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Old 03-16-03, 04:05 PM
Lafnalot Lafnalot is offline
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Lightbulb Diagnosing Bipolar Vs. Adhd

This is a terrific article addressing this very issue:

DIAGNOSING BIPOLAR VS. ADHD By Dr. Charles Popper




Similarities

Both disorders share many characteristics: impulsivity, inattention, hyperactivity, physical energy, behavioral and emotional lability (behavior and emotions change frequently), frequent coexistence of conduct disorder and oppositional-defiant disorder, and learning problems. Motor restlessness during sleep may be seen in both (children who are bipolar are physically restless at night when "high or manic",though they may have little physical motion during sleep when "low or depressed"). Family histories in both conditions often include mood disorder. Psychostimulants or antidepressants can help in both disorders (that is, depending on the phase of the bipolar disorder). In view of the similarities, it is not surprising that the disorders are hard to tell apart.

Differences

So what features can help in distinguishing these two disorders? Some distinctions are obvious.

1. Destructiveness may be seen in both disorders but differs in origin. Children who are ADHD often break things carelessly while playing ("non-angry destructiveness"), whereas the major destructiveness of children who are bipolar is not a result of carelessness, but tends to occur in anger. Children who are bipolar may exhibit severe temper tantrums, during which they release manic quantities of physical and emotional energy, sometimes with violence and property destruction.

2. The duration and intensity of angry outbursts and temper tantrums in the two disorders differs. Children who are ADHD usually calm down within 20-30 minutes, whereas children who are bipolar may continue to feel and act angry for over 30 minutes and even for 2-4 hours. The physical energy that a child with ADHD "puts out" during an outburst of anger could be mimicked by an adult who tries to "enact" the tantrum, whereas the energy generated by angry children who are bipolar could not be imitated by most adults without reaching exhaustion within a few minutes.

3. The degree of "regression" during angry episodes is typically more severe for children who are bipolar. It is rare to see an angry child who is ADHD display disorganized thinking, language, and body position, all of which may be seen in angry bipolar children during a tantrum. Children who are bipolar may also lose memory of the tantrum.

4. The "trigger" for temper tantrums is also different in these disorders. Children who are ADHD are typically triggered by sensory and affective overstimulation (transitions, insults), whereas children who are bipolar typically react to limit-setting (i.e., a parental "NO") and conflict with authority figures. A child who is bipolar will often actively seek this conflict with authority.

5. The moods of children who have ADHD or bipolar disorder may change quickly, but children with ADHD do not generally show dysphoria (depression) as a predominant symptom. Irritability is particularly prominent in children who are bipolar, especially in the morning on arousal. Children with ADHD tend to arouse quickly and attain alertness within minutes, but children with mood disorders may show overly slow arousal (including several hours of irritability or dysphoria, fuzzy thinking or "cobwebs", and somatic complaints such as stomach aches and headaches) upon awakening in the morning.

6. Sleep symptoms in children who are bipolar include severe nightmares (explicit gore, bodily mutilation). Additional information on the specific content of these dreams and why children do not freely reveal these dreams is available in another article by Charles Popper (Diagnostic Gore in Children's Nightmares). Children who are ADHD mainly show difficulty going to sleep, whereas children who are bipolar are more apt to have multiple awakenings each night or have fears of going to sleep (both of which may be related to the dream content described above).

7. The ability to learn in children who are ADHD is often compromised by the coexistence of specific learning disabilities, whereas learning in children who are bipolar is more likely compromised by motivational problems. On the other hand, children who are bipolar are more able to use motivation to overcome inattention; they can stay tuned to an awesome TV show for long periods of time, but children who are ADHD (even if interested) may not stay involved, follow the plot or even stay in the room (especially during commercials).

8. Children who are bipolar often show giftedness in certain cognitive functions, especially verbal and artistic skills (perhaps with verbal precocity and punning evident by age 2 to 3 years).

9. In an interview room, children who are bipolar often demonstrate dysphoric, rejecting, or hostile responses during the first few seconds of meeting. Children who are ADHD, on the other hand, are more likely to be pleasant or at least non-hostile at first meeting, and if they are in a noisy location, they may immediately show symptoms of hyperactivity or impulsively. Children who are bipolar are also often "interview intolerant". They try to disrupt or get out of the interview, ask repeatedly when the interview will end, or even insult the interviewer. The child who is ADHD, on the other hand, may get frustrated, bored, or more impulsive, but usually without direct challenging the interview or the interviewer.

10. The misbehavior of children who are ADHD is often accidental. If they crash into a wall (or a limit or an authority figure), it is often due to oblivious inattentiveness. The child who is bipolar, in the other hand, is more likely to crash into a wall with intent, for the sake of challenging its presence, Children who are bipolar are highly aware of "the wall" and are sensitive to ways of creating the biggest feeling of impact or challenge to it.

11. The child who is ADHD may stumble into a fight, whereas the child who is bipolar will look for a fight and enjoy the power struggle. While a child who is ADHD may engage in self-endangering behavior without noticing the danger, the child who is bipolar enjoys the danger and seeks it out. The child who is bipolar is intentionally dare-devilish (yet needle phobia is quite prevalent). In general, the danger-seeking is grandiosity ("I'm invincible") in the child who is bipolar and inattentiveness in the child who is ADHD.

12. In the child who is bipolar, danger-seeking grandiosity, energized giggling, and sexual hyperawareness may be seen early in the preschool years, and persist into adolescence and adulthood.

13. The natural course of ADHD is chronic and continuous, but tends toward improvement. There may be periods of worsening, however, during situational or developmental stress, or if a coexisting conduct disorder worsens. Children with bipolar disorder may or may not show clear behavioral episodes or cycles, but they do tend to exhibit increasingly more severe or dramatic symptoms over the course of years, particularly as the child becomes larger and the impulsivity becomes more difficult to contain.

14. Children with ADHD do not exhibit psychotic (thoughts and behavior reveal a loss of contact with reality) symptoms unless thy have coexisting psychotic depression, preschizophrenia, a drug-induced psychosis, a psychotic grief reaction. Children with bipolar disorder may, on the other hand, exhibit gross distortions in perceiving reality or in interpreting affective (emotional) events. They may even exhibit paranoid-like thinking or openly sadistic impulses.

15. Lithium treatment generally improves bipolar disorder but has no or little effect on ADHD.

The Coexistence of ADHD and Bipolar Disorder

Children may have ADHD, bipolar disorder, or unipolar disorder (depression), and some children have a combination of ADHD and bipolar disorder or ADHD and unipolar disorder (depression). A child who has either bipolar disorder or unipolar disorder, but not ADHD, may be misdiagnosed ADHD, however, because both the bipolar and unipolar disorders may include symptoms of inattention, impulsivity, and even hyperactivity. There is concern that ADHD is being overdiagnosed and bipolar disorder underdiagnosed in the population of children.

Last edited by Andi; 07-29-05 at 01:20 PM..
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Old 04-22-03, 03:21 PM
Lisa Rene Lisa Rene is offline
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Hiya!! I'm LisaRene and I have no clue what I am. I'll make a new label and stamp it on my forhead "PURPLE".

Purple is somewhere between depressed, ADD and Bipolar, I think. When I was little I cannot remember a single solitary night that I was not terrified to be in my bed alone. I put stuffed animals around my face because I thought that would keep the horrible monsters from getting me in my sleep. I would wake up drenched in sweat the next morning because of the amount of blankets I thought it took to keep me safe.

As a teen I didn't finish high school and later went back and got my GED. My parents divorced, I went to a private christian school where they pronounced me as Demon possessed and then took the liberty of casting out evil spirits on a regular basis. Hmmm it's a wonder I didn't finish school there. I got kicked out of my house when I was 17 and flowndered around on my own. Gosh the story is too long and boring, I'll cut to the chase.

1st Marriage/very physically abusive man, lasted 2 years and one child (my oldest Melanie). It was durning my 2nd marriage I went to my family physician and told him a little bit about my depression. I could not ever think of a morning I woke up without a hollow pit in the middle of my stomache. I felt guilty for every moment of my life. I was afraid some horrible thing would happen to my kids at any moment. I was afraid the end of the world was looming out of my bedroom window each and every moment. My doc put me on hmmm Paxil (made me feel like I had to go to the bathroom all the time) Zoloft (made me obsessive compulsive) but for the first time in my entire life I wasn't terrified to breathe or exist.

I said WOW!! is this what everyone else feels like all the time??? He said yes. Of course he was wrong. LOL Sooooo, eventually I ended up in a psychiatrist's office who put me on Luvox and Xanax. Within a three month time period I had 2 affairs (never even thought of having an affair before that). I painted the entire outside of a 2500 square foot house myself. Fixed a polyurethaned flat roof with tar and Mesh. I became Mario Andretti (world famous race car driver). Before that I wouldn't even venture out to the highway because I was terrified of it. I could actually outwrestle my husband out of pure adrenalin, I don't know how that's possible even now.

I landed the most amazing job with absolutely no experience and got paid much more than I deserved. I took a trip to Illinois (hate to travel), Got a divorce(at my request), bought a new house, and as an EXTRA bonus....I got a Boob job on top of all that!!! Whoa!! Now it's not that I was ever very fond of my boobs, but I know I would have never ever done such a thing. OOOH did I mention I was also able to leap tall buildings in a single bound?? I went from being afraid of every thing to being afraid of nothing and from feeling guilty for waking up in the morning to having absolutely no remorse for anything I did.

At the end of the 3 month period, I looked back just long enough to realize something was wrong. I went to my psychiatrist who said "ooh, oops I guess the medicine must have made you a little manic" At that, I went off both medications cold turkey, by myself. Including withdrawels, climbing the walls and feeling like I was soooo tense the skin was going to actually peal off my body all by itself. Sorry that's kinda graffic. I swore off medications. I somehow made it through about 5 years after that during wich time I'd take a tiny little half of a half of Luvox occasionally just to pull myself out of any really big dark holes along the way.

Finally in about October of this year I went to a new psychologist.....when I got tired of not being able to come out of my bedroom. He then titled me with the new diagnosis ADD. But, I ALWAYS read his notations when he's looking at me and writing, and he always puts ADD, Bi-Polar, and a couple of other titles I cannot remember right now. I asked him about it. He said I was Bi-Polar....But, Mania only induced by medication??? He said Bi-Polar type 3?? He asked me what I wanted to accomplish by coming to him....I said, I'm 38 why didn't anyone ask me that when I was 20? At 38, I told him I wanted to accomplish peace. I wanted PEACE.

So, I have fleeting moments of peace now. Sometimes referred to by me as "I'm bored and I don't have anything good to do." But that's ok because tomarrow, I may be overwhelmed and not want to come out of my room. This IS the most peaceful I've felt in many years. That's not the same as happy, the pills other people take to make them happy make me able to leap tall buildings in a single bound. And that's not good.

Sooooo, this is my Bi-Polarism coming out party. It doesn't feel like a party and I don't want any cake thank you very much. My mom told me she thought I was bi-polar, of course she doesn't think it runs in HER side of the family LOL. When I told her I was ADD, she said she didn't believe in ADD. Thanks mom!! (LOOK NO HANDS!!) I have no idea how to close this reply.....LOL, It was a load offa my chest anyway. OOOH wait!! That's not MY chest. hmmmm, hugsssss

Lisa : )
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Old 04-22-03, 10:06 PM
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Lisa, you are AWESOME, AWESOME, AWESOME. Oh man thank you for such an incredibly raw, adorably funny and real post. I have NEVER heard of Bipolar III though I'm sure I dont know it all (scarey thought eh?) I will do some more research. If you have mania induced by meds, thats Bipolar. Period. Bipolar II most likely. I have add, bipolar II ocd etc.

You remind me of myself. I had a horrible fear of ghost and demons, a phobia really, from childhood. I was an adult of about 28 before I could sleep without that fear gnawing at me. I would make myself so exhausted I could do nothing other than sleep for afew hours. As you said, a new label, "Purple" I yike it. I want to be chartreuse and purple plaid. k? I am so glad youre here Lisa, again, you are awesome.
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Old 04-23-03, 09:57 AM
Lisa Rene Lisa Rene is offline
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LOL, you always crack me up.....Chartreuse and purple plaid eh? Again with the big words...You know I'm gonna have to look that word up now!! Thanks for the response and hugsssss
Lisa
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Old 12-28-03, 08:32 PM
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well I Know for sure I have both adhd and Bipoar as well as PTSD which I like to Call "The Triple B****H threat! It's not easy lemme tell ya! My manic behavior extends from biting myself to crying fits of rage and I can not control it.....sometimes those fits are caused by the PTSD or not being able to concentrate because of ADHD.

I have always talked without think and acted without think and just did or said what was ever in my mind and that has caused alot of problems with not only myself but my family as well!

SUCKS TO BE ME! Then again, NOT!!!!!!
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Old 09-21-06, 04:55 PM
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Smile

Draga, you're me except that you're female and I'm not

As to everything wrote here; recognition!

I always felt kinda paranoid and a bit childish for the gross fear of sleeping..
that phobia of things you can't see coming atcha? Horrible..
Sweating is terrible yes. :-)

I think without this weird phobia I'd still have fear of sleeping; because it has moments where you do NOTHING, and it feels your unconscious gets total grips of ya -- kind of like at the end of feeling great, when a little depressed feeling creeps up behind you and you want to push it away.

Well, cheers
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Old 12-16-07, 01:53 PM
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Re: DIAGNOSING BIPOLAR VS. ADHD

Hi folks,

Wow! Great posts. Apologies in advance for mine, as it's a bit on the down side.

For now am trying to adjust to diagnosis of ADHD but have always secretly worried I might have bipolar as well. My father (non-biological, so no genetic link) suffered terribly from alcoholism, then docs said schizophrenia, before finally terming it manic depression (more commonly called "bipolar" these days).

I've always had a terrible fear of having Bipolar myself - but my doctor has not diagnosed it - just the ADHD around March this year. I'm female and aged 48 and have struggled with my weight for 30 years. In the past seven years I've had panic attacks and am on Efexor, which luckily stops th panic, but I've put on a heap of weight (need to lose 80-100 lbs). Doc said weight issues are often the result of underlying issues, and the weight will most likely not shift unless the issues are addressed.

He had me do a computer questionairre test and then sent me off for a SPECT Imaging test. I remember him saying he supected I had an attentional disorder (I didn't realise he was talking about ADD). Anyway, my test resullts came back, saying ADHD - "4-5 standard deviations from the norm." But then again, there seems to be much controversy about the validity of SPECT tests in medical circle, and even whether ADD/ADHD even exists in the first place!!! Sheesh!

Maybe my fear of bipolar comes from having seen my dad go from being my knight in shining armour when I was a little girl, to a sad and lonely death by suicide when he was 50 (I was 31 when he died).

Again, sorry this post is a bit of a downer. Not trying to depress anyone but I've had a rotten day today - huge argument with husband who does not believe I have ADHD and is sick to death of me, my mess and pretty much everything about me.

Ah, well, tomorrow is a new day - hopefully a much nicer one.
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Old 12-17-07, 01:00 PM
Lafnalot Lafnalot is offline
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Smile Re: DIAGNOSING BIPOLAR VS. ADHD

Hi ozgirl,

I was extremely angry and upset when I was given the diagnosis of BP with ADHD behaviors (I still am not very clear on that) But the differnce in my life since the diagnosis is worth every step I fought. I focus better, follow through with tasks, am more organized to make it possible for me to remember things and find things, (the list goes on) I was upset because each time I had been depressed I would think "Ok this may be the last time I ever have to go through this, so lets get through it" only to find out I will go through it over and over again...until that is a good friend pointed out that also means I will have uptimes over and over again too. So take heart and know its worth taking a look into...there is also the possibility you arent bipolar.But you willnever know unless you take a look

Good luck with everything
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Old 12-17-07, 01:34 PM
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Re: DIAGNOSING BIPOLAR VS. ADHD

From what I understand it is important to treat the BP first and then the ADHD. Sometimes the treatment of the BP might also help the ADHD.

"Maybe my fear of bipolar comes from having seen my dad go from being my knight in shining armour when I was a little girl, to a sad and lonely death by suicide when he was 50 (I was 31 when he died)." The important thing is to remember that this is a condition, limitation, ect., but IT IS NOT YOU! It is simply a condition. When I read something like you wrote I know right away that it's the mind saying "I am BP" and the story almost always concludes with "there is something wrong with me." When you are in the deepest depths of hell with suffering from BP it is very hard to remember this much less believe it. However, our condition does have some spaces in it and if you can remember that the condition is not you it will help.

Also never forget that this is a limitation/disease/condition that lies to you constantly.
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Old 12-17-07, 02:07 PM
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Re: DIAGNOSING BIPOLAR VS. ADHD

I don't find the examples to be similiarities, rather huge differences.
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Old 12-17-07, 10:19 PM
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Re: DIAGNOSING BIPOLAR VS. ADHD

Good read thanks for posting.
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Old 09-16-08, 03:27 PM
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Re: DIAGNOSING BIPOLAR VS. ADHD

omg...i may have been mislabled...a few times.
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Old 09-17-08, 09:02 AM
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Re: DIAGNOSING BIPOLAR VS. ADHD

Hi folks,

I go to see nprac today and try to explain/convince her I am misdiagnosed. I have gleaned much from site and articles and written a persuasive essay...hahaha, no really....with quotes and embedded links. I hope she listens...if not then cool, my illness, my life, my responsibility...I will be heard by someone....grooowwwwwllll.
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Old 09-17-08, 05:06 PM
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Re: DIAGNOSING BIPOLAR VS. ADHD

Ok, well...so much for getting her to listen to me or look at the material I prepared. I did get a referral to a coucilor and she can make the recommendation for testing, so I guess I am moving towards the goal of finding out one way or another.
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Old 09-17-08, 11:09 PM
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Re: DIAGNOSING BIPOLAR VS. ADHD

I've posted on this before, so I don't want to be redundant

My main reference source is Barbara Geller,MD

She's done a lot of work in this area; as there isn't a great deal.

Her work from (2003) pointed out a "One Way Comorbidity" between Bipolar Disorder & ADHD

Specifically, Over 90% of children / adolescents w/ (Pediatric) Bipolar Disorder, also have ADHD, while the opposite isn't true.

While there's no test for diagnosing ADHD & Bipolar Disorder, there have been 5 characteristics identified to help differentiate between the 2 groups :

1) elevated & expansive mood swings for varying lenghts of time ( the lenght of which can help determine the type)

Keep in Mind : these are NOT temper tantrums

2) a decreased need for sleep ( these kids can get by with only a few hours of sleep and wake up energized)

3) grandiose behavior (i.e.," I'm the world's greatest expert on everything," even if they have no clue).

(For younger kids, that translates to "bossy.)"

4) racing thoughts / flight of ideas

5) hypersexual behavior - ranges from frequent pleasure seeking ( self-touching, rubbing on furniture,etc., or much older than age sexualized statements )

There's no set cut off score or anything like that

The 2 that have the most empirical ( research) support are : decreased need for sleep & hypersexual behavior

hope that helps

tc

mctavish23

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P.S.

Absent a family history, which is obviously a pre requisite, as this is clearly genetic, I'll look at Mood Disorder NOS (Not Otherwise Specified) to try and cover behvior that isn't covered by ADHD.
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