Nausea Vomiting and BiPolar (BP)?

[bearded one]

I'm another parent, pretty much like most of you at the end of my rope. My wife and I have struggled for over three years now with a son with increasing episodes of defiance, mood swings, rage, refusal to do anything at school. This led to our being told by his school that he was suspended until he saw a professional. The psychiatrist is someone that he seems to get along with, and her initial feeling after three sessions is that this son is BiPolar (BP) and ODD.

With Bipolars, is it common for them to get out of school (he's 11) by vomiting and playing sick? We've had this nausea/vomiting problem for over two years now. The odd thing is that it isn't just when he is at school. He can throw up, leave school, and sometimes throw up (off and on) for the next couple of days. For those who have BiPolar (BP) kids, have you experienced this?

Anyway, the wife and I are starting into all of the IEP testing, therapy, medications and all the rest. It's almost overwhelming, at times, especially for my wife. Nobody else in the immediate family has any form of mental illness, but the psychiatrist says that BiPolar (BP) is very much genetic. It's bad enough to have to cope with an out-of-control kid, but then too find out that your defective genes had something to do with it is very hard to deal with.

Thanks for the help and a place to vent.

 

[crazymama30]

I am wondering if it is not anxiety due to school, anxiety can manifest in some very physical ways.

I would talk to your psychiatrist about it, and ask your difficult child if something at school upsets him.

 

[rlsnights]

Has he had a thorough work up by a pediatric gastroenterologist (pediatrician GI)?

If not, I would request one immediately and tell the pediatrician or referring doctor that son is being suspended for, among other reasons, the frequent vomiting. This may get you into pediatrician gi faster than usual, since most places have few pediatrician gi's and long waiting lists unless you are vomiting blood.

I think it's very important to rule out possible physical causes for this problem and not leap to the conclusion it's anxiety or BiPolar (BP) based behavior. Not to say that those aren't good explanations - just that other stuff needs to be ruled out first.

 

[smallworld]

I'm going to say it depends.

Your son should have a full medical workup to make sure there is no underlying physical problem before you assume it's psychological. Have you talked to his pediatrician about the nausea and vomiting problem? It could be a myriad of problems including GERD, migraines, seizures, celiac disease, etc, etc. My son, who has a diagnosis of bipolar disorder, also has debilitating migraines that cause nausea and vomiting. Once we got him on preventive migraine medications, the nausea and vomiting resolved.

If all the medical stuff is ruled out, anxiety that accompanies bipolar disorder can cause nausea and vomiting. Once the mood is stabilized with appropriate medication, the somatic symptoms often disappear. My daughter, who has a diagnosis of mood disorder, suffered from anxiety that caused stomachaches and headaches that disappeared when her mood was stabilized with the right medications.

Rule out physical causes first, psychological causes second. Hang in there.

 

[compassion]

In my experince with my difficult child and lots of reading, eating disordrs are very common with BiPolar (BP). Compassion

 

[smallworld]

You might want to first take your difficult child for a thorough exam and initial bloodwork with your pediatrician and have the pediatrician decide which specialist to refer to since some causes of nausea and vomiting are not related to GI, but to neurology (for example, seizures and migraines).

 

[rlsnights]

Forgot to say our psychiatrist says there is a some literature that is suggests there may be a link between BiPolar (BP) and inflammatory bowel disease (IBD). And the recent large genome studies have found evidence that also suggests a possible link between IBD and schizo/BiPolar (BP). In her own practice she has several BiPolar (BP) patients with IBD and feels there is definitely some kind of connection there. This is one of my reasons for suggesting the gi work up. Definitely could be migraine and seizures of course. Starting with the pediatrician (if not done already) is usually required to get into specialists.

IBD in boys may present first with poor growth -something that is rarely caught unless it is severe. Something to ask the pediatrician about if you have any question about whether his growth is on target. If he has changed doctors several times this may be hard to track since you need to go back 2 or 3 years at least to see if he's growing along the predicted curve.

 

[smallworld]

Interesting, Patricia. My father is an adult GI doctor. I'll have to ask him about that.

My kids all presented with slow growth, but no IBD. My girls ended up on HGH.

 

[BusynMember]

You don't list her medications. Some cause upset stomach. You may ask about that too.

 

[Wiped Out]

I was wondering too about what medications he is on because of the stomach upset.

Another thing that my difficult child developed was stomach migraines. We didn't know what was going on for the longest time. He would start throwing up about the same time each day for a couple of hours. Eventually it became worse and lasted longer. When he was in the psychiatric hospital he also had them. They were eventually dxd as stomach migraine. He takes Topamax which is a mood stabilizer but also used to treat migraines. For him it has worked great as far as taking care of the stomach migraines.

 

[GoingNorth]

If the GI stuff comes out OK, I would also look at school anxiety and the causes of that. I was bullied horribly for most of my school years from 6th grade onward. For me, the anxiety caused terrible diarrhea.

husband had 'stomach migraines'. He'd get the aura and then start throwing his guts up. The Army thought he was 'shamming' to get out of work for quite some time.

I got/get classical migraines with the aura, nausea and vomiting along with a horrible headache. husband's symptoms were just the same except for the headache

 

[Josie]

Celiac Disease is another condition that could cause the nausea and is linked to depression and schizophrenia.

My own daughter used to act like she was bipolar (in my humble opinion) with an official diagnosis of ODD and Depression. She was violent as well as defiant. Although she was not diagnosis'ed with celiac disease, going on the gluten free diet eliminated all of that behaviour. She also had to give up casein (milk).

Your PCP can order the celiac panel blood test if you don't get into the pedi GI quickly enough. Regardless of the results, you might consider trying the girlfriend diet. It might get rid of the nausea and the behaviour.

My older daughter had the behaviour problems and no GI issues. We never tested her for celiac because my younger daughter had stomach problems and never tested positive on the test. We did do a different test for gluten intolerance which was positive for both of them. My younger daughter's stomach problems have disappeared on the girlfriend diet.

 

[bearded one]

Celiac Disease is another condition that could cause the nausea and is linked to depression and schizophrenia.

My own daughter used to act like she was bipolar (in my humble opinion) with an official diagnosis of ODD and Depression. She was violent as well as defiant. Although she was not diagnosis'ed with celiac disease, going on the gluten free diet eliminated all of that behaviour. She also had to give up casein (milk).

Your PCP can order the celiac panel blood test if you don't get into the pedi GI quickly enough. Regardless of the results, you might consider trying the girlfriend diet. It might get rid of the nausea and the behaviour.

My older daughter had the behaviour problems and no GI issues. We never tested her for celiac because my younger daughter had stomach problems and never tested positive on the test. We did do a different test for gluten intolerance which was positive for both of them. My younger daughter's stomach problems have disappeared on the girlfriend diet.

Thank you, as I wouldn't have thought of a celiac panel test. Glucose intolerance runs in the family and I know diet certainly contributes to the problem. It's interesting that right now, the confirmed diagnosis. is ODD and depression, with BiPolar (BP) suspected because of symptoms similar to what your daughter had.

 

[bearded one]

Forgot to say our psychiatrist says there is a some literature that is suggests there may be a link between BiPolar (BP) and inflammatory bowel disease (IBD). And the recent large genome studies have found evidence that also suggests a possible link between IBD and schizo/BiPolar (BP). In her own practice she has several BiPolar (BP) patients with IBD and feels there is definitely some kind of connection there. This is one of my reasons for suggesting the gi work up. Definitely could be migraine and seizures of course. Starting with the pediatrician (if not done already) is usually required to get into specialists.

IBD in boys may present first with poor growth -something that is rarely caught unless it is severe. Something to ask the pediatrician about if you have any question about whether his growth is on target. If he has changed doctors several times this may be hard to track since you need to go back 2 or 3 years at least to see if he's growing along the predicted curve.

When you say 'inflammatory bowel disease' is that another name for 'irritable bowel syndrome'? I have IBS, which runs in the family. He's been to his peds doctor and just had a basic checkup. Drawing blood on this kid is probably going to take a miracle from God. But, as another poster suggested, celiac disease or some type of inflammatory/iriitable bowel syndrome could certainly be aggravating the problems.

No migraines, but if he escapes that he will be very lucky. Every one else in the family has them with histories of migraines on both sides of the family going back for generations. Usually they are controlled by a regular intake of caffeine, but with this kid, caffeine makes him belligerant and out of control.

Thanks to all for the help and suggestions. I'm glad I found this site!

 

[rlsnights]

No Inflammatory Bowel Disease (Crohn's Disease and Ulcerative Colitis) is NOT the same as IBS. Both these diseases are autoimmune diseases of the intestinal system. Both can be life-threatening if left untreated or if the symptoms cannot be brought under control either medically or surgically. UC often requires colectomy - removal of the colon. Crohn's eventually requires surgery with something like 80% of Crohn's patients having at least one surgery in their lifetime. Both have periods of flaring and remission that are unpredictable. Both are serious illnesses that cause permanent damage and require medical and/or surgical intervention. Most Crohn's patients and some UC patients require long-term chemotherapy to suppress their immune system.

IBS and other functional problems with the intestines are not uncommon in people with IBD but IBS does not cause severe and permanent damage to the bowel and other organs. I am not suggesting that IBS is not a difficult and sometimes severely life-disrupting condition. But IBS affects the way the bowel functions without causing detectable damage to the intestines.

Ulcerative Colitis affects primarily the Colon or large bowel and causes extensive ulceration and swelling in the bowel. It's like having a massive sore on the outside of your body but it's inside the colon. Typical symptoms of UC are diarrhea ( up to 20x per day) or, less often, constipation, bleeding with stools, weight loss, fatigue, belly pain. Can include inflammation of the stomach and liver along with arthritis and joint pain. Of the two diseases, UC symptoms are much more likely to be noticeable and have a sudden onset.

Crohn's Disease can affect the entire digestive system including all the organs that make it up like the liver, pancreas, gallbladder, etc. Crohn's also causes extensive ulceration and swelling but it can occur anywhere within the small and large intestines and in the stomach. Crohn's often also causes perianal disease, fistulas, abscesses, full and partial blockages, and more permanent damage like strictures (extreme narrowing of the bowel due to swelling and scar tissue) which must often be removed surgically. Crohn's in children can and often does have an insidious onset and a child may be seem healthy for years before obvious symptoms appear. Even after diagnosis, Crohn's patients may have periods of "remission" where the disease is not actually in remission but there are few or even no discernible symptoms. Some people may have only minor changes in bloodwork and Crohn's often requires colonoscopy and endoscopy with biopsies to confirm the diagnosis. Typical symptoms include poor growth (in children), diarrhea, sometimes severe constipation, vomiting, reflux, some belly pain, thin bones, fatigue, arthritis along with the other things I mentioned before.

It is very unlikely that your child has IBD but, given the seriousness of the illness and the fact that Crohn's can go undiagnosed for years, it is worth at least being considered in the differential diagnosis of chronic vomiting. There are a number of other GI conditions including cyclical vomiting that can cause persistent vomiting and usually require a specialist to diagnose.

Abdominal migraines do not necessarily cause headaches. They cause GI symptoms like nausea, vomiting and significant belly pain. There may be a similar constellation of symptoms to "regular" migraines but not always. They are typically diagnosed in children not adults.

 

[emotionallybankrupt]

I think this is a very interesting thread. We went through very similar symptoms with my older daughter, from a very young age (about 5), long before any abnormal behavioral issues surfaced. It even progressed to the point of her being hospitalized, scoped, and biopsied, with never any diagnosis except anxiety involvement, which I believe was a legitimate factor but not the whole story. I also think she has the IBS (and the doctor later diagnosed this), but I still think there is something else there that was never diagnosed. In later years, however, the picture became more muddled with attention-seeking and manipulative behaviors, so that it became impossible to tease apart the true symptoms from the manufactured ones.

Her dad had similar issues, although more clear-cut IBS. I'm convinced BOTH of them had/have the personality disorder issue, Auditory Processing Disorders (APD) for him, and a developing mixed bag for her.

The only thing we found that DID help, was for me to let her be in charge of the timing of her eating. For example, I was raised to believe that parents made sure their children ate breakfast in the mornings before school. She would protest, and I would insist. After a while of this, I learned I was not doing her any favors. For whatever reason, her body simply would not tolerate the food first thing in the morning, and her dad was the same way.

Good luck in figuring out the puzzle. I will be extremely interested in your findings.

 

[bearded one]

I think this is a very interesting thread. We went through very similar symptoms with my older daughter, from a very young age (about 5), long before any abnormal behavioral issues surfaced. It even progressed to the point of her being hospitalized, scoped, and biopsied, with never any diagnosis except anxiety involvement, which I believe was a legitimate factor but not the whole story. I also think she has the IBS (and the doctor later diagnosed this), but I still think there is something else there that was never diagnosed. In later years, however, the picture became more muddled with attention-seeking and manipulative behaviors, so that it became impossible to tease apart the true symptoms from the manufactured ones.

Her dad had similar issues, although more clear-cut IBS. I'm convinced BOTH of them had/have the personality disorder issue, Auditory Processing Disorders (APD) for him, and a developing mixed bag for her.

The only thing we found that DID help, was for me to let her be in charge of the timing of her eating. For example, I was raised to believe that parents made sure their children ate breakfast in the mornings before school. She would protest, and I would insist. After a while of this, I learned I was not doing her any favors. For whatever reason, her body simply would not tolerate the food first thing in the morning, and her dad was the same way.

Good luck in figuring out the puzzle. I will be extremely interested in your findings.

Don't worry, I'll share! Some people just can't eat in the morning and our difficult child is one of 'em, along with his mom. Try and make him eat, he pukes. So, he goes to school with no breakfast and by 9 or 10 a.m., his blood sugar is in the toilet and he desperately wants to eat. The school he is in has snacks brought in on a rotating basis among the families of the kids (small Christian school, eight or nine kids). But, difficult child doesn't like the snacks, wants only his, and the conflict begins. They did finally let him have his own snacks, but trying to keep this kid fed at the right time is a major PIA.
Wife has to work, while I sleep days/work nights. With difficult child out of school right now, sometimes I get up to a kid who has had nothing to eat and is totally out of control. I try leaving food for him that he can heat up, but if it's not what he's wanting that day, he won't eat it.
I'm pretty sure he doesn't have IBD, there's nothing to indicate that. IBS is highly probable along with lactose intolerance and maybe gluten intolerance. We're working on figuring out what type of diet he needs.

 

[emotionallybankrupt]

I try leaving food for him that he can heat up, but if it's not what he's wanting that day, he won't eat it.

Well...in the spirit of brainstorming and "picking your battles," would it be worth seeing what would happen to let difficult child "call the shots" TOTALLY on what he eats and when, in exchange for decent behavior? Just let him name it up, and you buy it and let him have it on his terms? He'd pay with those "natural consequences" if he made stupid choices, because he probably wouldn't feel very good. Then maybe he'd let you make suggestions of healthier choices to at least go along with whatever he's choosing. Again, not a total freebie. The freedom to make "grown-up" decisions, like being in complete control of his diet, PLUS having you go out of your way to accommodate him, would have to be linked with other "grown-up" behaviors.

I know. Letting a child be totally in charge of his diet goes against the grain with me, and my guess is that it does with you too, but it's at least another possibility in your tool box, at least for a trial run.

 

[bearded one]

Well...in the spirit of brainstorming and "picking your battles," would it be worth seeing what would happen to let difficult child "call the shots" TOTALLY on what he eats and when, in exchange for decent behavior? Just let him name it up, and you buy it and let him have it on his terms? He'd pay with those "natural consequences" if he made stupid choices, because he probably wouldn't feel very good. Then maybe he'd let you make suggestions of healthier choices to at least go along with whatever he's choosing. Again, not a total freebie. The freedom to make "grown-up" decisions, like being in complete control of his diet, PLUS having you go out of your way to accommodate him, would have to be linked with other "grown-up" behaviors.

I know. Letting a child be totally in charge of his diet goes against the grain with me, and my guess is that it does with you too, but it's at least another possibility in your tool box, at least for a trial run.

No, we've tried that. The only thing he really wants is high sugar, high caffeine and highly processed foods, all of which turn him into a raging monster that no one wants to have around. He doesn't care how bad it makes him feel or act. It's almost like an addiction with him. Thanks for the thought though as there must be an answer out there somewhere!

 

[GoingNorth]

If you check back a couple of pages on Watercooler, you will see a thread discussing caffeine addiction.

It's a known medical condition, and withdrawals can be ferocious and recur each time blood levels of caffeine drop. AMs are the worst time one has been without one's 'fix' for eight or more hours.

Withdrawal from caffeine is characterized by a ferocious headache (rivalling a migraine in some cases) stomach upset, extreme irritability and agitation, etc.

So, it is VERY possible that he NEEDS that caffeine hit first thing in the AM