OCD Related Conditions The Link Between OCD and Bipolar Disorder By Owen Kelly, PhD Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders. Learn about our editorial process Owen Kelly, PhD Medically reviewed by Medically reviewed by Steven Gans, MD on August 05, 2016 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Review Board Steven Gans, MD Updated on October 08, 2019 Print South_agency/E+/Getty images Table of Contents View All Background OCD Treatment Clinical research suggests that OCD and bipolar disorder co-occur with each other at a higher rate than would be expected by chance. Importantly, the presence of bipolar disorder can affect OCD symptoms and treatment. Let’s explore the link between OCD and bipolar disorder. What Is Bipolar Disorder? Before discussing the link between bipolar disorder and OCD, it may be helpful to first describe the symptoms of bipolar disorder. Bipolar disorder is a mental illness where the affected person experiences one or more "manic" or "mixed" episodes; however, most people with bipolar disorder have also had one or more episodes of depression. Mania is a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week. A manic episode is usually accompanied by three or more of the following symptoms. Dramatic decrease in the need for sleepEngaging in pleasurable activities with a high potential for painful consequences, such as impulsive spending and risky sexExtreme distraction and unable to focusGoal-directed activity (often of a social, professional or sexual nature)Inflated self-esteem or grandiosityMore talkative than usual or pressure to keep talkingRacing thoughts To be diagnosed as a manic episode, these symptoms have to be severe enough to cause major disruption at work or at home. In addition, a manic episode often requires that the person goes to the hospital for treatment. It is not uncommon for people with mania to show features of psychosis, such as delusions. Currently, there are four subtypes of bipolar disorder: Bipolar I: The most severe form, usually requires hospitalizationBipolar II: Similar symptoms, but the mania is not as severe; however, people often experience severe depressionCyclothymia: Rapid fluctuation between hypomania and depressive symptoms that are not severe enough to meet the criteria for a Major Depressive EpisodeBipolar Disorder Not Otherwise Specified: Disorders with bipolar features that do not meet the criteria for the specific bipolar disorders OCD and Bipolar Disorder Research has established a strong link between bipolar disorder and OCD. It has been estimated that between 10% to 35% of people with bipolar disorder also have OCD, with most reporting that their OCD symptoms started first. Indeed, OCD is thought to be the most frequently occurring anxiety disorder among people with bipolar disorder. Interestingly, one analysis found that OCD occurs with bipolar disorder at a much higher rate than the major depressive disorder. This study found that people with bipolar disorder are between two and five times more likely to have OCD than people with major depressive disorder. In general, people who are affected by both bipolar disorder and OCD seem to have very high rates of other forms of mental illness; in particular, panic disorder as well as impulse control disorders. Although there is not one particular gene that links OCD and bipolar disorder, there is increasing evidence that these two disorders may share some genes. Behaviorally, both people with bipolar disorder and people with OCD show a decrease in specific types of verbal memory. Implications for Treatment When bipolar disorder and OCD occur together, the symptoms of bipolar disorder tend to be much worse and more difficult to treat than bipolar conditions that occur without OCD. People with both OCD and bipolar disorder also tend to show more frequent use and abuse of substances such as drugs and alcohol. Substance use often complicates treatment and usually predicts worse outcomes. There is also some evidence that when OCD occurs with bipolar disorder, there are fewer checking compulsions but more obsessions related to religious and sexual themes. It is important to note that OCD in the presence of bipolar disorder may require the use of different treatment strategies, as many of the antidepressants that are commonly used to treat OCD can sometimes exacerbate or even cause symptoms of mania or hypomania. Also, when OCD and bipolar disorder co-occur, it has been suggested that the treatment of bipolar disorder symptoms takes priority owing to their potentially destructive and harmful nature. Was this page helpful? Thanks for your feedback! Learn the best ways to manage stress and negativity in your life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Issler CK, Monkul ES, Amaral JA, et al. Bipolar disorder and comorbid obsessive-compulsive disorder is associated with higher rates of anxiety and impulse control disorders. Acta Neuropsychiatr. 2010;22(2):81-86. doi:10.1111/j.1601-5215.2010.00457.x Perugi G, Akiskal HS, Pfanner C, et al. The clinical impact of bipolar and unipolar affective comorbidity on obsessive-compulsive disorder. J Affect Disord. 1997;46(1):15-23. doi:10.1016/s0165-0327(97)00075-x Additional Reading American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: 2013.