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Can You Have Bipolar Disorder and OCD?

What are bipolar disorder and OCD?

Bipolar disorder is a condition that causes major swings in activity, energy, and mood.

Obsessive-compulsive disorder (OCD) results in a person having unwanted ideas, thoughts, or sensations to recur in the brain and body.

The two conditions share many symptoms. Some experts even believe they can occur together.

About 2.6 percent of American adults experience bipolar disorder symptoms and 1 percent experience OCD every year. More than 20 percent of people with bipolar disorder also show signs of OCD.

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Differences

What are the differences between bipolar disorder and OCD?

Bipolar disorder shares some similarities with OCD. Both people with bipolar disorder and OCD are likely to experience:

But several key differences exist. These are present with OCD, not bipolar disorder:

  • recurring obsessions and compulsions
  • uncontrollable ruminating thoughts
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Symptoms

What are the symptoms of both conditions?

Bipolar-OCD comorbidity, or occurrence of both conditions in a person, is a fairly recently studied phenomenon. A 1995 study first found that more than half of those with bipolar disorder also experienced other mental disorders, including OCD.

Some people with bipolar disorder experience OCD symptoms without having OCD. This is known as having OCD tendencies. They may only experience these symptoms when they have a very low or very high mood.

But a person may have both conditions and experience their symptoms at all times. Symptoms of bipolar disorder with OCD comorbidity include:

  • depressive episodes — feeling very sad, or low
  • dramatic and sometimes fast shifts in mood
  • manic episodes — feeling very happy, or high
  • recurring obsessions and compulsions
  • social problems, such as social phobias
  • uncontrollable ruminating thoughts

Other symptoms may include:

  • higher rates of obsessive ideas about sex and religion than people with just OCD
  • lower rates of ritual checking than people with just OCD
  • higher rates of substance abuse than people with just bipolar disorder or OCD
  • more episodes of depression, increased rates of suicide, and more frequent admission to hospitals than people with just bipolar disorder or OCD
  • more chronic depressive and manic episodes and residual mood symptoms than people with just bipolar disorder
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Diagnosis

How is bipolar disorder and OCD diagnosed?

Because the conditions can occur together and share some symptoms, sometimes people are misdiagnosed with the opposite condition.

It can be helpful for those diagnosed with bipolar disorder who display symptoms of OCD to seek mental health counseling.

To check if symptoms are caused by OCD, a doctor will likely perform a physical exam, lab tests, and a psychological evaluation. It can sometimes be challenging to diagnose OCD because the disorder’s symptoms can be very similar to those associated with other mental health disorders that involve anxiety — like bipolar disorder.

Those who have OCD but show other signs of bipolar disorder may also want to seek mental health counseling. The anxious behaviors associated with OCD may be signs of manic or hypomanic bipolar episodes.

As with diagnosing OCD, a doctor is likely to conduct a physical exam, lab tests, and a psychological evaluation to help determine a diagnosis of bipolar disorder.

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Treatments

What treatments are available for one or both conditions?

Treatment for each condition varies. So it’s important to have a proper diagnosis.

Treating one condition

Bipolar disorder

Bipolar disorder is a lifelong condition. Treatment must focus on the long term and continue even when a person feels fine. A psychiatrist handles treatment of people with bipolar disorder. They may prescribe a combination of medication and therapy.

The goal of bipolar disorder treatment is to even out mood and decrease symptoms fast. Once achieved, a person should focus on maintenance treatment to manage their disorder and prevent a relapse.

Common bipolar medications include:

  • Anticonvulsants: Some anti-seizure medications are used to control the mood swings associated with bipolar disorder. Examples include:
    • valproate sodium injection (Depacon)
    • divalproex sodium (Depakote)
    • carbamazepine (Tegretol XR)
    • topiramate (Topamax)
    • gabapentin (Gabarone)
    • lamotrigine (Lamictal)
  • Antidepressants: These drugs treat depression associated with bipolar disorder. They aren’t always most effective because people with bipolar disorder also experience mania. Examples include:
  • Antipsychotics: These drugs are used to treat a variety of mental disorders, including bipolar disorder. Examples include:
  • Benzodiazepines: This medication is used to treat insomnia and anxiety, which people with bipolar disorder may experience. But these medications are highly addictive and should only be used on a short-term basis. Examples include:
  • Lithium: This drug works as a mood stabilizer and is one of the most widely used and effective treatments for bipolar disorder.

Common bipolar disorder therapies include:

OCD

OCD, like bipolar disorder, is a long-term condition requiring long-term treatment. Also like bipolar disorder, treatment of OCD typically involves using a mix of both medication and therapy.

Typically, OCD is treated with antidepressants such as:

But doctors may also use other types of antidepressants and antipsychotic medications.

When it comes to therapy, cognitive behavior therapy is most often used to treat OCD. Specifically, exposure and response prevention (ERP) is used. This involves exposing a person to a feared object or obsession, and then helping that person learn healthy ways to cope with their anxiety. The goal of ERP is for the person to manage their compulsions.

Treating both conditions

Experts say that the management of bipolar disorder and comorbid OCD should be focused first on stabilizing a person’s mood. This involves use of multiple medications, such as lithium with anticonvulsants or atypical antipsychotics with apripiprazole (Abilify).

But when the two conditions occur together, it’s also important for doctors to diagnose the type of bipolar disorder a person is experiencing.

For example, when treating type 2 bipolar disorder with comorbid OCD, after full treatment of mood symptoms with mood stabilizers, a doctor may want to cautiously add another treatment. Specifically, they may prescribe antidepressants effective for both depressive and OCD symptoms that have a low risk of inducing a full manic episode. These medications may include selective serotonin reuptake inhibitors (SSRIs): fluoxetine, fluvoxamine, paroxetine, and sertraline.

But doctors must take caution when mixing various medications to treat both conditions when they occur together. The wrong mix could cause more frequent, more intense, or unusual symptoms.

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Outlook

What is the outlook for bipolar and OCD?

Bipolar disorder and OCD are different conditions with similar symptoms that can sometimes occur together. It’s important to determine which condition you have, or if you have both conditions, in order to receive appropriate treatment. Seek help from your doctor or mental healthcare provider if you suspect you have one or both conditions.

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