Bipolar and Trauma

I got assigned to a doctor today. We saw an adolescent male with bipolar, which is rare, though is over-diagnosed. His symptoms of mania were bouts of aggression, violence, assertion, not thinking of or caring about consequences (bought a car and drove it around town before having a license), and not needing much sleep. His depression manifested as suicidality and maybe some other stuff (I'm trying to rush through this to get back to studying; I've finally been assigned reading again). He had been put on an anti-depressant, which is the last thing you want to use for bipolar since it can cause wild mood swings, hold the person in mania, or even keep them depressed. The doc switched him to valproic acid, a mood stabilizer.

I was amazed how all the kids we saw were so matter-of-fact and open talking about their experiences such as physical, emotional, sexual abuse; drug use; cutting; suicidal thoughts and attempts. At the same time, one girl had a moment's hesitation when admitting she was sexually active. I'm not sure if they're open talking about their past because it's already been brought to light in previous sessions or if they are able to emotionally detach from those aspects of life in such a way that they can talk about them like everyday topics. As opposed to the one girl's reluctance to admit to a sex life, which she may still hold on to as a private or positive part of her life (or could just feel reluctant to talk about it with two males). It will be interesting seeing what trends like this develop.

I mentioned trauma because almost every kid we saw today had had some sort of emotional trauma. This disillusions them by shattering their basic assumptions of life. The doc said researchers have boiled down the inborn assumptions everyone has: The world is safe, I'm worthy of love, My caretaker is competent, Life is worth living. Most psychiatric disorders can be traced to one or more of these being shattered by negative experiences. But, genetics is a big part of the mix, too, so lots to think about.

Scott