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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5334
Experience:  Dr. Mark is a PhD in psychology in private practice
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My 16 year old grandson has been a AG student for all his

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My 16 year old grandson has been a AG student for all his school years. He is now in Early College which h will graduate highschool and also have a assoiates degree at the same time. For the past year he has started slipping on grades, being very disrespectful to his single mom and two yonger brothers. Both brothers have ADHD,THEIR mom and dad have Bipolar disorder. The dad has been out of his life for the most part for the last 14 years. At times my grandson is as sweet and kind as he could be. But in just a snap of the finger he can become in a rage and almost a panic. Never admits he is wrong and now does not care at all about his grades , family or even self. We are thinking he may have something like the Bipolar going on also. What do you think!
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 5 years ago.

Hi! I believe I can be of help with this issue.

First, let me say that your grandson at 16 is going to be difficult to diagnose. His symptoms could be any number of problems, from teenage hormones to a mood disorder; yes, they could certainly be consistent with Bipolar Disorder (BD). BD is a hard to diagnose sometimes until later in adolescence or early adulthood when the hormonal system is more set. But BD is certainly something you would want evaluated given the family history.

I also want to say that I will paste for him a technique for getting some quick relief when he is feeling anxiety or anger to help him control himself. The technique is not a cure, but it will help hum in moments of difficulties, depression and anxiety, and he can use it over and over again. Because his moods when they swing from one pole to the other will produce a lot of anxiety. Hopefully he will show you my answer and he will agree to having the evaluation and use these tools I'm putting in.

And this is actually the key to my answer to you that you need to consider and think about. You need to see if he will accept going to get a proper psychiatric evaluation for BD. Let's look at the Diagnostic Criteria for BD. Then I'll continue.

Symptoms of mania or a manic episode include:

Symptoms of depression or a depressive episode include:

Mood Changes

  • A long period of feeling "high," or an overly happy or outgoing mood
  • Extremely irritable mood, agitation, feeling "jumpy" or "wired."

Behavioral Changes

  • Talking very fast, jumping from one idea to another, having racing thoughts
  • Being easily distracted
  • Increasing goal-directed activities, such as taking on new projects
  • Being restless
  • Sleeping little
  • Having an unrealistic belief in one's abilities
  • Behaving impulsively and taking part in a lot of pleasurable,
    high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments.

Mood Changes

  • A long period of feeling worried or empty
  • Loss of interest in activities once enjoyed, including sex.

Behavioral Changes

  • Feeling tired or "slowed down"
  • Having problems concentrating, remembering, and making decisions
  • Being restless or irritable
  • Changing eating, sleeping, or other habits
  • Thinking of death or suicide, or attempting suicide.

What do you think? Does this sound like it describes your grandson's situation? The idea is that the mood swings back and forth unpredictably, with some quicker than others. Here's a quote from the DSM-IV: "Sometimes individuals experience severe mood swings from periods of extreme depression to periods of exaggerated happiness. This is known as bipolar disorder or manic-depressive illness, an illness that involves episodes of serious mania and depression. The individual's mood usually swings from overly "high" and irritable (mania) to sad and hopeless (depression) and then back again, with periods of normal moods interspersed."

That he tries to minimize his problems and symptoms is symptomatic of BD as well as adolescence. Why?

Because if he does have BD, he really believes what he says: he thinks EVERYONE is as unhappy and feeling the turmoil he feels within themselves. I had one person with BD say the same exact thing to me. She was then challenged to poll everyone she knew or would feel comfortable asking if this was true. She was SHOCKED to find out, she reported back, when she found out that most people don't feel the kind of turmoil and suffering inside as a constant state of being that she did.

The people with BD I've worked with often change their attitude toward treatment when they realize that they DO NOT have to be miserable and in turmoil all the time and don't have to make their families miserable.

And so I hope he will agree to the BD evaluation with a psychiatrist.

Let me end off with this because it may be of use to him as well:

In my practice, I use the resources with people with BD from Mary Ellen Copeland. She's American, but so what. I have found her work easy for people to use and easy to keep up with. The biggest problem is forgetting to keep to the plan when times are good and then something happens! Copeland also had BD and was hospitalized. She's a therapist and developed a BD treatment protocol called Wellness Recovery Action Plan (WRAP). First let me cite one of her books for you.

The Depression Workbook: A Guide for Living with Depression and Manic Depression by Mary Ellen Copeland. American Amazon:

I believe from my experience that it is SO important for him to not just take the meds for BD and expect them to do everything. He will have to take charge of managing your BD. And having a strategy like the WRAP program is a coherent way to do this. So that he can regulate his moods as they cycle. Here's what I mean:

Most people are like cars with automatic transmission. They tool around the day going from a little sad and then they feel a little glad and if they get to too high a gear, the emotional transmission just automatically sends them back to a lower gear and if the low gets too low, the transmission clicks into a higher gear. Rarely are they thinking about it. They are usually within their normal range.

Those with BD are like a car with a manual transmission. They start having a racing mood and unless they downshift manually, they're going to be out of control soon until they can't maintain that and they cycle down and then get too far down, etc. So they have to continually use the clutch and manually adjust the emotional gear.

That's what a program like the WRAP plan is about. It gives you the tools to notice what's going on and to make adjustments. So that is why I'm stressing it for him . So along with medications (psychiatrist) he will need to find a therapist to work on a mood management program.

I wish you the very best and be hopeful and confident for the future!

Now, I want to give you a tool to use for when the irritation is overwhelming or there is anxiety. Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from depression or anxiety (the poles of BD), when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum. And this is good also for just general anxiety without panic attacks and for feeling as though you are in a dark hole of depression as well.

I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?


  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.


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