Precursors to Mental Illness

Often, when patients are newly diagnosed, they reflect on when it became clear they had a mental illness. Behaviors, which recently became the “stuff” of mental illness, were identified as pathological and were the rightful subject of clarification and treatment. Sometimes though, behaviors and moods can be seen earlier in life, long before a diagnosis and long before it seems to be necessary for an intervention. I am not talking here of childhood bipolar as much as I am precursors to an adult (young adult) onset of bipolar disorder. My own case is a good illustration of what I mean:

Diagnosed as the surfacing of bipolar disorder when in my mid- twenties, I can recall having mood swings in high school. I remember thinking when I had an up mood, to enjoy it while I could because I would be down by the next day at that time. Even then, it was clear to me my moods alternated and more often than not stayed in the dysphoric or melancholy range much of the time. Being a teenager, I just figured this was part of who I was. A thoughtful, sensitive young boy as well as teenager, I tended to be a loner. I spent long periods entertaining myself. Looking back on it, I displayed isolating behavior, another depression forerunner. I was shy and had difficulty mixing with other children. As well, I was super-sensitive to a slight. Children were sometimes unintentional tormentors. Because of this sensitivity to others, the societal imperative placed on correct social behaviors was difficult for me. At the time I simply saw myself as odd, my solitude counter to the accepted social norms. The issue that stems from this is: what is an extreme, and what are normal childhood issues?

Looking back, what may have been precursors to bipolar disorder in childhood and adolescence were often displaced as being normal. Not acknowledging differences in childhood behaviors may be due to wanting to see a child as normal; with social behaviors and parental expectations lived up to. This can lead a child to hide their moods, not reporting them to a parent because of a perceived expectation to the contrary, that they act normal. Not wanting to appear odd or different can motivate a child or teenager to fulfill an expectation of health or normalcy despite what is actually going on.

We know that mood changes are normal for teenagers and this makes it difficult to identify what is ill and what is normal adolescent angst. Certainly abnormal behavior can’t be laid at the door of parents simply because they failed to pick up on what may be illness. Should you as a parent see behaviors and mood swings in your child, it is important to educate yourself in order to pick up on what could be an opportunity that could aid earlier recognition, and if appropriate, treatment. Listening to and not just talking to your children is the first step.

Behaviors That Can Be Red Flags

1. Depressed mood
2. Social isolation
3. Extreme shyness
4. Excessive tearfulness
5. Acting out; sudden flare-ups of temper
6. Mood swings in excess of what would be deemed normal
7. Hiding feelings from a parent
8. A “flat line mood,” one which remains instant (does not differ over time)
9. Non-communication with a parent for a sustained period
10. Expressed thoughts of alienation or meaninglessness
11. Hyper behavior or insomnia
12. Poor grooming
13. Erratic behavior
14. Changes in appetite
15. Sudden weight loss or gain

Should any combination of these red flags arise, it would be good to discuss them with your family doctor or a mental health professional.