What Is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder is a mental health condition that involves a person experiencing intrusive thoughts over and over that prompt them to perform an action to try and neutralize the thoughts. In this case, the recurrent intrusive thoughts are the obsessions, and the rituals that try to counterbalance the thoughts are the compulsions.
It is common for the obsessions to be related to maintaining cleanliness or avoiding germs and illness, or doubts about having completed a task such as turning off a stove. These thoughts and actions are excessive and interfere with daily life.
What Is Bipolar Disorder?
Bipolar disorder is a mental health condition that involves a person experiencing fluctuations between mania or hypomania often alternating with major depressive episodes. There may be phases between bipolar episodes of depression and mania in which the person is not experiencing symptoms, or their symptoms are not severe enough to be considered a bipolar episode. Even though these phases between episodes can last years, bipolar disorder is a lifelong condition.
Perfectionism, or the need for things to be in perfect orderUnwanted thoughts of aggression, sex, religion, or harmExcessive fear of germsExcessively checking to see if something has been doneExcessive cleaning or hand washingCounting rituals
What’s the Link Between OCD and Bipolar?
The link between OCD and bipolar disorder is not entirely clear, and there is some debate among healthcare professionals about how they are connected. The symptoms are commonly seen together. It is generally thought that OCD and bipolar disorder are two separate conditions, although in some cases there may be an interconnected genetic relationship.
Changes in appetite or weightChanges in sleep, sleepiness, and energyFluctuations between feeling extremely happy and extremely sadFeeling jumpy or on edge during phases of extreme happinessFeeling restless or empty during phases of extreme sadnessTalking excessively and fast or very little and slow during different phasesFluctuations in interest and ability to do activities or be socialChanges in sex drive and level of sexual activityShifts between very high and very low feelings of self-worth
Diagnosis and Prevalence
About 2.3 million people in the United States have bipolar disorder. About 2.2 million adults in the United States have obsessive-compulsive disorder. Of people with bipolar disorder and their comorbidities, about 15% to 20% have OCD.
Bipolar disorder, OCD, and both occurring together can be diagnosed by a healthcare professional specializing in mental health, such as a psychologist or psychiatrist. This is done by assessing symptoms and how those symptoms impact daily life over time.
Treatment of Comorbid Mental Disorders
Treating comorbid mental disorders presents a challenge beyond treating one alone. This is because some treatments for one condition may make another worse, or because the treatments for one could interfere with the other. For example, selective serotonin reuptake inhibitors, or SSRIs, are often used to treat OCD, but they increase the risk of bipolar manic episodes and symptoms.
Treating OCD
Obsessive-compulsive disorder is treated with prescription medications, psychotherapy or talk therapy, or both together. For prescription medications, selective serotonin reuptake inhibitors are generally used. Cognitive behavioral therapy, or CBT, is often used, particularly as a type of behavioral therapy known as exposure and response prevention (ERP).
Transcranial magnetic stimulation, or TMS, is a newer treatment for OCD that is being studied along with the other treatment options.
Treating Bipolar Disorder
Like OCD, bipolar disorder can be treated with prescription medications, psychotherapy or talk therapy, or a combination of the two. For prescription medications, mood stabilizers and second-generation antipsychotics are generally used, along with possible additional medications to treat specific bipolar symptoms. Cognitive-behavioral therapy and psychoeducation may be used as talk therapy methods.
Additionally, there are newer therapies called interpersonal and social rhythm therapy, or IPSRT, and family-focused therapy that are tailored to bipolar disorder. Electroconvulsive therapy, or ECT, and transcranial magnetic stimulation may also be used.
Beyond medications and psychotherapy, coping methods such as exercise and supplements can help.
Treating Both Conditions Together
When treating comorbid bipolar disorder and OCD, the mood needs to be stabilized with mood stabilizer medications before treating the OCD. The combination of mood stabilizers and antidepressants, including SSRIs, can be used to treat comorbid bipolar disorder type II and OCD. However, SSRIs can potentially increase manic episodes or mood cycling in bipolar illness.
Talk therapy is recommended alongside medications, and other coping methods can be helpful, too.
Summary
Bipolar disorder and obsessive-compulsive disorder, or OCD, can be comorbid, meaning they occur together. Bipolar disorder involves fluctuations between depressive episodes and manic episodes, while OCD involves excessive intrusive thoughts and behavioral responses to those thoughts. Both conditions, occurring separately or together, can be diagnosed by a healthcare professional such as a psychologist or psychiatrist by assessing the symptoms and how they impact daily life over time.
For more mental health resources, see our National Helpline Database.
The treatment of co-occurring bipolar illness and OCD can present some challenges. However, successful treatment is possible, and people with symptoms of both have options to manage their symptoms. Treatment options include medications, talk therapy, coping methods, or a combination of these options.
A Word From Verywell
Being diagnosed and living with one mental health condition can be hard. A second diagnosis may feel overwhelming. If you have been diagnosed with OCD and bipolar disorder, or think you may be experiencing both, you are not alone. Support is available, and there are treatment options to help minimize symptoms and increase quality of life. Talk to a healthcare professional, such as a psychologist or psychiatrist, to learn about treatment options best for you.
