The Phenomenology of Early-Onset Bipolar Disorder

Background and Purpose

The prevalence of bipolar disorder diagnoses prior to age 18 (early-onset bipolar disorder - EOBD) has increased at a rate disproportionate to our understanding of its phenomenology. Existing research has explored its neurobiological etiology, yet significant limitations remain in the development and delivery of psychosocial rehabilitation interventions targeted to issues of stigma, and individual and family functioning. Within the literature, researchers agree that an improved understanding of the phenomenology of EOBD is needed; however, qualitative data from the adolescents and young adults with bipolar disorder remains largely absent in our conceptualization and treatment of EOBD.

The purpose of this qualitative study is to increase understanding of the experience of EOBD through semi-structured interviews. This study addresses aspects of EOBD such as onset, diagnosis, and experience of symptoms; psychosocial and identity development; stigma; treatment interventions; and developmental changes occurring through emerging adulthood.

Methods

This study incorporates a transcendental phenomenological design. Telephone interviews were conducted with 8 participants ages 18-25 in which they were asked about their experience of bipolar disorder during adolescence (ages 13-17). Interviews were transcribed and analyzed to identify essential themes of participant’s experiences. Individual descriptions were constructed of each participant’s experience of EOBD, as well as its subjective meaning and impact on elements of adolescence such as identity development and interpersonal relationships. A composite description was derived from the individual descriptions that represents the experience of early-onset bipolar disorder.

Results

Participant data yielded themes across six domains: experience of illness; healthcare and treatment; reactions and coping; interpersonal relationships; labeling and stigma; impact on identity; and mediating factors.

Participants described their experience of EOBD as a struggle to manage symptomatology and normative adolescent developmental tasks. Participants described not understanding EOBD or their subjective experience, and stated most family members, peers, and healthcare providers also were not knowledgeable or did not understand; however, family members and peers were also described as supportive. Participants described an association between perceived healthcare providers’ knowledge of EOBD and whether healthcare and treatment outcomes were beneficial. Participants described psychotropic medication as more beneficial than psychotherapy; however, psychotropic medication was viewed as a significant challenge due to side effects and impact on sense of self, relationships, and maintaining academic performance. Participants described strong impact of labeling and stigma on identity development and sense of self. Interpersonal relationships and healthcare were described as sources of labeling and stigma.

Conclusions and Implications

Participants described EOBD as an isolating experience in terms of symptoms and effect on daily and social functioning. In concordance with findings, healthcare providers’ familiarity with EOBD and adolescent developmental factors carries important implications for the effectiveness of treatment interventions. Psychoeducation and involvement of the support system may mediate course of illness. Diagnostic labeling carries implications for development of stigma by provider as well as support system.

Future research should address the inception and impact of labeling within the healthcare system, as well as the role of support in mediating impact of stigma on identity development.