Bipolar disorder: Your thoughts

When it comes to bipolar disorder in children, controversy abounds.

Who is really "bipolar," and who is reacting directly to circumstances in the family? Who should take medication, and who should try other interventions? Should we have different diagnoses for children who have extreme tantrums, or would new disorders simply lead to more kids on psychiatric medications?

These are all open questions, and there are no easy answers. Mental health professionals have their own general opinions on these issues, but must approach each patient as an individual, since there is a wide range of behaviors and responses to treatment that any one child can exhibit.

CNN.com readers gave about 1,000 responses to my recent article on bipolar disorder in children. A lot of people were passionate about whether parenting plays a role in mental disorders. Reader 400thecat writes:

My 14-year-old son has Type 1 Diabetes. When you mention insulin to anyone, medicine is part of great science.

My 19-year-old son is autistic. When you mention Risperdal or Prozac to anyone, suddenly we are being duped.

Every organ in the body can have a problem and it is acceptable, but when the brain is not normal it is always viewed as a parenting issue.

The point here is that mental disorders such as autism and bipolar disorder are physiological problems just like diabetes, and require constant monitoring and treatment just as diabetes does. Studies have shown genetic components to mental disorders, meaning some kids will inherit a predisposition to develop bipolar disorder regardless of "bad parenting." But there is a lot more stigma around mental illnesses, and the mechanisms behind them are not as well understood.

Having said that, as Dr. Charles Raison points out in the article, there can be situations that cause children to behave badly, and it is very important to identify any non-biological reasons for bipolar-like symptoms. Medications should not be the first line of defense, says Dr. Rakesh Jain, a psychiatrist in Lake Jackson, Texas.

Bipolar disorder in children is much more complex than the adult version, leaving much room for misdiagnosis and confusion, notes Garry Earles, a clinical social worker in Turners Falls, Massachusetts. The mental health community is divided on whether adult criteria for bipolar disorder should be applied to kids, or whether more "mixed" symptoms - persistent irritability, rapid cycling between moods - are the signatures of a bipolar child. That's why some are pushing for a new diagnosis: Temper Dysregulation Disorder with Dysphoria. But this, too, is mired in controversy - a New England Journal of Medicine commentary in May cautioned that it could be "applied trivially to any kind of temper tantrum."

Got more to say? Share your thoughts below.