The Link Between OCD and Bipolar Disorder

Bipolar disorder is a condition characterized by extreme changes in mood, behavior, and thoughts. Obsessive-compulsive disorder (OCD) is a condition that causes recurring, intrusive thoughts and repetitive behaviors.

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.

This article discusses the link between OCD and bipolar disorder including the symptoms and how the conditions are diagnosed when they co-occur. It also covers common treatments for the two conditions and how their co-occurrence can complicate the treatment process.

Symptoms

Before discussing the link between bipolar disorder and OCD, it may be helpful to first describe the symptoms of the two conditions. 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.

The symptoms of OCD include obsessions (repeated, unwanted thoughts) and compulsions (behaviors performed to relieve distress). Common symptoms of OCD include unwanted thoughts, perfectionism, excessive checking, excessive cleaning, or counting rituals.

Shared Symptoms

Symptoms that may occur in cases of comorbid bipolar disorder and OCD include:

• Changes in activity levels
• Changes in sleep patterns
• Feelings of sadness or depression
• Intrusive thoughts
• Sudden shifts in mood
• Recurrent thoughts and behaviors
• Social issues

Sometimes people may exhibit more OCD symptoms during depressive episodes. This may include more extreme shifts in mood, strong feelings of depression, intense obsessions and compulsions, and uncontrollable thoughts.

Differing Symptoms

While there is some overlap in symptoms, there are some distinct symptoms that differentiate the two conditions. One of these is the presence of episodes of mania that occur with bipolar disorder and not with OCD.

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.

• A dramatic decrease in the need for sleep
• Engaging in pleasurable activities with a high potential for painful consequences, such as impulsive spending and risky sex
• Extreme distraction and unable to focus
• Goal-directed activity (often of a social, professional, or sexual nature)
• Inflated self-esteem or grandiosity
• More talkative than usual or pressure to keep talking
• Racing 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 hospitalization
• Bipolar II: Similar symptoms, but the mania is not as severe; however, people often experience severe depression
• Cyclothymia: Rapid fluctuation between hypomania and depressive symptoms that are not severe enough to meet the criteria for a Major Depressive Episode
• Bipolar Disorder Not Otherwise Specified: Disorders with bipolar features that do not meet the criteria for the specific bipolar disorders
  

Diagnosis

Because bipolar disorder and OCD can occur alongside one another, it can complicate the diagnosis process. The two conditions can sometimes share symptoms, which can lead to misdiagnosis in some cases. 

Your healthcare provider may also perform a physical exam and lab tests in order to rule out medical conditions that might be contributing to your symptoms. 

People with bipolar disorder are often more likely to seek treatment during a depressive episode than they are during a manic episode, which may contribute to problems with misdiagnosis.

During your appointment, be sure to describe any other symptoms that you have experienced in the past, including any periods of mania or obsessions and compulsions. This can help your doctor make an accurate diagnosis and recommend the appropriate treatment, whether you have bipolar disorder, OCD, both, or some other mental health condition.

OCD and Bipolar Disorder

Research has established a strong link between bipolar disorder and OCD. Comorbidity is very common among psychiatric conditions, but the co-occurrence of OCD and bipolar disorder can be particularly disruptive and challenging to treat.

There is some evidence suggesting that the overlap between the two conditions may be due to the fact that OCD symptoms may actually be symptoms of bipolar depressive episodes and not a separate occurrence of OCD.

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. Research has also shown that people with co-occurring OCD and bipolar disorder have a higher disease severity, a greater need for specific treatment strategies, and an increased risk for suicide.

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.

Treatment

Both bipolar disorder and OCD can impair a person's ability to function as they normally do. They can also cause considerable distress. There are treatments that can help relieve symptoms.

Treatment for OCD

Common treatments for OCD include medications, cognitive behavioral therapy (CBT), and exposure and response prevention. SSRI antidepressants may be helpful for treating symptoms of OCD, but can sometimes trigger manic or hypomanic episodes in those with co-occurring bipolar disorder.

Treatment for Bipolar Disorder

Management of bipolar disorder often involves psychotherapy and medication. CBT is commonly used as well as mood stabilizers, atypical antipsychotics, and antidepressants.

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.

Mood stabilization should be the priority of treatment. SRI medications may be unnecessary with CBT preferred for OCD symptoms.

A Word From Verywell

It is not uncommon for bipolar disorder and OCD to occur together. Experiencing both conditions at the same time can make diagnosis more challenging, so it is important to talk to a mental health professional if you are having symptoms of either condition. 

While the co-occurrence of the two conditions can create special concerns during treatment, there are effective treatment options available. Getting the right diagnosis and treatment can help you manage your symptoms and live your life to the fullest.