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Obsessive-Compulsive Disorder and Bipolar Disorder – Cousins?

Posted on by Natasha Tracy

Bipolar disorder has an approximate prevalence in society of 1% and obsessive-compulsive disorder has an approximate lifetime prevalence of 2.5%. When you put those two numbers together, you should have a very small population that has both bipolar disorder and obsessive-compulsive disorder.

However, this turns out not to be the case. Actually, according to a recent study, 50% of people with obsessive-compulsive disorder also have a depressive disorder and 10% have bipolar disorder.

In short, if you happen to have both disorders, you’re not alone.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is an anxiety disorder that was once thought quite rare; however, now we see it manifest in both children and adults. OCD can range in severity from minor to severe and crippling.

OCD is, “. . . characterized by distressing intrusive obsessive thoughts and/or repetitive compulsive actions (which may be physical or mental acts) that are clinically significant.”

The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) has criteria for both obsession and compulsion.

Obsession is not psychosis and is defined by:

  • “Recurrent and persistent thoughts, impulses, or images are experienced at some time during the disturbance as intrusive and inappropriate and cause marked anxiety and distress. Persons with this disorder recognize the pathologic quality of these unwanted thoughts (such as fears of hurting their children) and would not act on them, but the thoughts are very disturbing . . . ”
  • “The thoughts, impulses, or images are not simply excessive worries about real-life problems.”
  • “The person attempts to suppress or ignore such thoughts, impulses, or images or to neutralize them with some other thought or action.”
  • “The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind . . . “

Compulsion is defined by:

  • “An individual performs repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) in response to an obsession or according to rules that must be applied rigidly. The behaviors are not a result of the direct physiologic effects of a substance or a general medical condition.”
  • “The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviors or mental acts either are not connected in a way that could realistically neutralize or prevent whatever they are meant to address or they are clearly excessive.”

DSM-TR-IV definitions taken from Medscape Reference.

People with OCD recognize that their obsessions or compulsions aren’t reasonable, but unfortunately, that alone is not enough to stop the obsessions or compulsions.

Obsessive-Compulsive Disorder and Bipolar

In the study on the impact of affective disorders (like bipolar disorder) on OCD, it was found that:

  • People with OCD and bipolar disorder had the most severe symptoms
  • People with a depressive disorder and OCD had less severe symptoms
  • People with OCD and no affective disorder had the least severe symptoms
  • The symptom severity did not correlate with the presence of other nonmood disorders

Another study found that the comorbidity of OCD and bipolar disorder is correlated to familial presence of the disorders and people with both disorders have:

  • Greater symptom severity
  • An earlier age of onset
  • A greater number of depressive episodes
  • A higher prevalence of suicide attempts

Diagnosing Obsessive-Compulsive Disorder and Bipolar Disorder

All this is a long-winded way of saying that correct diagnosis of both disorders is important in order to properly treat the patient. If only one disorder is treated, treatment is much less likely to be successful. So if you find you have obsessive-compulsive leanings (or any other anxiety disorder symptoms), be sure to discuss it with your doctor because it could be making your bipolar worse and he can’t help you if he doesn’t know you have a problem.


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