Childhood Bipolar Disorder - Tantrums or Mania?

Doctor Ellen Leibenluft discusses the difference between a tantrum from a manic episode.

The question of how to tease out or differentiate a tantrum from a manic episode is one which has gotten a great deal of attention. First of all, a manic episode should really last longer. The current diagnostic criteria say that to have hypomania which is a kind of lower level, less severe form of mania it should last at least 4 days. To have true mania it should last at least a week. Now of course somebody who has mania isn't irritable or euphoric 24/7 during that week, but most days, most of the time, they do have that mood state, whereas a tantrum of course tends to last 30 minutes, at most an hour, even let’s say a couple of hours, but that’s hardly a week. The other thing that differentiates a tantrum from an episode of mania is that an episode of mania isn’t just about a change in mood. At the same time that you have the change in mood, you should have changes in your sleep, changes in your activity level, changes in how your thoughts are going. So, it's not just a sort of transient half hour to two hour kind of thing, it’s a period of time that goes on for at least a week or in the case of hypomania at least 4 days, during which a lot is different. They’re not just more irritable, but they also have all these other kinds of changes. So you don’t make the diagnosis of mania based on one symptom, you don’t make it based on irritability. You make it based on a change in mood from that person’s baseline that’s accompanied by changes in sleep, appetite, activity level and all of that happening at the same time.