I’m trying to deal with the fact that my daughter has been diagnosed with bipolar disorder. Lisa was away at school and at first I didn’t realize how serious her problems were. She was a great kid and smart in school when everything just crashed. Now she’s on medication and doing well. I’ve heard this is a genetic problem, but no one in our family has ever had this type of disorder. As parents, could we have somehow caused this to happen?

There is little doubt that bipolar disorder (manic-depressive illness) is a genetic disease; that is, it runs in families, with close relatives more likely to be affected than unrelated persons. This knowledge is supported by family studies, adoption studies and twin studies. The heritability of bipolar disorder is high at 50% to 80%.

There is a significant correlation between stressful life events and first hospital admissions during a manic phase. This correlation lessens as the illness progresses. However, stressful life events only exacerbate the underlying disorder, they do not create the illness.

The onset of bipolar disorder may occur from childhood to the fifties, with the average age of onset being in the early twenties. More than one-third begin in the teenage years or earlier. The estimated lifetime risk for the illness is 0.8 percent. Thus, the frequency of the illness is similar to schizophrenia.

Many children and adults with mild symptoms of mania and depression are unlikely to think of themselves as ill and may go undiagnosed and untreated ("silent bipolars"). Others may be more appropriately diagnosed with bipolar II disorder. To help identify those in this group, it is often best to examine lifestyles. Specifically, those relatives with disturbing driving histories, multiple marriages and relationships, substance abuse problems, and significant money management difficulties may warrant a closer look.

Once the diagnosis has been made, the critical issue at hand is support, understanding and appropriate ongoing treatment and medical follow-up. There is no one to blame.

Joshua W. Calhoun, M.D.
Chief, Division of Child & Adolescent Psychiatry
St. John’s Mercy Medical Center
St. Louis, MO

As parents you did nothing to cause your daughter’s illness. Bipolar disorder does run in families, but is not inheritable as you may think of Huntington’s chorea or cystic fibrosis. Cancer and heart disease run in families, but the genetic components are not understood for those illnesses either. Usually, when families search their heritage, they can find the members who had a mental illness, although it may not have been recognized or diagnosed at the time.

Numerous research studies have identified certain common gene markers in the families of persons with bipolar disorder. However, replication by other studies has been problematic. At centers like Washington University here in St. Louis such studies continue. We are hopeful that one day a gene, or genes, for bipolar disorder will be identified and more effective treatments created as a result.

A feeling of having caused your daughter’s disorder is quite normal among families who have a relative with mental illness. NAMI of St. Louis provides families such as yours an opportunity to interact with other families in the same situation through support groups and education classes. Educate yourself about bipolar disorder. The more information you have, the more prepared you are to understand your daughter’s mood swings and to be supportive of her in her day-to-day struggles with the illness.

Marge Parrish, Associate Director
NAMI of St. Louis
(formerly Alliance for the Mentally Ill of Metropolitan St. Louis)

(314) 966-4670

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