Is There A Link Between OCD And Bipolar Disorder?

Bipolar disorder is classified as a mood disorder (sometimes referred to as “affective disorders”), and obsessive-compulsive disorder (OCD) is an anxiety disorder. While bipolar disorder and obsessive-compulsive disorder generally have very different symptoms and manifestations, it is possible to experience both conditions simultaneously. Read on to find out what the potential links are between these two mental illnesses.

What is bipolar disorder (BD)?

Bipolar disorder, also called bipolar affective disorder, is a mood disorder that’s estimated to affect around 2.8% of adults in the US. Its primary manifestation is significant or extreme mood swings between high or “manic” states or episodes and low or depressive states or episodes. During a manic episode, an individual with bipolar disorder may feel overly energized, euphoric, distracted, and impulsive. During periods of bipolar depression, they may feel excessively tired and sad and may lose interest in activities they used to enjoy. 

Despite involving depressive symptoms, bipolar disorder is distinct from unipolar disorders like depression. The main difference between bipolar and unipolar disorders is the biphasic nature of bipolar disorders. While unipolar disorders usually involve staying at one mood elevation for long periods of time, those experiencing bipolar disorder often go through the periods of mania mentioned above. Manic and depressive episodes can be short and intense (as is the case with hypomania or acute mania) or longer lasting.

Bipolar disorders tend to manifest in one of four types, which are defined by the duration (which helps differentiate whether the disorder is being defined as a chronic illness or an episodic illness) and the severity of symptoms. These four types include:

• Bipolar I disorder typically manifests as at least one manic state that lasts at least seven days or requires hospitalization.

• Bipolar II disorder typically manifests as at least one hypomanic episode and one depressive episode, but both are typically in a less severe form than with bipolar I.

• Cyclothymic disorder typically manifests as mood swings as well, but with duration and severity that do not qualify as bipolar I disorder or bipolar II disorder.

• Unspecified bipolar disorder typically manifests as similar symptoms but with less regularity or intensity than the other three types of bipolar disorder.

It’s unclear precisely what causes bipolar disorder, but researchers believe it may be a combination of genetics (whether you have a family history of bipolar disorder) and environmental factors. 

What is obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder is an anxiety disorder in which an individual may feel controlled by obsessions leading to compulsive behaviors. Obsessions are intrusive thoughts or urges that are typically based on flawed or dysfunctional beliefs. For some people, especially those who struggle to find support or manage OCD symptoms, these obsessions may dictate their behavior. For instance, an intrusive thought that someone may break into their home may cause someone with obsessive-compulsive disorder to repeatedly check to make sure the door is locked. 

Around 1.2% of US adults experience OCD each year. Someone with a pre-existing anxiety disorder may develop OCD over time, though this is not always the course of this disorder. There’s no clear cause, but both genetic and environmental factors likely play a role.

More information can be found about these conditions online, but it is important to use reliable sources. When conducting research, make sure to use trustworthy mental health publications, like the J. Affect. Disord. (Journal of Affective Disorders) and the J. Clin. Psychiatry (Journal of Clinical Psychiatry.) 

The link between BD and OCD symptoms

Bipolar disorder patients (or those who are experiencing bipolar disorder) often experience another mental health issue simultaneously, known as a comorbid disorder. These comorbid disorders can range from eating disorders and generalized anxiety disorder to OCD. Depending on which condition is considered the primary mental disorder, this can result in what's known as comorbid OCD or comorbid bipolar disorder. 

In both bipolar disorder and obsessive-compulsive disorder, patients may exhibit obsessive thinking. While this is a core symptom of OCD, research shows that rumination is also common in individuals experiencing bipolar disorder. The results of one systematic review show that obsessive thinking can occur during either manic or depressive mood episodes. 

Additionally, compulsive behaviors are common in both mental health conditions. A study in the Journal of Clinical Psychiatry (J Clin Psychiatry) found that individuals with obsessive-compulsive disorder and bipolar disorder exhibited compulsive behavior related to ordering.

Genetic overlap is also thought to help explain similarities in the clinical features of bipolar disorder and obsessive-compulsive disorder. A primary link is thought to be the serotonin transporter gene 5-HTT. Researchers have found a significant difference in the function of 5-HTT in certain brain regions (e.g., the dorsal cingulate cortex) in individuals with BD and OCD compared to those without obsessions and compulsions.

According to one report, OCD accounts for 21% of all comorbidities in people with bipolar disorder.

The prevalence of psychiatric comorbidity between these two mental health conditions is evident in not only adults but also children and teens. In one study, published in the Journal of Affective Disorders (J Affect Disord), researchers concluded that comorbid OCD and bipolar disorder can have a substantial clinical impact on adolescents and children. 

The high rate of comorbidity has caused debate over whether these are always two separate conditions, or whether there may be another type of bipolar disorder that’s characterized by obsessive-compulsive symptoms as well. While this topic is still being researched, it can be helpful to be aware of it because it can affect treatment. For example, selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat obsessive-compulsive disorder. However, studies show that selective serotonin reuptake inhibitors have the potential to precipitate manic symptoms, potentially leading to a full manic episode in people with bipolar disorder. Treating the obsessions and compulsions of OCD and the manic and depressive episodes of bipolar disorder may require a unique approach that involves multiple modalities (e.g., selective serotonin reuptake inhibitors and mood stabilizers). 

The presence of both bipolar disorder and obsessive-compulsive disorder can lead to significant complications. Researchers in a study published in the Journal of Affective Disorders (J Affect Disord), found that comorbid BD and OCD is associated with greater functional impairment than BD without OCD. There is also evidence that the presence of OCD can decrease the efficacy of treatment for BD. In a study published in the Journal of Clinical Psychiatry (J Clin Psychiatry), participants with a comorbid anxiety disorder exhibited decreased responses to mood stabilizers.  

It’s also worth noting that an individual with comorbid bipolar disorder and obsessive-compulsive disorder is more likely to experience substance use issues (sometimes incorrectly referred to as “substance abuse”) than someone with only bipolar disorder or only OCD. Concerns like alcohol use disorder (AUD) can further complicate treatment of comorbid OCD and BD. According to the National Institute on Alcohol Abuse and Alcoholism, “People with AUD and co-occurring psychiatric disorders bring unique clinical challenges tied to the severity of each disorder, the recency and severity of alcohol use, and the patient’s pressing psychosocial stressors”. 

The same is true for impulse control disorders, as well as suicidal behaviors; individuals with bipolar disorder and OCD are more likely to experience suicidal ideation and behaviors than those with only one disorder or the other. These are two reasons that properly diagnosing and treating both conditions in individuals experiencing comorbid BD OCD can be so important.

Treatment for bipolar disorder and OCD 

Treatment for both of these conditions typically involves some combination of medication and talk therapy, however there are distinct differences in the modalities that are commonly utilized. According to the American Psychiatric Association (APA), the first-line treatment for bipolar disorder is typically medication. Multiple medications may be prescribed for bipolar disorder, with mood stabilizers and antipsychotics being the most common. On the other hand, the APA states that OCD treatments primarily involve therapy and antidepressants. 

Because certain medications commonly used to treat OCD patients may trigger or exacerbate manic episodes in people with bipolar disorder—such as selective serotonin reuptake inhibitors—a proper diagnosis is a key element of safe, effective treatment for someone experiencing both. In some cases, selective serotonin reuptake inhibitors may be prescribed alongside mood stabilizers. If you suspect you may be experiencing physical or mood symptoms of bipolar disorder and obsessive-compulsive disorder, it’s typically important for you to provide this information to your healthcare provider so you can receive appropriate treatment.

In addition, the type of talk therapy recommended for someone with bipolar disorder usually differs from the type used for treating OCD. For bipolar disorder and other mood disorders, cognitive behavioral therapy (CBT) may be recommended in order to help the individual recognize and shift negative thought patterns. Interpersonal and social rhythm therapy (IPSRT) could also be part of treatment, to help an individual establish healthy routines. For OCD, however, one of the most common psychotherapy modalities is exposure and response prevention (ERP). A form of CBT, exposure and response prevention is meant to decrease the maladaptive behaviors associated with OCD. It involves exposing the individual to situations that trigger their obsessions in a controlled environment with the aim of supporting them in not turning to their compulsions as a result. An individual with comorbid bipolar disorder and obsessive-compulsive disorder may need one or more of these modalities to effectively manage their symptoms.

Options for connecting with a therapist

Approximately two-thirds of individuals living with complex psychiatric disorders like bipolar disorder or OCD do not receive treatment. For those who do not because of barriers to care such as availability or affordability, online treatment methods can represent a viable alternative. With a virtual therapy platform like BetterHelp, individuals can meet with a licensed provider from the comfort of their own home or anywhere they have an internet connection—and for a cost that’s typically lower than in-person visits and comparable to most insurance co-pays. Research suggests that online therapy is “no less efficacious” than traditional, in-office methods, which means that many people facing mental health challenges can get the care they deserve online.