age are more likely to have comorbid anxiety disorder and to engage in substance abuse. Early onset is associated with more psychotic symptoms (even into adulthood), rapid cycling, mixed states, and longer delays from first symptoms to diagnosis. Those who receive an early diagnosis are more likely to have a significant family history of BPDm and they attempt suicide more often.

    Prevalence

    • A study in 2004 evaluated 983 adult patients with BPD and found that 27.7 percent had early onset. The same prevalence of an early diagnosis---30 percent--was found in a second study of 1,630 adult patients. In June 2009, researchers at the Massachusetts General Hospital studied 3,658 adults diagnosed with BPD. Their study reported that 29.19 percent were diagnosed before the age of 13, 38.35 percent were diagnosed between the ages of 13 and 18, and 32.44 percent had adult-onset bipolar disorder.

    Onset and Treatment

    • Treatment is the same regardless of the age of onset. Medication is always necessary to stabilize moods and will be required throughout the individual's life. This is a challenge, because many of those with BPD stop taking their medications due to side effects or during phases when their mood is stable. The result is a potentially devastating acute mood episode. Research has shown that including education and psychotherapy results in a better outcome. Therapy encourages compliance with medication and helps the individuals and their families to understand the disease, learn how to identify impending mood swings, and develop coping skills.

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