Understanding bipolar disorder in teens: recognising signs and seeking help

Explore how to recognise and manage bipolar disorder in teens, distinguishing usual adolescent behaviour from the early signs of this mental health condition.

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Teenagers often face a range of emotions during adolescence, from feeling excited and energised to feeling overwhelmed or irritable. However, if their mood swings are extreme, rapidly cycle from crushing lows to excessive highs, and are causing problems in their day-to-day life, this could be a sign they’re struggling with a mental health condition, such as bipolar disorder.

It can be tricky to tell when a teenager is dealing with more than the ‘normal’ range of emotions that the teenage years bring, and whether they may need professional support. Here, we explore the signs to look out for and what to do if you’re worried that a teenager may have bipolar disorder.

Spotting the early signs of bipolar disorder in teens

Bipolar disorder, which was formerly known as ‘manic depression’, is a condition that affects the brain’s ability to regulate moods. It can cause a teenager to experience intense emotional fluctuations, impacting the way they think, feel and act.

The signs of bipolar disorder in a teenager can vary significantly from one person to another, but typically, they experience several common symptoms. These symptoms can be grouped into two broad categories:

Depression
Mania

In order for bipolar disorder to be diagnosed, young people need to have experienced both depression and mania. In addition, their symptoms need to be persistent, different to the person’s usual behaviour, and independent of drugs, life events and physical health issues.

Depressive symptoms in teenagers

Depressive episodes are characterised by a significant decrease in energy and mood, which lasts for at least 7 consecutive days. These periods can cause a range of distinctive symptoms in teenagers:

Persistent sadness - teens may express ongoing feelings of sadness or appear emotionally ‘flat’. They may also have bouts of tearfulness, that seem unusual for them
Low energy – they have a noticeable reduction in their energy levels, making them seem unusually tired or sluggish
Withdrawal from social activities - they might pull away from friends and family, and show no interest in things they used to enjoy
Changes in appetite and sleep - changes in sleeping patterns and appetite are common in teenagers going through a depressive episode. They may eat and sleep too little or too much
Feelings of worthlessness or guilt - teens may be very self-critical or feel as though they’re not good enough
Difficulty concentrating - they might struggle to focus on schoolwork or other daily tasks. This can cause a significant drop in their academic performance
Thoughts of death or suicide - in more severe cases, teens might express thoughts of death, suicide, or engage in self-harming behaviour

It’s important to understand that many of the symptoms listed above are common in adolescence and don’t necessarily indicate depression or bipolar depression. For example, teenagers may feel sad and appear ‘low’ following a break-up or some form of disappointment in their life. Therefore, if you notice these symptoms in a teenager, a useful first step is for you to ask them what’s happening and how they’re feeling. It might be that there’s a clear reason for the change in their mood.

The depression that’s experienced as part of bipolar disorder causes a marked difference in the young person’s usual personality, and a subjective feeling of sadness, with no known trigger. If these symptoms last beyond a limited period of time and cause significant disruption to the young person’s life, it’s important to get help. You can read more about depression and teens here.

Manic symptoms in teenagers

Manic episodes in teenagers are characterised by an intense and unusually high level of energy, which last for at least 7 days. During these episodes, teens may show several key symptoms, including:

Thoughts

Inflated self-esteem - teens might display an unnaturally high self-confidence, which can appear as arrogance. They might even think of themselves as being invincible or having superpowers
Racing thoughts - their thoughts may rapidly jump from one idea to another, making it difficult to concentrate or hold conversations. They might talk non-stop or jump from topic to topic
Severe mania can also cause psychosis, which can include hallucinations, delusions and persecutory paranoia

Mood and sleep

Decreased need for sleep - despite high activity levels, they might need much less sleep than usual. They might not go to bed at all, and stay awake for days at a time
Elevated mood – during a manic phase, teenagers may display an intense and overwhelming sense of happiness, euphoria and elation

Behaviours

Excessive energy - teens may seem hyperactive, excitable or 'wired', showing a drastic increase in activity levels
Impulsivity – they may make reckless decisions without considering the consequences, which can sometimes lead to risky behaviours. The impulsivity that’s experienced as part of mania will be different to the teen’s usual behaviour and present a significant risk to them

Teens may also show signs of hypomania. This is a milder form of mania, characterised by an elevated mood, increased activity or energy levels that are different from the young person's normal state. People experiencing hypomania may feel more energetic, more optimistic and more productive than usual. They might also display behaviours such as talking faster, having racing thoughts, being easily distracted, or engaging in riskier activities than they normally would.

However, unlike full-blown mania, the symptoms of hypomania are less severe and don’t tend to cause significant impairments in day-to-day life. Also, hypomania doesn’t involve psychosis (such as hallucinations or delusions).

Gender-specific signs of bipolar disorder

As well as the more general symptoms, certain signs of bipolar disorder can be more common in girls and boys, reflecting the different ways they may experience and express their emotions.

Signs of bipolar disorder in teenage girls	Signs of bipolar disorder in teenage boys
May be more likely to internalise their emotions	May be more likely to externalise their emotions
Severe mood swings that disrupt daily activities	Increased irritability, aggression or hostility, especially during manic episodes
Bouts of tearfulness and intense stress during depressive episodes	Taking on multiple projects with unrealistic expectations
Excessively impulsive decisions during manic periods	Significant drop in academic performance during depressive phases
Rapid and dramatic changes in weight, sleeping patterns, or academic performance that don’t align with their usual behaviour	Withdrawal from friends or hobbies they previously enjoyed
	Persistent boredom during depressive episodes

While the above distinctions may be true for some teenage girls and boys, it’s important to understand that it’s possible for any of these symptoms to be experienced by young people of any gender.

Types of mood swings in teenagers

There are different ways that an adolescent with bipolar disorder, or similar difficulties, may experience their mood swings:

Depressive episodes that tend to be shorter or less intense, but mania/elevated mood episodes that are more severe. For example, this might involve an episode of mania/elevated mood that lasts longer than 1 week, or one that’s so severe it results in hospitalisation
Regular episodes of depression, with milder mania/elevated mood episodes
Rapidly cycling mood swings. This is usually considered to be more than 4 mood swings in 1 year. Each of these episodes may last for months, weeks or days at a time, and there may be short periods in between episodes where their mood is stable
Experiencing both depressive and hypomanic episodes over the course of 2 years, but they aren’t severe enough to have a negative impact on daily living, so they don’t reach the threshold for a full diagnosis of either depression or mania. Although these mood swings are less severe, that can last for a significantly long time

When and how bipolar disorder emerges in adolescents

The symptoms of bipolar disorder usually start to emerge between the ages of 15 to 25, although in some cases, signs may start to appear as early as 12. However, this tends to be when there’s a strong genetic link for bipolar disorder, for example, if the young person has a parent or sibling who’s been diagnosed with the condition.

Understanding this timeline is important for parents, as it can help them to differentiate between normal mood variations associated with puberty, and the potential early signs of a mood disorder. Also, while someone may be predisposed to developing bipolar disorder or psychosis, psychosocial factors like drug use or academic pressure can trigger an earlier onset of this and intensify the symptoms. This insight helps in understanding how external influences can accelerate and exacerbate the condition, highlighting the importance of monitoring and managing these risk factors.

More useful information:

Differentiating between bipolar disorder and puberty

Some of the symptoms of bipolar disorder, or indeed, many mental health conditions, can be mistaken for typical teenage behaviours. Staying up late, being rebellious, using poor judgement and being moody are common in many teens. Here’s how to tell the difference between ‘normal’ mood swings and the mood fluctuations associated with bipolar disorder:

Frequency – bipolar disorder mood swings happen more frequently and unexpectedly compared to those in typical puberty
Intensity – the emotional extremes of bipolar disorder are more severe, going beyond typical teenage reactions
Duration - mood swings in bipolar disorder last significantly longer, often several days to weeks, unlike the brief moodiness seen in puberty
Impact on daily life - bipolar disorder can severely disrupt daily activities and responsibilities, which is less common with normal adolescent mood swings
Influence of external factors – typical adolescent mood swings tend to be influenced by external factors, such as social interactions and environmental changes. In contrast, mood swings associated with bipolar disorder don’t tend to respond to external circumstances, indicating a deeper, internal cause

Brief limited intermittent psychotic symptoms (BLIPS) and acute and transient psychotic disorders (ATPD)

It's also important to understand that many symptoms commonly associated with bipolar disorder are similar to those seen in two other conditions: brief limited intermittent psychotic symptoms (BLIPS) and acute and transient psychotic disorders (ATPD). BLIPS and ATPD are conditions that involve brief, sudden episodes of psychotic symptoms that tend to resolve quickly, without any further episodes. Current research suggests that BLIPS and ATPD are more common in adolescence than previously thought. While psychotic symptoms can be concerning for teenagers and their families, they might indicate BLIPS or ATPD rather than bipolar disorder. Typically, BLIPS and ATPD cause one-off episodes that, with the right care and attention, don't usually lead to serious or long-term mental health problems.

This, coupled with the fact that the symptoms of bipolar disorder can mimic typical teenage mood swings, is why it can be challenging to diagnose bipolar disorder in young people.

Assessment and diagnosis

If you think your teen may be showing signs of bipolar disorder, it’s important to reach out for support. You can prepare for this by keeping a record of your teen’s behavioural patterns and mood fluctuations. Key bits of information to take with you to an initial appointment include:

How often their mood swings happen
How long each mood swing lasts
The severity of your teen’s highs and lows (you could use a rating scale to record this, so you can see a clear pattern and distinguish from what’s ‘normal’ for your teenager)
The impact their mood swings are having on their day-to-day life

Getting a diagnosis for bipolar disorder involves some key steps:

Visit your GP or contact a private specialist – the first step is for you to make an appointment for you and your teen to see their GP. Here, you’ll be able to discuss your child’s symptoms and the impact they’re having on their life. Your GP won’t be able to formally diagnose bipolar disorder, but if they think your teen would benefit from seeing a mental health expert, such as a psychiatrist, they’ll be able to refer you for this. Alternatively, you can contact a private mental health service provider, like Priory, directly. We provide assessments, diagnosis and treatment for bipolar disorder
Specialist assessment – the next step will be for your teen to receive an assessment with a child and adolescent mental health services (CAMHS) psychiatrist. This is a medical doctor who’s trained in diagnosing and treating bipolar disorder. During this, your teen will be able to discuss their thoughts, feelings, behaviours, relationships and lifestyle. The CAMHS psychiatrist will be able to offer their assessment and impression about your child’s difficulties, and then give advice and information on next steps for support and treatment

Long-term management and lifestyle

Managing bipolar disorder in teenagers usually involves a combination of medication, therapy, psychoeducation, mood monitoring and lifestyle adjustments. Medication can help to treat depressive/manic episodes and stabilise moods, while therapy, such as cognitive behavioural therapy (CBT), can provide tools for coping with the disorder and improving communication within the family. Psychoeducation helps the teenager and their loved ones learn more about their condition, and mood monitoring helps people to recognise when their mood is starting to swing and plan for early warning signs of an episode.

Supporting a teenager with bipolar disorder

Balanced support - when you’re supporting any teenager with mental (or physical) health difficulties, it’s important to try and find the right balance. This might mean avoiding being overprotective, as this could potentially cause your teenager to avoid you or isolate themselves. However, it’s still important to let them know that you’re always there to support them, in whatever capacity they need
Traffic light communication system – it can be useful to establish a communication system that respects the teen's need for space while keeping channels open. For example, implementing a 'traffic light' system allows the teenager to communicate their state of mind using colours: 'red' could signal severe distress, 'amber' might mean they’re feeling uneasy but not in immediate danger, and 'green' indicates a stable mood. This system can help you stay tuned-in to how your teen is feeling, without the need for constant verbal check-ins. Your teen could simply text you the colour they’re ‘feeling’ at different intervals throughout the day. You could also involve your child’s teacher in this process, or another adult that they trust within their school/college environment
Tailored support - it’s also important to establish how your teenager wants to be supported. They might not want to be asked lots of questions, but they might not want to be left alone either. It might be that they’d like to watch a film or walk the dog with you when they’re feeling ‘red’, until they feel they're at an ‘amber' level
Make use of charities, support groups and CAMHS resources - it’s important to remind your child that they can contact a supportive charity, such as ChildLine or the Samaritans, anonymously by telephone or web chat if they need a confidential discussion. Engaging with support groups and communities can also be beneficial. Organisations like Bipolar UK and YoungMinds offer peer support and resources for teenagers and their families, fostering a supportive network that can make navigating the challenges of bipolar disorder more manageable for everyone involved
Encourage them to engage with treatment – if your teen is diagnosed with bipolar disorder and has started receiving treatment, it’s crucial to support and motivate them to fully engage with their treatment plan. This might involve taking them to therapy sessions, fostering an open environment where they feel comfortable discussing their treatment, and reminding them about the importance of taking their medication
If you’re concerned about your child’s safety – either their own safety or that of other people – then you should get urgent medical help by dialling 999. Here’s some more crisis support information.