The article by Birmaher et al1 in the March 2009 Archives contributes to the controversy regarding bipolar disorder (BD) in school-aged children. As Birmaher et al note, most of these children met criteria for BD not otherwise specified but not BD type I or BD type II, because they lack the “episode duration requirements for those diagnoses.” However, without the episode duration requirements, one has a patient with considerable emotional lability and intensity that, especially in a child, cannot be easily differentiated from being a precursor of a personality disorder (eg, borderline or histrionic personality disorders) or related to attention-deficit/hyperactivity disorder. It is unclear whether it serves any purpose to call these children's disease BD.
Jeffrey A. M. Bipolar Disorder?. Arch Gen Psychiatry. 2010;67(11):1198. doi:10.1001/archgenpsychiatry.2010.143