Monday, March 19, 2007

Mustard Seeds and the Two Poles

“My ten-year old son has dramatic mood swings. He can be happy one minute and another minute, he’s in a rage for no apparent reason.”

“What sets him off?”

“Mustard seeds.” (I love this one… an actual quote).

“He is irritable all the time, overly aggressive with his peers at school and defiant (ie. yells, curses at parents, etc.) to the point of belligerence towards us. We went to see a professional (ie. physician, psychiatrist, psychologist, etc.) who said that he has bi-polar disorder!! We’re terrified. Does this mean that he will have this the rest of his life?”

Bi-polar disorder implies that a child has two (bi) (polar) opposite emotions or behaviors with some implication that transitions from one pole (depression) to other pole (anger, mania, etc.) may occur rather abruptly and with minimal (mustard seeds) or no apparent cause. Does your child present with features of “bi-polar”? The answer is “yes” and most likely your child would meet the diagnostic criteria for bi-polar disorder. But, this diagnosis is a symptom-based diagnosis, it refers to a cluster of symptoms (such as “headache”) and does not actually have a defined etiology or cause (such as “trigeminal neuralgia, cervical neck strain, brain tumor”, etc.).

Does he have bi-polar disorder? Hmmmm… From a process perspective, bi-polar disorder symptoms may be related to the presence of primitive limbic system-driven “fight or flight” activation (ie., gas pedal for emotions, drives, instincts, etc.) that is not adequately or effectively modulated by higher level frontal lobe inhibitory systems (ie., brakes, social rules, etc.). In other words, symptoms of bi-polar disorder are related to limbic system activation and/or frontal lobe dysfunction.

  • Limbic system activation may be causally related to biological/genetic factors (possibly “true” bi-polar disorder with a higher state of background arousal) or in response to environmental factors including trauma, unmet needs for safety or security, abuse, neglect, etc. (possibly post-traumatic stress disorder).
  • Frontal lobe dysfunction may be related to biological/genetic factors with associated failure to establish limbic-frontal lobe subcortical connections (possibly Fragile-X syndrome, Asperger’s Syndrome, prematurity, etc.) or environmental factors including neglect, deprivation, etc. (possibly Reactive Attachment Disorder).

The solution?, consider completion of a comprehensive evaluation that may facilitate identification of etiological factors contributing to your child’s symptoms/problems so that subsequent treatment interventions may focus on treating the cause, not medical management of superficial symptoms!

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