The Bi-Polar Prepubescent Adolescent: A Literature Review and Clinical Case Study of an Eleven-Year-Old Black Female

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This paper describes the difficulty of diagnosing Bipolar Disorder in the prepubescent adolescent through a review of the literature on the subject and an actual clinical case study. An eleven-year-old premenarche “'unofficial adoptee” was seen by the author first in a psychiatric emergency room and then an in-patient children's unit of a major urban psychiatric facility in 1985. The progress of her diagnosis from an adjustment disorder, conduct disorder, and oppositional disorder to a personality disorder and finally Bi-polar Disorder is discussed in terms of differential diagnosis and the need for certain family, social, cultural, psychological, and biological information. The unique behavioral presentation of adolescent bipolars, in comparison to adults with this disorder, is also presented by example and corroborated by reports in the literature. The difference in cycling patterns and the more common occurrence of mixed features in young bi-polars is another point stressed by this paper. Finally, the need to “get into the world” of the troubled child is discussed and brought into focus through the case example of the development of the patient-therapist relationship between this disturbed bi-racial girl and her clinician. Treatment and outcome are addressed at the end with suggestions for other therapists faced with similar clinical, social, and ethical issues.