OCD Symptoms and Diagnosis The Link Between OCD and Bipolar Disorder By Owen Kelly, PhD 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 Updated on February 22, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Akeem Marsh, MD Medically reviewed by Akeem Marsh, MD LinkedIn Twitter Akeem Marsh, MD, is a board-certified child, adolescent, and adult psychiatrist who has dedicated his career to working with medically underserved communities. Learn about our Medical Review Board Print South_agency/E+/Getty images Table of Contents View All Table of Contents Background Diagnosis OCD Treatment Treatment Frequently Asked Questions 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 levelsChanges in sleep patternsFeelings of sadness or depressionIntrusive thoughtsSudden shifts in moodRecurrent thoughts and behaviorsSocial 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 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 Recap While they may share some symptoms, bipolar disorder often includes episodes of mania that distinguish it from OCD. Symptoms of OCD can also sometimes occurring during depressive episodes and disappear during manic episodes. 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. To make a diagnosis, a healthcare provider will ask questions to assess the nature of the symptoms that you are experiencing as well as their duration and severity. 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. Recap When OCD and bipolar disorder occur together, it can make both conditions harder to diagnose. Talking to your doctor about your symptoms and noting any episodes of mania can help them make a more accurate diagnosis. 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. How Often Do OCD and Bipolar Disorder Co-Occur? Research suggests that around 20% of people with bipolar disorder will also experience a co-occurrence of OCD at some point during their lifetime. When OCD symptoms are present, they typically occur secondary to bipolar disorder as opposed to representing a separate disease process. 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. Recap It is not uncommon for OCD and bipolar disorder to occur together. It is not entirely clear, however, if OCD is always a separate condition or if some OCD symptoms are a manifestation of bipolar disorder. 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. Treatment Priorities 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. 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. Frequently Asked Questions What treatment takes priority when you have OCD and bipolar disorder? Some researchers suggest that mood stabilization should be the primary focus of treatment because it is the most disruptive and potentially harmful. Psychotherapy treatments, such as CBT, can be helpful for symptoms of both bipolar disorder and OCD. How do you help a person who has bipolar disorder and OCD? You can help by listening, being supportive, and paying attention to changes in their moods and behaviors. You might also encourage them to talk to a healthcare professional and maintain a positive attitude about treatment around them. Research suggests that social support that is positive about mental health treatment can improve treatment adherence. Learn More: How to Help a Loved One With Bipolar Disorder What medications can treat OCD and bipolar disorder? Research suggests that the use of mood stabilizers followed with the anticonvulsant topiramate can be helpful in the management of comorbid bipolar disorder and OCD. The use of the antipsychotic olanzapine along with an SSRI or the tricyclic antidepressant clomipramine can also be effective. 11 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. Amerio A, Odone A, Marchesi C, Ghaemi SN. Treatment of comorbid bipolar disorder and obsessive–compulsive disorder: A systematic review. Journal of Affective Disorders. 2014;166:258-263. doi:10.1016/j.jad.2014.05.026 Amerio A, Tonna M, Odone A, Stubbs B, Ghaemi SN. Course of illness in comorbid bipolar disorder and obsessive-compulsive disorder patients. Asian J Psychiatr. 2016;20:12-4. doi:10.1016/j.ajp.2016.01.009 Amerio A, Stubbs B, Odone A, Tonna M, Marchesi C, Ghaemi SN. The prevalence and predictors of comorbid bipolar disorder and obsessive-compulsive disorder: A systematic review and meta-analysis. J Affect Disord. 2015 Nov 1;186:99-109. doi:10.1016/j.jad.2015.06.005 Amerio A, Odone A, Liapis CC, Ghaemi SN. Diagnostic validity of comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review. Acta Psychiatr Scand. 2014;129(5):343-358. doi:10.1111/acps.12250 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 Domingues-Castro MS, Torresan RC, Shavitt RG, et al. Bipolar disorder comorbidity in patients with obsessive-compulsive disorder: Prevalence and predictors. Journal of Affective Disorders. 2019;256:324-330. doi:10.1016/j.jad.2019.06.018 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 Abdel Hamid AAL, Nasreldin M, Gohar SM, Saleh AA, Tarek MA. Sexual and religious obsessions in relation to suicidal ideation in bipolar disorder. Suicide Life Threat Behav. 2019 Dec;49(6):1552-1559. doi:10.1111/sltb.12540 Sharma L, Reddy YJ. Obsessive–compulsive disorder comorbid with schizophrenia and bipolar disorder. Indian J Psychiatry. 2019;61(7):140. doi:10.4103/psychiatry.IndianJPsychiatry_527_18 Chakrabarti S. Treatment attitudes and adherence among patients with bipolar disorder: a systematic review of quantitative and qualitative studies. Harv Rev Psychiatry. 2019;27(5):290-302. doi:10.1097/HRP.0000000000000228 Kazhungil F, Mohandas E. Management of obsessive-compulsive disorder comorbid with bipolar disorder. Indian J Psychiatry. 2016;58(3):259-269. doi:10.4103/0019-5545.192001 Additional Reading American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: 2013. By Owen Kelly, PhD Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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