The Link between Bipolar Disorder and Obsessive-Compulsive Disorderby Natasha Tracy - February 16th, 2015
Bipolar disorder is known as an affective, or mood, disorder. It is characterized by periods of extremely elevated mood (mania or hypomania) and periods of extremely low mood (depression) as well as euthymic (non-symptomatic) periods. Obsessive-compulsive disorder, on the other hand, can be thought of as an anxiety disorder and is characterized by intrusive, distressing and obsessive thoughts and/or compulsive mental or physical actions. (Note that in the latest Diagnostic and Statistical Manual of Mental Disorders, obsessive-compulsive disorder is no longer included with the anxiety disorders and is actually considered its own category of disorder.)
On their faces, these two disorders seem to be very different as one is primarily seen in mood changes while the other typically manifests in thought and action changes. However, recent research has shown that obsessive-compulsive disorder (OCD) and bipolar disorder, commonly occur together and also run in families.
Bipolar Disorder and Comorbid Obsessive-Compulsive Disorder
According to a 2014 review, Diagnostic Validity of Comorbid Bipolar Disorder and Obsessive-Compulsive Disorder: A Systematic Review, 11-21% of people with bipolar disorder also suffer from obsessive-compulsive disorder and 6-10% of people with obsessive-compulsive disorder also have bipolar disorder. Compare this with the general population risk of bipolar disorder being at only around 3.5% and the lifetime prevalence for OCD being around 2.5%, according to Medscape Reference.
People with both bipolar and OCD tend to have a higher number of depressive episodes overall and may have more antidepressant-induced mania or hypomania. Obsessive-compulsive symptoms tend to be worse during depressive episodes and improve during mania or hypomania. This data suggests that obsessive-compulsive symptoms are secondary to bipolar symptoms.
Additionally, according to Impact of Comorbid Anxiety Disorders and Obsessive-Compulsive Disorder on 24-month Clinical Outcomes of Bipolar I Disorder, people with both disorders have a decreased chance of remission within a two-year period.
Are Bipolar Disorder and Obsessive-Compulsive Disorder Genetically Linked?
It appears that bipolar disorder and OCD, as well as schizophrenia and schizoaffective disorder, are genetically linked as they tend to run in families. According to a 2014 study, Obsessive-Compulsive Disorder, Psychosis, and Bipolarity: A Longitudinal Cohort and Multigenerational Family Study, people with OCD had a 13-fold increase in their risk of having bipolar disorder and schizoaffective disorder. Relatives of those with OCD (but who did not have OCD themselves) had a significantly increased risk for bipolar disorder, schizophrenia, and schizoaffective disorder. The magnitude of this risk decreased as genetic distance increased.
While this data does not prove genetic linkage, it is suggestive of it and proves as a useful basis for further study.
Treating Bipolar Disorder and Comorbid Obsessive-Compulsive Disorder
While treatment of bipolar disorder is usually accomplished with a mood stabilizer, an antidepressant is typically frontline treatment for OCD alone. Unfortunately, using an antidepressant alone in a person with bipolar disorder can result in a worsening of the disorder including an induction of hypomanic or manic symptoms making the treatment of OCD with comorbid bipolar disorder challenging.
According to Treatment of Comorbid Bipolar Disorder and Obsessive-Compulsive Disorder: A Systematic Review, most people with bipolar and comorbid OCD require multiple mood stabilizers or mood stabilizers plus atypical antipsychotics in treatment. It was rare that the addition of an antidepressant led to clinical remission (only noted in one study) so antidepressants were noted as not being necessary in most cases. Psychotherapy may also be helpful for those suffering from both conditions.
In all, while the presence of both illnesses may tend to worsen treatment outcomes, treatment is possible.
Natasha Tracy is a bipolar freelance writer for Canadian drugs pharmacy