Teen Bipolar Disorder and the Abnormal Brain: Making Sense of New Research

Claudia Gold, MD
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Two glaring omissions stand out in the recent widely publicized Yale study titled, in the Yale News, “Adolescent Brains Develop differently in Bipolar Disorder.” Using MRI to compare a group of teens with the diagnosis of bipolar disorder according to DSM criteria with a group that did not have this disorder, they found volume decrease in the area of the brain cortex known to be involved in emotional regulation.

The first omission is any mention of the possible effects of medication. While the newsletter does not even mention medication, the study itself does say that the teens carrying the bipolar were on medication but that “medication was not systematically studied.” The long-term effects of psychiatric medication are unknown. A study in the Archives of General Psychiatry suggested that one of group of drugs, the atypical antipsychotics, which are often used to treat bipolar disorder, might themselves be linked to decreased brain volume.

But perhaps the more glaring omission is anything about the early history, or life story, of these teenagers.

Elegant and compelling research by Harvard psychiatrist Martin Teicher and colleagues demonstrates that mental illness in the setting of what they term “maltreatment” is a very different entity, in terms of course of illness, response to stress, brain structure and gene expression, than the same DSM named “disorders” in the absence of these experiences.

Maltreatment is broadly defined as being “characterized by sustained or repeated exposure to events that usually involve a betrayal of trust.”

It includes not only physical and sexual abuse, but also emotional abuse, including exposure to domestic violence, humiliation and shaming, as well as emotional and physical neglect. The incidence of childhood maltreatment ranges from about 14% in one-year prevalence to 42% in retrospective reviews covering the full 18 years of childhood.

The way maltreatment is defined has great significance in the way we think about the connection between childhood experiences and adult mental illness. The word “trauma” itself may convey a kind of “not me” response, but when the term is defined in this way, we see that these experiences are, in fact, ubiquitous.

This research shows that it is meaningless to talk about mental health disorders, as defined by the DSM system, without knowledge of this early life experience.

But perhaps more importantly, the language we use has great implication for treatment. The Yale study authors recognize that the brain is “plastic” so prevention is possible. But without recognizing the role of early life experience in development of the brain abnormalities, the treatment might very well end up being a drug.  Broadening our understanding of the cause of the brain abnormalities, as Teicher’s work demonstrates, shows that true prevention lies in supporting young families, and intervening early in families where children are at risk for experiencing maltreatment.

Teicher recommends starting with the way we name these disorders:

We propose using the term ecophenotype to delineate these psychiatric conditions. We specifically recommend, as a first step, adding the specifier “with maltreatment history” or “with early life stress” to the disorders discussed here so that these populations can be studied separately or stratified within samples. This will lead to a richer understanding of differences in clinical presentation, genetic underpinnings, biological correlates, treatment response, and outcomes.

The Yale study, tellingly published in the journal “Biological Psychiatry” gives the impression that these “disorders” are biological in the way that, to use a frequent comparison, diabetes is. This view is a disservice to our humanity; to the way our lives have meaning because of our relationships with others and the stories we tell. The first and critical step in prevention of “bipolar disorder” is to recognize that these stories exist, and to make space and time to hear them.

32 COMMENTS

  1. Thank you for sharing this study and the questions you raise. I am attending a medication appointment for a new client whose grandma believed her granddaughter had bipolar disorder, based on an intake interview at a local clinic. I plan to attend and challenge putting this bright, creative survivor on brain poison. I will forward your words to the grandma to read. She needs to understand the arbitrary nature of diagnosis and the risks involved in trusting the face on the TV screen to know what is best for her granddaughter. Unfortunately many parents and guardians have blind faith in the competence of prescribers and do not understand the substantial risks involved in submitting themselves or their family members to the world of psychotropic medications. I can’t tell a client not to take a medication, but I can challenge my clients to understand the effects of what they do take and whether the risks involved are worth it.

    • I am an adult and was an adult when first prescribed the dangerous psychiatric medications. I am sure that if I were a teen-ager in the twenty-first century; I would be prescribed these terrible drugs because I am bright, creative, head-strong, strong-willed, and exuberant. Many times, my natural personality; especially now that I am not taking the drugs and reclaiming my true self can cause “problems” with others such as my mother; who doesn’t always understand me. I wish I had someone like you, a caring, knowledgeable person who wishes to keep a bright young person from harm; in my corner; even as an adult. But, I am strong and I can take care of myself. I do wish you much luck in what you do. You seem to be kind of an “earth angel.” So many bright, creative, strong-willed minds, of all ages have been damaged by illicit diagnosis of bi-polar disorder, schizo-affective disorder, even schizophrenia, and other false made up disorders. Additionally, the toxix, addictive drugs, and various “treatments” such as CBT, DBT, ACT, psycho-social clubhouses, sheltered workshops, and other such nonsense have sought to “dumb-down” and destroy the minds, self-worth, potential, and natural God-given temperments, personality, gifts, abilities and talents of so many in these times. I cry inside for all of us; but I am strong. I will not only survive. I will thrive. God bless your caring and knowledge.

    • Jorwig:

      all the best to you and your young client. In light of the acknowledgment by NIMH’s Dr. Thomas Insel that the DSM is crock (he said it has no scientific validity), ask them to justify the bipolar “diagnosis” in this case and the proposed ‘treatment,” which would be the destruction of a young life by cocktails of neurotoxic drugs. What is the rationale and justification for the “diagnosis” and proposed “treatment” when the highest-ranking mental health official in the U.S. confirms that psychiatric “diagnoses” have no scientific validity? Also, far too often, the “bipolar” label results from other drugs (antidepressants or stimulants). I sincerely hope that the presiding official(s) in your case shows more than clueless deference to the prevailing mistreatment of people in distress.

  2. Typical reductionistic “research” based on untested assumptions and ignoring of inconvenient variables. Thanks for bringing it to light. Unfortunately, the mainstream will no doubt latch onto this as proof of the “biological nature” of “bipolar” without giving any thought to the extreme limitations of the study, which frankly make it almost completely meaningless.

    —- Steve

    • Thanks Steve, I agree with your thoughts. The most obvious and common sense ideas are lost on these people (authors of the first article) who think of bipolar disorder as one concrete “illness” with a biological or genetic basis. The importance of a continuum/variable syndrome of distress, and the effect of environmental experience, is missing in their thinking, and cause and effect are constantly misunderstood.
      Although rather impersonal and static, the article by the Harvard psychiatrists reads better and is a step in the right direction.

  3. I think the reason the trauma concept hasn’t taken hold is that people equate it with abuse and maltreatment.

    But it’s traumatic to be a smart kid. It’s traumatic to have poor social skills, and not everyone gets those innately. It’s traumatic to be a highly motivated person in a get-by world. It’s hard to be an anti-authoritarian, ask Bruce Levine. All of that is betrayal of trust.

    So I was a middle class kid raised by decent parents and I had a whole litany of trauma issues that no one addresses because I was a middle class kid with decent parents. So if we continually speak of trauma as maltreatment, we’re going to keep alienating the middle class people with nice parents, or at least people who think of themselves that way even if it’s false.

    Maltreatment is basically inherent and inalienable for lots of groups in our society. Maltreatment is not one on one, it’s societal. Everyone, take caution of how we talk about trauma.

    • What a moving and profound comment, Corrina, I feel the truth of it in my heart. Indeed, it is traumatic to live in a stigmatizing society, where negative projections abound. We’ve all been caught in that societal crossfire, characterized by utter lack of nurturing, compassion, or tolerance. No wonder we live in what some refer to as ‘a sick society.’ Thanks for speaking your truth so plainly.

        • At some point, one has to walk away from society’s expectations and define one’s own expectation for themselves for which to strive. That would be living by one’s truth, not by the truth of others, and a good example of healing from social trauma. It’s certainly an option.

      • A sick society, indeed. Mad people are so often denied a piece of their humanity because the sanist able-normative majority psychiatrizes us by refusing to honor who we are PRIOR to and ABOVE our “patient” and “patient-based” selves. Human beings have spent thousands of years evolving to become the species we are today by creating, maintaining, and changing social relationships that keep us alive, breeding, and thriving. The sanist population of the able-normative majority disrupts and often terminates Mad people’s ability and opportunity to build and keep these relationships. How could Mad people possibly exist in a world which insists upon our compulsory devolution to a less-advanced form of humanity and not suffer biological repercussions from this savagery?

    • Maybe trauma isn’t the best word then. Trauma traditionally would be an emotional response to what is generally agreed to be a terrible event, not an event that can be experienced as trauma given a person’s temperment (on a bad day I can be devastated when the mail is late, but seriously..traumatic?) . I think THERE lies the diference between those of us who need more support to cope with life and those who don’t and there lies the discussion of what alleged “illness” needs attention. Why are some of us more vulnerable? I have two siblings who were fed, raised and loved the same. They are calm, sensiible, very mild individuals. I am…well…not. I function at a level acceptable to me, but why am I so different? Why when the mail is late would I be devastated and they would shrug (all things being relative?)

      • You don’t have the same life history, you’re not identical. Does the in-born, hereditary part of personality play a role in how one responds to the environment? Sure it does. But being a sensitive person is not sick. In fact our society need more “mad” people who respond more to abuse and injustice.

    • I’m with you on this one, Corinna. Many (not all) in the psychiatric survivor community, because they suffered childhood sexual or physical trauma, have been very vocal about equating bipolar disorder/schizophrenia with severe childhood trauma –period. Now, it’s almost taken as a given. Carl Jung and Joseph Campbell saw something different.

      Quote from the Jungian Center for the Spiritual Sciences
      But Jung and Campbell recognize that there is another type of hero, a type for our time, now evolving in response to current crises—crises that are not so obvious as earthquakes, tsunamis, or other disasters. These crises are cultural and are reflected in what Joseph Campbell has called “the collapse of the timeless universe of symbols.” It is in response to this grave situation that a new form of hero is emerging.
      ” A previous essay on this blog site spoke of the crucial role played by symbols, and how our world is now jeopardized by the loss of the “symbolic life.”We live in a society that no longer supports the gods, with social units no longer centered around religion but around economic and political organizations.Our focus now, as a global culture, is on competition for “material supremacy and resources,” and this materialistic focus has led to the decay of the arts, morality and ritual.”

    • I will not apologize about talking about trauma, child abuse or neglect. It happens in middle class neighborhoods too. People treat TRAUMA as if it is a four letter word. Part of the reason is the because people do not want to believe that domestic violence, incest, the rape and human trafficking of minors occurs in white middle class and upper middle class neighborhoods. It’s a dirty little secret.

      Corrina, you are right to say that as a middle class kid you may not have been traumatized by your parents. However, many kids develop attachment disorders as a result of the kind of parenting they experienced as young children. This is not a subject that is easily broached with a parent – i.e. the kind of parenting they provided their children has led to disruptive behavior in school, for example, or that what they are told is ADHD behavior is really a result of the way their brain developed as a result of early childhood experiences with their parent. It’s much easier for a psychiatrist to suggest that a child needs medications because of some genetic predisposition towards brain abnormality rather than as a result of poor parenting. Statistics show that over 60% of children develop some form of unhealthy attachment in relationship to their parents. It’s not the exception. It’s the norm. Our society is not raising healthy children, and those children raised in unhealthy environments is not limited to the inner city or poor neighborhoods.

      I’m not suggesting that there was anything wrong with your parents or the way that you were parented. I’m just want to make clear that it is not quite accurate to depict the issue as mere ‘maltreatment’ or as a function of society in general. There are specific reasons ways in which children are traumatized which are connected to early parental attachment. These have neurological consequences in terms of subsequent brain development. Attachment failure can also be viewed as trauma in a clinical sense since the kinds of brain changes that occur are similar in either case.

  4. “The long-term effects of psychiatric medication are unknown.”

    Umm… no, they’re not. The fact that they cause “structural changes” (brain damage) is indisputable, in both human and animal studies. Science knows far more about the effects of psychotropic drugs on the brain than they do the effects of “mental illness” on the brain. In fact, you of all people should know, that 9 out of 10 times they think they’ve discovered “new evidence” of biological correlates to “mental illness”, they’re actually observing the effects of drugs on the brain.

  5. As a man whose life was ruined by numerous psychiatric drugs, merely as an outpatient with anxiety (worrying about things) and depression (sadness in my life), I can’t bear to see all these teens falling into this endless “bipolar” trap.

    Based on pharmaceutical corporation propaganda and the rampant speculation of physicians, children with psychological/emotional issues are given very dangerous drugs. Then, after the results are inevitably poor, the dosages are increased, the drugs are changed, more drugs are added, etc., all via unproven guesswork. This often goes on for years. If the child doesn’t improve, he is called a “non-responder.” If the child gets worse, it is blamed on her “incurable illness.” This needs to stop now!

  6. A major health problem these days is the vast over-diagnosis of bipolar disorder in children and adolescents. Almost all the adolescents and young adults that I’ve seen who have been given that diagnosis, have no real history of true mania or hypomania, but have had histories of emotiol trauma. This study both doesn’t account for the effect of medication on the brain, nor is it convincing of the diagnosis to begin with.
    The most important factor, from a clinical point of view, of the main cause of emotional distress is trauma, and not “brain disease”.
    A worry with the publication of this study is that it will encourage the continued over-diagnosis of bipolar disorder and the overuse of medications. Many doctors, both psychiatrists and family physicians, will interpret this study as indicating that people who can be squeezed into this diagnosis should be started on medication quickly in order to avoid brain atrophy. The reality is that it is not clear what this study is indicating, what diagnoses were valid, and is it certainly does not show that medication use will prevent brain loss.

    • Trauma is the right word. I wish I could put stars or happy faces on all the comments I like here. So many good comments that point out how research is propagating so much misinformation about mental health and so called, ‘bipolar disorder’. The rates of bipolar disorder and ADHD being diagnosed among young people it’s completely absurd and out of control! I think it is a form of child abuse to misdiagnose these kids and force them on medications. I will be seeing my psychiatrist next week and I will be bringing a few books with me that he can read at his leisure:

      #1 – Dr. Bessel van der Kolk, “The Body Keeps Score”
      #2 – Dr. Sebern Fisher, “Calming the Fear”
      #3 – Dr. Bruce Perry’s article, “Children’s hyperactivity ‘is not a real disease’, says US expert”
      http://www.theguardian.com/society/2014/mar/30/children-hyperactivity-not-real-disease-neuroscientist-adhd

      I am now of the opinion that a psychiatrist has no business being a psychiatrist if they are not trauma informed and have not kept up on the latest in neuroscience research when it comes to attachment issues and trauma. I’m sure my psychiatrist writes prescriptions for teenagers every day for antidepressant medications and ADHD drugs. His specialty is adolescent care, and I am sad every time I see them walking outside his office while I await my turn. Time to stop the nonsense. Time for psychiatrists to do some soul searching and self reflection about their practices, priorities and commitment to the patient (especially when it involves the well being of children).

      • I love the work of Dr. Bessel van der Kolk, “The Body Keeps Score” and Dr. Robert Scaer (“The Trauma Spectrum”) and agree totally that trauma is foundational in much mental or emotional suffering. But I would not discount the host of other environmental and epigenetic factors that come into play, including the fact that the effects of trauma can be inherited.

  7. please forgive a poem as comment – I wrote it recently

    LITHIUM

    Stabilise my mood with a song and a rose
    Comfort my mother in her drunken delusion
    I am the child bystander of chaotic confusion
    Of thrown things in kitchens
    Of tears before bedtime, before lunchtime, after breakfast.

  8. Another crap study. They didn’t control for the meds? Great, one can then use this study to make a paper ball for you pet to play with or as a backup in case you run out of toilet paper. That’s really all there is to say about it.

    • This is the crux of the problem with much of the psychiatric research, a scientific investigation is invalid unless they control for all variables, including medication, and potential other etiologies, which the government funded Yale “mindless” psychiatric researchers are apparently still not doing. Of course, Andreasson’s research is imperitive and relevant to this research, how absurd Yale researchers would ignore it.

      And we all need to recognize that the neuroleptics, given to non-psychotic “bipolar” patients, can in fact cause both the positive and negative symptoms of so called “scizophrenia” / “bipolar.” Via both neuroleptic induced deficit syndrome and the central symptoms of anticholinergic intoxication sydrome, also seeminly called anticholinergic toxidrome.

      Truly, it seems, we are a country – or world – now wasting billions into researching and covering up iatrogenic fraud for social control reason only. Historically, only evil governments advocated belief in psychiatry, how long will we take to realize that’s what we’re actually dealing with?

  9. “Bipolar disorder” used to be called an energy disorder.

    Bipolar Disorder, also known as manic depressive illness, is a serious medical illness that causes shifts in mood, energy, and ability to function. A disorder associated with mood swings ranging from depressive lows to manic highs.

    Humanity needs to face the reality of electromagnetic toxicity: http://www.gordoncooper.com/wp-content/uploads/2013/01/Earth_at_Night_America.jpg

    I’ve been talking about electromagnetic toxicity for years but I’m not this guy so nobody can hear me. Listen to this guy: http://www.humansofnewyork.com/post/65345059446/im-retired-now-but-i-was-the-ceo-of-the-ny

    He said, “We’re never going to stop needing energy, so we just have to find the most efficient ways of creating it.”

    OOH, OOH, I know the answer! Psych drugs! After all of our brains have been fried by electromagnetic toxicity, we can all stand in line at the pharmacy and pick up our energy pills. Brilliant! That’s just my polar acting up (I’m missing the other side, so I have no balance).

    We have massive electromagnetic toxicity. Just look at that picture of the United States. It did NOT look like that 100 years ago. It didn’t look like that 50 years ago.

    Humanity seems to know little to nothing about it, let alone have that precious wisdom or understanding.

    Our planet is covered in wires, physically and energetically. TV and the computer (internet) are both very high powered magnets. Telecommunications are atmospheric. The human mind is also atmospheric. There is a fusion between telecommunications and the human mind (and the brain, too).

    Electricity is the number one cause of humanity’s population explosion. Electricity and telecommunications is the number one cause of climate change. Electricity and telecommunications are never suspected as cause and contributor in psychiatry’s OH SO PRECIOUS bipolar (energy) disorder.

    Most people these days are waiting for earth’s BIPOLAR shift to occur. That’s not a joke.

    Is there electricity in the human brain? Interesting! Very, very interesting.

    I leave it to the genius scientists to figure it out all, for industry, of course, while keeping poor suffering humanity in the brightly lit dark. They’re NEVER going to produce the sort of science that would impact their own industries. It just isn’t going to happen.

    Lastly, I’d like to invite psychiatry to Come To The Light…

    (There’s no brain science here, so I expect this will be VERY difficult to understand. Give it a try.) http://www.drbrucegoldberg.com/EnergyVampires.htm

  10. There have been some wonderful points on this blog and in the comments- points about trauma and the impact of a society oriented around money and material possessions, among other issues. My concern in reading all of this are for the many people who have bipolar disorder and need medication to get back to themselves and who would be very discouraged from seeking treatment because of all the comments that make it appear that medication is essentially poison and that bipolar disorder is really not a medical condition. The truth is that sometimes medication is the only thing that helps. I know because I have been there with my own family. I tried many nontraditional forms of treatment for my daughter who suffers from bipolar disorder-none of which worked one tiny iota. My daughter has not suffered from trauma or abuse. She is a wonderful person who is unfortunately genetically loaded. After all the non traditional treatment approaches failed to work, it was my job as a loving parent to begin the quest for the right medication combination to work for her. We found it and now she has herself and her life back. I would like to see more research focus that looks at the biological underpinnings of bipolar disorder, such as genetics, the mechanisms by which the brain is affected , and ultimately what medications truly work. At present the state of the research is such that it can take months or years or never- to find the right medication. It took our family almost a year of what was basically a nightmare for my daughter and for our family. Before this she was alternately severely depressed with suicidal ideation and cutting, and manic with hallucinations, delusions, enormous amounts of energy and no judgment call whatsoever. I can’t tell you how grateful we are to her NP who finally prescribed the right medication combination and has gotten her life back. I am convinced that without medication she would have suffered terribly, possibly even dead by now. Medication is not the enemy for someone who truly has bipolar disorder. Indeed, it is the only savior.

  11. As this article rightfully points out, controlling for previous medications taken is critical. Especially for bipolar disorder, whose symptoms we sometimes see in children as side effects of antidepressants and sometimes stimulants. The question being, whether the bipolar disorder that is organic is the same in terms of etiology as the “bipolar disorder” that develops as a result of psychotropic medication. It is likely that they are not the same. Hence, this history needs to be known in order for an appropriate treatment plan to be developed.