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The term “comorbidities” defines two medical conditions simultaneously occurring in the same person. In terms of psychiatric disorders, obsessive-compulsive disorder (OCD) and bipolar disorder are two commonly occurring comorbidities that may affect the person more severely than any one of them alone. Both diseases also share many common aspects in addition to similarities. OCD, for example, leads to obsessive thoughts that may become so distressing that they force the individual experiencing them to take certain compulsive actions to find relief. Bipolar disorder, on the other hand, causes extreme mood shifts and changes in energy levels.
While bipolar disorder is characterized as a mood disorder, OCD is not a part of this category. Despite this major difference, OCD and bipolar can often occur together with many commonalities. Moreover, some experts also speculate that the symptoms of OCD are more likely to occur in people with bipolar disorder than in the general population. [1]
Bipolar Disorder and OCD: Is There a Connection?
At present, experts are unsure about the occurrence of bipolar and OCD together and if the two mental health disorders share a connection. However, there are certain theories and aspects to consider in this regard:
Genetics
Like OCD, bipolar disorder potentially has a genetic element involved in its onset. Research suggests that both disorders share several genes that may explain the prevalence of bipolar with OCD tendencies in a person. [2] While this genetic connection is not definitive yet, researchers continue exploring this field.
Anxiety
Anxiety and anxious, racing thoughts are a common feature of OCD but also routinely happen to people with underlying bipolar disorder. The occurrence of this common symptom also points towards a potential connection between the two psychiatric disorders.
Obsessive, Intrusive Thoughts
Intrusive thoughts and negative obsessive thinking are primary features of both OCD and bipolar disorder. This commonality highly signifies that both disorders may share a closer connection than anyone could think of.
Compulsive Bipolar Disorder: How Each Disorder Affects the Other
Both OCD and bipolar disorder can significantly affect each other’s active symptoms in the following ways:
How Having OCD Impacts Bipolar Symptoms
OCD symptoms can potentially exacerbate the depressive episodes experienced by a person with bipolar disorder. Moreover, these symptoms can also increase the severity of bipolar attacks. The uncertainty and constant fear triggered by obsessions secondary to OCD add to the feelings of despair and hopelessness that a person going through a depressive bipolar phase feels. This, in turn, leads to even greater uncertainty and doubt regarding bipolar symptoms, pushing a person into a vicious cycle.
Rumination, a common symptom of OCD, including unhelpful, repetitive problem-solving thoughts, may often cross over, latching on to the symptoms of bipolar disorder.
How Having Bipolar Disorder Impacts OCD Symptoms
During a depressive episode triggered by bipolar disorder, a person may feel that their low emotions and negative thoughts due to OCD have increased. Anxiety levels also heighten due to active bipolar symptoms that lead to more obsessive thoughts and consequent compulsions. That said, some evidence suggests that having active bipolar symptoms can reduce the incidence of checking compulsions in a person who suffers from OCD alone. Additional theories also suggest that OCD symptoms tend to lessen in severity during an active mania or hypomania episode while increasing during depressive bipolar cycles.
OCD and Bipolar Treatment: How to Approach?
Treatment of comorbid mental health disorders presents significant challenges as experts struggle to find the right balance to manage symptoms. This is because certain treatments that benefit one condition may worsen the other or interfere with the treatment for the other. For instance, selective serotonin reuptake inhibitors or SSRIs meant to treat OCD can increase the risk of experiencing bipolar manic episodes in a person with both mental health disorders.
Treatment for Bipolar Disorder
Bipolar disorder treatment often needs to be long-term, given the chronic nature of this illness. It may continue even when a person is in symptom-free periods.
- Medication: Mood stabilizers are the first line of treatment to control the symptoms rapidly and are sometimes combined with other medications to increase overall efficacy. Some experts also use antidepressants for bipolar disorder, but others avoid it as they may trigger hypomania and mania.
- Psychotherapy: Many experts recommend joining a type of talk therapy session while taking mood stabilizers to keep bipolar symptoms under control. The type of therapy can vary depending on individual circumstances and needs. For instance, psychoeducation is a therapy that helps patients learn about their conditions so that they can identify triggers and avoid them in a better way. Cognitive behavioral therapy or CBT is another technique that helps people identify any negative behavioral patterns and thoughts that trigger bipolar disorder symptoms so that they can be avoided in the future or dealt with more healthily.
Treatments for OCD
As with bipolar disorder, OCD treatment needs to be long-term for better outcomes. For effective results, most experts combine the use of medications with psychotherapy.
- Psychotherapy: Cognitive behavioral therapy (CBT) is often the mainstay of treatment for many psychiatric issues, including OCD. Exposure and response prevention (ERP) is a subtype of CBT that involves gradually exposing a person to their obsessions while encouraging them to resist their compulsions and avoid using them as a coping tool. This treatment method has been specifically designed to help people change their relationships with obsessions and alter the way they respond to them.
- Medication: In most cases, a type of antidepressant known as selective serotonin reuptake inhibitor (SSRI) is the best medication to keep OCD symptoms under control in conjunction with an appropriate form of therapy.
Treatment for Both OCD and Bipolar Disorder
Treatment for both OCD and bipolar disorder can be tricky and requires careful planning and execution. In most cases, experts prefer treating bipolar disorder first and ensuring that their patient’s mood is stabilized before they can move on to treating OCD. This concept comes from research that suggests that OCD treatment may become potentially ineffective if the bipolar symptoms are not adequately dealt with first. [3]
The psychological treatments for both OCD and bipolar disorder mentioned above are effective for most people. In addition, such people also require close monitoring as they are at a higher risk of self-harm, erratic behavior, and substance abuse. It is imperative to seek assistance from an expert who is qualified to deal with both disorders together, as managing them simultaneously while avoiding complications can be tricky without adequate guidance.
FAQs
Can you have OCD and bipolar together?
Research suggests that there is a possible link between OCD and bipolar disorder. Research has found that OCD is more likely to occur alongside bipolar disorder than other psychiatric health issues, such as depression. It is strongly believed that having one mental health condition strongly increases the possibility of encountering another one. However, this link is particularly strong in the case of bipolar disorder and OCD. Some researchers even speculate OCD as a type of bipolar disorder instead of being an independent disorder.
What is the prevalence rate of bipolar mania and OCD?
Multiple studies and reviews have found a higher rate of comorbidity between OCD and bipolar disorder. The prevalence of OCD in people with bipolar disorder varies across different studies, typically between 10 to 21 percent. Some studies have also concluded that a person with bipolar disorder is between three to ten times more likely to develop OCD compared to the rest of the population.
Can bipolar disorder trigger OCD symptoms?
Some experts believe OCD to be a secondary manifestation of a mood disorder, such as bipolar disorder, instead of being a separate condition. According to some studies, an individual is more likely to develop OCD symptoms during depressive bipolar episodes than during mania. These OCD symptoms are also more prevalent in periods between mania and depression, suggesting a possible biological link between OCD and bipolar disorder. However, more research is needed for further confirmation.
References
1 Daihui PE, Jiang K. Comorbid bipolar disorder and obsessive-compulsive disorder. Shanghai Archives of Psychiatry. 2015 Aug 8;27(4):246.
2 Hamidian S, Pourshahbaz A, Bozorgmehr A, Ananloo ES, Dolatshahi B, Ohadi M. How obsessive–compulsive and bipolar disorders meet each other? An integrative gene-based enrichment approach. Annals of General Psychiatry. 2020 Dec;19:1-0.
3 Perugi G, Akiskal HS, Pfanner C, Presta S, Gemignani A, Milanfranchi A, Lensi P, Ravagli S, Cassano GB. The clinical impact of bipolar and unipolar affective comorbidity on obsessive–compulsive disorder. Journal of affective disorders. 1997 Oct 1;46(1):15-23.
