Cyclothymia: “A diagnosis is not a label, it is the beginning of a solution”

How to Raise a Bipolar Child? In her book “Mon enfant cyclone” Laetitia Payen talks about her experience as a mother whose youngest son suffers from cyclothymia. This condition is characterized by sudden mood swings and is still misdiagnosed by health professionals, especially in children. On the occasion of World Bipolar Disorder, which takes place on March 30, a look back at this disease with Laetita Payen, director of the Cycling Association.

“At home Stan gave us hell”† With these words begins the testimony of Laetitia Payen, mother of two children in her book My cyclone child† Her youngest son, Stanislas, suffers from cyclothymia, a bipolar disorder that is still poorly understood in children. To support this goal, the professional iconographer became president of the Cycling Association, which helps families with children and teens with mood disorders. She fights for an early diagnosis of neurodevelopmental disorders.

Photo credits: Courtesy of Flammarion

How did Stan’s problems arise before his diagnosis?

It was very complicated from birth. He was a little boy who slept little and cried a lot. We thought it was due to the health problems he had built up in the first two years of his life. After she was two years old, the sleep disturbances continued. The gestures of everyday life have become impossible. Putting on his coat, sitting down to eat, putting him in the car seat… In Stan there was an intolerance to frustration that led to crises of terrible intensity. They can last more than an hour and repeat several times a day.

Obsessive-compulsive disorders soon followed. When he went to bed, the slippers had to be perfectly aligned on the floorboards. He had to be in the same place at the table, the cutlery had to fit perfectly on his plate.

Added to this was the hypersensitivity that caused problems at school. He couldn’t stand loud noises, which caused problems in the cafeteria. For example, it happened to him that he did not support the smell of the mistress. On vacation we went to a eucalyptus candy factory, we urgently had to leave the house.

He was a little boy who was always warm. The heat can give him seizures both in class and at home when a fire is lit.

How have crises evolved over the years?

It got out of hand around the ages of four and five. I was covered in bruises. At five o’clock he was able to break open his bedroom door, loosen the slats of his bed and throw them down the stairs. When he had his tantrums, we had to restrain him so he didn’t hurt himself, but also so he wouldn’t destroy everything around him. Especially when we weren’t home.

There were two facets and during the crises he was physically transformed. His eyes began to roll and a hoarse voice, not the same as a five-year-old boy’s. At those moments we lost him, he wasn’t anymore.

There were also insults, intimidation. He might say to me “Mom when do you cry because I like it when you cry”. He said to me, “Is this your favorite object?” before hitting him against the wall. And lots of little things. For example, he can blow in my ears, make the same sound for 4 hours. We were exhausted and there was a sense of misunderstanding. It was horrible.

Between these tantrums, Stan could suddenly become very affectionate. How did you react?

It took some time to recover. He could say to me, “Mom, I love you so much I could go on stage and tell the whole planet”. Everything was too much. It is the disease of excess.

In your book you talk about loneliness before the diagnosis, both for you, your family and for Stan.

We wondered, we wondered what we had done wrong. However, we had the example of Atsuki, our first daughter with whom everything was going well. But we’re not the only ones having a hard time. The school can’t take it anymore, our friends can’t take it anymore, his sister can’t take it anymore. She told me, “When Stan is in crisis, I feel like a ghost”. My husband told me “I feel like I’m losing life points, it’s like I’m dead inside”. There is exhaustion. We are ashamed. We live in the stress of the next crisis.

In your book you talk about the “hell” you went through. What are the positive signs you were looking for in difficult times?

Exhaustion makes us fall over and think we will no longer love our child. It’s the hardest. We have no solutions. Stanislas worded it and that helped us. He told us his fears “by throwing tantrums, you won’t love me anymore”. One day, when I asked her sister what she wanted to do when she grew up, I asked her the same question. “I won’t do anything, I’ll kill myself”. Beyond our own suffering, this is what enabled us to hear his. This gave us the strength to continue fighting.

We note that Stan was diagnosed thanks to your steps, after numerous misdiagnoses by health professionals.

We were told about Hyperactivity Deficit Disorder, then Autistic Disorder, High Intellectual Potential… But none of them stuck at all. I spent my nights, my evenings browsing the internet trying to find a solution.

Cyclothymia, which is part of the spectrum of childhood bipolar disorder, is misunderstood by many health care professionals. Usually there is a problem with the criterion of bipolarity in children. Today, the recognized consensus is based on the diagnostic criteria for adults with a typical and caricatured bipolarity called BPA.

For most doctors, there must be a “characterized” manic crisis to diagnose bipolar disorder in a child. And it is almost never found in children under the age of fifteen. These are different symptoms in children.

What were the stages of care after diagnosis?

Support is based on three pillars. Behavioral and cognitive therapy teaches how to better manage your emotions and identify the triggers of crises. There is psycho-education, for the parents and the child. This allows you to become an expert in the condition. The child becomes an actor of his illness. He knows how to adopt a healthy lifestyle, watch his sleep, identify the triggers… The parents learn and understand the disease. This makes it possible to respond better to the child’s behavior and to detect the underlying emotion. This is the basis on which care will weigh.

If necessary, there may be drug therapy, namely a mood stabilizer. Stan had to accept it, it was an excuse to be receptive to behavioral and cognitive therapy and psychoeducation.

Officially, bipolarity does not exist in children, there is no mood regulator for children. As in adults, an anticonvulsant is used to control this mood disorder. In children with epilepsy, there is only an indication for epilepsy.

Bipolarity is still poorly recognized and diagnosed in children?

Some doctors are faced with dogmas and do not update their knowledge. Among these physicians, a large proportion has psychoanalytic obedience. It’s a double danger to the parents, it’s all about parenting. Some doctors feel that diagnosing a child means locking him up and putting a label on him.

For us, before the diagnosis, we were very locked in. The diagnosis was liberating. Moreover, a diagnosis is not a label, but the beginning of a solution. It indicates a direction to be taken. The Cycling Association is committed to treating mental disorders in the same way as physical illnesses. That is, prevention, diagnosis and treatment as soon as possible.

The differential diagnosis is also one of the reasons. It is a condition that can be confused with other conditions. At the top of all neurodevelopmental disorders. I am thinking in particular of TDH, autistic disorder, depression, and with particularities such as sensitivity and high potential.

Some want to treat symptoms without causing symptoms, in the case of bipolarity this is problematic. Following this line of reasoning, we give psychostimulants for hyperactivity or antidepressants for depression. These are drugs that make conditions worse.

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