Teen bouts with bipolar disorder can be easily misdiagnosed and cause a downward spiral of problems
By Donna Vickroy, Daily Southtown, October 12, 2004
Staff Writer

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Like a lot of teens, Ryan Dignan spent much of his junior year of high school feeling angry. sad and frustrated.

Classes at his Orland Park school were demanding. He didn't make first string of the varsity football team, which was disappointing. He wanted to spend more time with his friends.

Ryan seemed to be struggling with the ups and downs of adolescence.

Unlike most kids, though, Ryan's behavior was due to anything but normal teenage angst.

When Ken Dignan talks about his third son now, it's almost as if he is talking about two different people: the outgoing, fun-loving, high-achieving Ryan and the sullen, sad and barely able to function Ryan.

In reality, it wasn't that there were two Ryans, it was that one Ryan was existing in two worlds.

Such can be the life of a teen with bipolar disorder, a condition that is often confused with depression and often masked by substance abuse. Bipolar disorder frequently presents itself during the teen years. But too often the extreme behavior is attributed to other causes - a lack of discipline, a bout of depression, attention deficit disorder or normal teenage rebellion. A wrong diagnosis can make the problem worse.

Swinging between high and low

Affecting up to 6 percent of the population, bipolarism is a psychiatric mood disorder that causes patients to swing from super highs to super lows. During a manic state, sufferers may feel jubilation, excitement and high energy. Mania can also be accompanied by suspicion, anger and rage. During a depressed state, victims tend to feel sad and hopeless. They may sleep a lot or even feel suicidal.

Cases of bipolar disorder that present themselves during a patient's youth tend to be more malignant, yet they can also be more difficult to diagnosis accurately.

"Adolescent behavior in general makes it extremely difficult to recognize bipolar," said Dr. William Gilmer, associate professor of psychiatry at Northwestern University Feinberg School of Medicine.

Victims may appear to be rebellious or argumentative, typical teen behavior.

Amanda Frawley remembers heated arguments, especially with her mother, during her teen years. She mouthed off a lot and was prone to rages.

"I went to different psychiatrists and therapists who thought I had depression," Frawley said.

It wasn't until two years ago, when she was 27, that she was diagnosed as bipolar. Today, Frawley runs a support group out of Redeemer Lutheran Church in Oak Forest. The group is a local chapter of the Depression and Bipolar Support Alliance.

"It's something you never get rid of," she said. "But it helps to talk with others who have it."

Frawley's story is not unusual.

Misdiagnosis very common

Gilmer said too often medical help is not sought until a victim experiences a severe low. In general, people with bipolar disorder are more likely to spend time at the depressed end of the mood spectrum, often compelling doctors to diagnose them with depression.

"If a person with bipolar disorder is treated with anti-depressants, he may experience a worsening of the bipolar disorder," Gilmer said. "He may actually be at a higher risk of committing suicide."

It's not unusual, he said, to hear stories similar to that of NBC news personality Jane Pauley, who recently announced her bout with bipolar, which she attributes to incorrect medication.

Of people diagnosed with chronic recurrent depression, it's estimated that about one-third may actually have bipolar disorder, he said.

Dr. Harold McGrath, medical director of psychiatry at Advocate Christ Hospital and Medical Center in Oak Lawn, said when bipolar presents itself in the manic stage, it is fairly easy to diagnose. But most patients are not brought in for help until they're in the depressive state. Teens who are brought to the emergency room by parents complaining their child is depressed soon find out depression is only half the problem.

"It is very common that youngsters who have early depression end up being properly diagnosed later with bipolar disorder," McGrath said.

The best way to diagnose bipolar disorder is with a series of psychiatric and neurological tests, McGrath said.

Because bipolar mimics other conditions, yet calls for a unique treatment, other conditions have to be ruled out or addressed, he said.

Between 18 and 35 percent of teens with ADD also have bipolar, he said.

From ideal kid to problem child

Ryan went from being the family's golden child to being a living nightmare, Dignan recalls.

"He was a great kid, really energetic, the life of the party," Dignan said.

He loved sports and played on the football, baseball and wrestling teams at Sandburg High School in Orland Park, all while maintaining a 3.8 grade point average.

"His heart was wonderful. He had more compassion and an intuitive ability to sense how everyone around was feeling," Dignan said.

Ryan finished the fall semester of his junior year, then announced to his family he couldn't handle school anymore.

"He thought people were talking about him, that they didn't like him," Dignan recalled.

"I thought he was burnt out. I got him a tutor."

One night the following summer, Dignan and his wife, Joni, were awakened by a call from the Orland Park Police Department.

"They said they were taking Ryan to Palos Hospital," Dignan said.

He had driven his car into a park, knocking over a portable toilet and landing on top of a teeter-totter. Police arrived to find Ryan sitting on the car, shouting "shoot me, kill me."

Like a lot of bipolar people, Ryan had begun self-medicating. He'd been drinking and smoking marijuana.

After his hospital visit, the Dignans put their son in a rehab center, where he spent two weeks on lockdown.

It was there that doctors diagnosed bipolar disorder.

"That opened up the whole world of chemical imbalance, a nightmare that a lot of people are dealing with," Dignan said.

Clues are in the genes

Gilmer said bipolar disorder is largely hereditary.

"There is a genetic vulnerability. We don't know what the factors are that lead to an expression of that vulnerability, but it does seem that the earlier the onset, the greater the genetic link," he said.

Teens diagnosed with bipolar are very likely to have family members with mood disorders, he said. There tends to be a history of alcoholism or suicide somewhere in the family line.

McGrath said often bipolar co-exists with other problems, especially substance abuse.

"It's estimated that 65 percent or more of people with bipolar disorder are substance abusers," he said.

"In fact, early substance abuse in children is often a sign of bipolar disorder," McGrath said.

Bipolar patients who abuse drugs, especially cocaine or alcohol, can end up profoundly depressed, McGrath said.

"There is a high incidence of both suicide attempts and suicide success in bipolar people who are not managed," he said. "You cannot successfully treat the illness while a patient is using drugs."

Alcohol derails best-laid plans

Substance abuse kept Ryan from managing his condition. He dropped out of school, couldn't keep a job and alternated between manic highs, when he'd slam his fist through the wall in frustration, to depressed lows, when he'd sleep into the afternoon.

"The substance abuse offset any good the medication was doing," Dignan said. "It was almost like he was living in a hurricane, or like a car going a hundred miles an hour with no brakes."

Over the years, Ryan had been seen by countless doctors who prescribed all kinds of medications. He'd enrolled in a number of rehab programs. Yet, after each treatment, he returned to self-medication, which prevented him from living a stable life.

Every now and then, sheer determination would compel Ryan to try to pull things together. He took the GED test and passed without even studying. He applied to Western Illinois University as a business major, just like his older brother. He was accepted.

But just when he seemed to be getting a handle on things, his disorder would propel him back into chaos.

He left for Western in August 2001. In October, the Dignans got a call from university officials saying their son had barricaded himself in his dorm room and was threatening suicide. The Dignans discovered their son had spent his first two months away from home partying.

"As a parent you hope against hope that something will change," Dignan said. Their older son Andy went down to Macomb and brought Ryan home.

And there he stayed, until the following summer when the Dignans sent him to a rehabilitation site called New Life Center in Phoenix.

"He wasn't happy there but he seemed to realize that something had to be done," Dignan said.

When he came home, he seemed better and began helping his father in his ministry work. A pastor at Eagle Rock Church in Orland Park, Dignan hosts a local access television show called "Ken Dignan, From the Heart." Ryan used to help him prepare his shows, which air on Total Living Network and Family Net.

Through September and October 2002, Ryan actually seemed more focused and happier, Dignan recalled.

But the holidays loomed.

"He loved Christmas," Dignan said. "He always wanted the holidays to be perfect."

As December drew nearer, Dignan said, Ryan began to express concern.

"He'd say, 'Dad, am I always going to be like this?' or 'Dad, I hope I don't mess up Christmas.'"

Ryan complimented his father following his Dec. 6 sermon. The next Friday, Dec. 13, Ryan did some mailings for his dad's TV program. That night he had dinner with his parents and then announced he was going out.

"We told him to be careful," Dignan said. "Then we went to bed."

As was custom for Joni Dignan, she awoke about 5 a.m. and went into Ryan's room to make sure he'd made it home safely.

He hadn't slept in his bed. She began checking the house.

"Then I heard Joni screaming, 'Oh, no. Oh, no. Ryan's hung himself,'" Dignan said.

Ken Dignan was afflicted with polio as a baby, a condition that has not prevented him from marrying, having four children and pursuing a career in ministry, but has left him unable to maneuver stairs.

Joni Dignan cut her son down from the basement ceiling, his near 6-foot body toppling her over.

The coroner came, the police came.

An autopsy would later reveal that 20-year-old Ryan died without any illegal drugs in his system.

'Surviving the nightmare'

"It is one of the most painful things because you think it didn't have to happen," Dignan said. "You're always questioning yourself, 'Is there something we could have done?'"

Dignan has spoken at District 218 and District 230 about the horrors of losing a son to suicide. He cautions youngsters to avoid drugs and advises parents to watch over their kids.

"There's a world out there that needs help," Dignan said. "We seem to want a pretty life, a clean life, a life that makes sense, a life that is one-two-three.

"We want to think that if you live in a $500,000 house, you'll have cleaner problems. But no matter where you live, there exist the same problems."

Following their son's suicide, the Dignans joined LOSS, Loving Outreach for Suicide Survivors, a support group started by the Rev. Charles Ruby of Catholic Charities. Ken Dignan also began to journal, a mission that has resulted in a book about his experience.

"Surviving the Nightmare: Losing a Son to Bipolar Disorder and Suicide" is now being edited.

In addition, each fall Dignan puts together a free benefit concert. The second annual Ryan Dignan Memorial Concert will be held Nov. 20 at Trinity College, Ozinga Chapel, in Palos Heights. The Christian rock group Sanctus Real will perform. Professional organizations that address bipolar disorder, substance abuse and suicide will be on hand to dispense information.

Donna Vickroy may be reached at dvickroy@dailysouthtown.com or (708) 633-5982.


We must not build the future for our youth,
we must build our youth for our future.
-Franklin D. Roosevelt