The following excerpt is taken from Chapter
3 of Bipolar Disorders: A Guide to Helping Children and Adolescents
by Mitzi Walsh, copyright 2000 by O'Reilly & Associates, Inc. For book
orders/information, call (800) 998-9938. Permission is granted to print and
distribute this excerpt for noncommercial use as long as the above source is
included. The information in this article is meant to educate and
should not be used as an alternative for professional medical care.
Some of the most persistent problems that children and adolescents with
bipolar disorders have involve types of thinking that are irrational and
difficult for others to understand. When young people learn to recognize and
name these "thought errors," it can help them avoid making a scene,
getting embarrassed, and getting in trouble. Once you can label and dissect an
irrational thought, you take away some of its power. The longer these patterns
are allowed to continue, however, the more likely they are to become ingrained,
lifelong habits. These habits of thought contribute to development of the
hard-to-treat personality disorders that often bedevil bipolar adults.
Problematic thought styles include:
- Catastrophizing. Seeing only the worst possible outcome in
everything. For example, your child might think that because he failed his
algebra test he will get an F for the semester, everyone will know he's stupid,
the teacher will hate him, you will ground him, and moreover, he'll never get
into college, and on and on. No matter what soothing words or solutions you try
to apply, he'll insist that there's no remedy.
- Minimization. Another side of catastrophizing, this involves
minimizing your own good qualities, or refusing to see the good (or bad)
qualities of other people or situations. People who minimize may be accused of
wearing rose-colored glasses, or of wearing blinders that allow them to see
only the worst. If a person fails to meet the minimizer's high expectations in
one way--for example, by being dishonest on a single occasion--the minimizer
will suddenly write the person off forever, refusing to see any good
characteristics that may exist.
- Grandiosity. Having an exaggerated sense of self-importance or
ability. For example, your child may fancy herself the all-time expert at
soccer, and act as though everyone else should see and worship her fabulous
skill as well. She may think she can run the classroom better than her
"stupid" teacher, or feel that she should be equal in power to her
parents or other adults.
- Personalization. A particularly unfortunate type of grandiosity that
presumes you are the center of the universe, causing events for good or ill
that truly have little or nothing to do with you. A child might believe his
mean thoughts made his mother ill, for example.
- Magical thinking. Most common in children and adults with
obsessive-compulsive disorder, but seen in people with bipolar disorders as
well. Magical thinkers come to believe that by doing some sort of ritual they
can avoid harm to themselves or others. The ritual may or may not be connected
with the perceived harm, and sufferers tend to keep their rituals secret.
Children are not always sure what harm the ritual is fending off; they may
simply report knowing that "something bad will happen" if they don't
touch each slat of the fence or make sure their footsteps end on an even
number. Others may come to feel that ritual behavior will bring about some
- Leaps in logic. Making seemingly logic-based statements, even though
the process that led to the idea was missing obvious steps. Jumping to
conclusions, often negative ones. One type of logical leap is assuming that you
know what someone else is thinking. For instance, a teenager might assume that
everyone at school hates her, or that anyone who is whispering is talking about
her. Another common error is assuming that other people will naturally know
what you are thinking, leading to great misunderstandings when they don't seem
to grasp what you're talking about or doing.
- "All or nothing" thinking. Being unable to see shades of
gray in everyday life can lead to major misperceptions and even despair. A
person who thinks only in black-and-white terms can't comprehend small
successes. He's either an abject failure or a complete success, never simply on
his way to doing better.
- Paranoia. In its extreme forms, paranoia slides into the realm of
delusion. Many bipolar people experience less severe forms of paranoia because
of personalizing events, catastrophizing, or making leaps in logic. A teen with
mildly paranoid thoughts might feel that everyone at school is watching and
judging him, when in fact he's barely on their radar screen.
- Delusional thinking. Most of the other thought styles mentioned
above are mildly delusional. Seriously delusional thinking has even less basis
in reality, and can include holding persistently strange beliefs. For example,
your child may insist that he was kidnapped by aliens, and really believe that
it is true.
Not only are these thought styles in error, they're intensely uncomfortable
to the person who uses them--or should we say suffers from them, because no one
would deliberately choose to have these anxiety-producing thoughts. When these
thoughts emerge in words and deeds, the damage can be even worse. Expressing
such ideas alienates friends and family, and can lead to teasing, ostracism,
and severe misunderstandings.
Young children in particular don't have much of a frame of reference when it
comes to thinking styles. They may well assume that everyone thinks this way!
Older children and teens are usually more self-aware. Unless they're in an
acute depressed, hypomanic, mixed, or manic episode, they may try hard to keep
their "weird" thoughts under wraps. That's an exhausting use of
mental energy, and makes the sufferer feel terribly alienated.
The same chemical imbalances that cause bipolar disorder are at the root of
these thought errors, although they also have a basis in life experiences. When
you have been taunted, teased, bullied, and ridiculed on a regular basis, for
example, personalization and paranoia are not that farfetched. You may have
been scapegoated so often that you start to feel like you really are
the cause of all problems.
The rigidity that these problematic thought patterns have in common may also
come from life experiences, at least in part. Many clinicians suspect that
because people with bipolar disorders often deal with illogical waves of
emotion and activity, they try to impose strict structures on their thoughts
and beliefs to compensate. It's easy to get carried away with this, though,
especially for children who don't have a lifetime of "normal"
thinking to compare these thought patterns to.
Because these thought styles have at least some chemical basis, medication
helps in many cases. Another good approach (especially when it's used in
conjunction with medication) is cognitive therapy, a type of talk therapy
geared precisely toward helping people identify erroneous thinking and mistaken
beliefs about themselves and the world.
First, you have to listen to what's being said--really listen. You might
even want to take notes. Don't interrupt or make a value judgment on the
thoughts your child is expressing while you're in active listening mode.
Next, ask questions about the thoughts expressed. See if you can help your
child express the logic (or discover the lack of it) behind his statements. It
can be hard to do, but try to avoid evaluating his words yourself. What you're
trying to do is not so much to tell him the "right" way to think, but
to help him discover his own thought errors, and to help him learn ways to
correct or avoid these mistakes in the future.
Knowing the formal rules of logic can be extraordinarily helpful to someone
with bipolar disorder. These are taught in speech classes and sometimes in
writing classes, and can also be learned from books. They'll help your child
know when others are trying to fool her, and also give her some clues for
recognizing when her own brain is playing illogical tricks.
Kids with a visual bent may benefit from diagramming their thoughts using
boxes and lines, or using computer programming-style "if-then"
statements. This technique can help people see how flexible most situations and
problems are, with many possible choices, solutions, and end results.
"Choose your own adventure" books that let readers drive the story by
making choices for the characters are another vehicle for explaining this
concept. You can also ask "what do you think made him do that?" and
"what if?" questions about the thoughts and choices of characters in
their favorite books or movies.
Truly delusional thinking can become entrenched, sometimes very quickly.
Keeping the lines of communication open should help you spot this kind of
trouble before it occurs, although many people with delusional thoughts are
very secretive about them. Because delusions are a type of psychosis (a loss of
connection with objective reality), medication is almost always used to help
break the pattern. When delusions are potentially harmful to the patient or
others, full or partial hospitalization may be called for until medication can