Mania Symptom Profile Changes with Age

Catching up on my reading, I came across an article on posing the argument that the Bipolar patient’s mania symptom profile changes with age.  The study found that compared with adults, adolescents (aged 10-17 years) with bipolar I disorder had significantly higher YMRS item scores – relative to the total score – for aggression and irritability.  Conversely, YMRS grandiosity and sexual interest item scores were higher in adults than adolescents.

Upon reflection it became clear that their findings mirror my experience with Bipolar Disorder.  While in my late teens and early 20’s, becoming agitated was something I dreaded.  Not only would I awake every morning wondering what kind of day my mood would allow me to have, I was always on edge waiting for the inevitable spark to set me off and bring with it bouts of screaming, china-smashing and risky-behavior I came to dread.  When I was young, my mania was a much more physical thing.  I’m amazed my family never tried to have me hospitalized.  I think my worst manic experience came when I was 21 or so.  I clearly remember driving like a lunatic in a 25 mph zone and daring myself to crash into a tree.  I almost did it, too.  I’ll never know what stopped me but that is the point where I decided I needed help and saw a doctor.

As I’ve aged, as the study points out, the manias haven’t mellowed, their dynamic has simply changed.  Grandiosity is really the main feature now – whether it is taking on a grand project that allows for no sleep until completed or believing in some grand life-circumstance that simply isn’t there. I would say the risky behavior has turned in on itself and become a form of grandiosity that a handful of times has bordered on psychosis.  The bottom line is if one were to diagram my journey through mania over the last two-and-one-half decades, today’s points of interest are not what they were twenty-five years ago.

I’m encouraged that the conclusion of the study states,

“Age-grouped differences in the assessment of bipolar manic disorder need to be taken into account to better understand the psychopathology of mania and to build consistent diagnostic criteria for community care.”

Keeping in mind another recent study that puts the average diagnosis time of Bipolar at 13.5 years from first onset of symptoms, I can’t help feel that one benefit of putting in place more granular, age-aware criteria for mania may make it possible for some individuals to be diagnosed sooner.

Another thing this study makes abundantly clear is that Bipolar is a very fluid disease.  Cycle time, wellness period length, episode features and the meds required for an effective cocktail are always changing.  Those of us living with Bipolar must be forever vigilant and be agile enough to react appropriately to whatever our disease throws at us in order to maintain optimum mental health.  Which, quite frankly, is pretty exhausting, but that is fodder for another post.

Really interesting stuff.
I don’t remember being manic as a kid, just depressed. But you know how memory is.
The point you make about fluidity is *so* true. This illness is ever changing. Just when you think you’ve got a handle on it, the sucker slides out of your grip.

I know this is hardly an original thing to say, but the name Bipolar is pretty ridiculous for an illness where so many of the symptoms of mania and depression are the same!

I’m related to a number of people with bi polar and care about their struggles deeply which is why I’m reading here. The point by Gledwood above has struck me. I was amazed recently to realise that while one gets manically high and doesn’t necessarily feel they need help (grandiosity etc), the other gets manically low – like incredibly depressed but in a highly agitated way and terribly aware there is something very wrong. – sorry – hard to explain.

Hey thanks for your response. I think you are right – a mixed state – and indeed it is hard not to feel like a scrambled egg when watching people we love going through that :). I’m always looking for answers that will help me understand mental illness better so I can try to get the right kind of help for my family. When one family member was in hospital having attempted suicide, he was definitely in this mixed state, as well as having to cope with the trauma of physical injuries. I had to advocate in the hospital for assistance for his mental illness. It was not fun! Anyway, I have a question which it would be great if someone could shed some light on. This person was fixated throughout his illness on guilt related to sexual fantasies. To me it was similar to Obsessive Compulsive Disorder. His thoughts were going round and round on his feelings of worthlessness until he felt suicide was the only answer. I am wondering if anyone else has seen OCD as something that can occur with bi polar disorder – is it a symptom, or another disorder which some people can suffer with alongside bi-polar? There is a happy ending – this person is recovering well – and leading a creative life. Hopefully the medication and therapy will keep working for him.
Cheers and thanks for reading.

More often than not, bipolar people also have a comorbid disorder – that is another illness occurring at the same time. (Personally, I have GAD – General Anxiety Disorder) Hopefully your family member was able to hook up with a good therapist and define/work through whatever was ailing them. It is absolutely possible to live a fulfilling and productive life with the right therapy & meds. I’m glad to hear your family member appears to be doing just that. 🙂


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