OCD and Bipolar Disorder: How They Are Connected

Comorbidities are two medical conditions that occur together in the same person at the same time. For example, a person may have bipolar disorder and an anxiety disorder. Bipolar disorder can sometimes occur with obsessive-compulsive disorder, or OCD. Read on to learn more about the connection between these conditions and how they are treated.

Obsessive-Compulsive Disorder and Bipolar Disorder - Illustration by Michela Buttignol

Veyrwell / Michela Buttignol

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.

OCD Symptoms

Common symptoms of OCD include:

  • Perfectionism, or the need for things to be in perfect order
  • Unwanted thoughts of aggression, sex, religion, or harm
  • Excessive fear of germs
  • Excessively checking to see if something has been done
  • Excessive cleaning or hand washing
  • Counting rituals

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.

Bipolar Symptoms

Common symptoms of bipolar disorder include:

  • Changes in appetite or weight
  • Changes in sleep, sleepiness, and energy
  • Fluctuations between feeling extremely happy and extremely sad
  • Feeling jumpy or on edge during phases of extreme happiness
  • Feeling restless or empty during phases of extreme sadness
  • Talking excessively and fast or very little and slow during different phases
  • Fluctuations in interest and ability to do activities or be social
  • Changes in sex drive and level of sexual activity
  • Shifts between very high and very low feelings of self-worth

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.

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.

Mental Health Helpline

If you or a loved one are struggling with bipolar disorder and/or OCD, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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.

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.

Frequently Asked Questions

  • What comorbidities are associated with bipolar disorder?

    Comorbidities are physical or mental health conditions that occur together. In addition to OCD, some examples of comorbidities that are associated with bipolar disorder are anxiety disorder, attention deficit hyperactivity disorder (ADHD), drug or alcohol use disorders, and eating disorders.

  • What triggers OCD?

    It is not entirely clear what causes OCD. However, it may be triggered by traumatic experiences or certain types of infections during childhood. Other factors include genetics, differences in the brain, and stress.

  • Does bipolar cause compulsive behavior?

    Bipolar disorder and obsessive-compulsive disorder do occur together. However, their relationship is complex.

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8 Sources
Verywell Health 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.
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