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Obsessive-Compulsive Disorder and Bipolar Disorder – Cousins?

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.

You can find Natasha Tracy on Facebook or GooglePlus or @Natasha_Tracy on Twitter.

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10 Responses to Obsessive-Compulsive Disorder and Bipolar Disorder – Cousins?

  1. thanks. I saw2 a child so tidy so good when he was young, well after a publick skool and a chair over his head, now hes in his late twentys they say he has by polar, hes not seen his mother over ten years. can social services be to blame for taking him as a baby of nearly two who had a wounderfull relationship learning of his mum, did they cause it or was his cleanleness part of the symptoms at two his toys had to be put away and he noticed his sister left them out

  2. when he came back from care his cleanliness had died down and he had worms what the fuck did Jayne strugnell do to my son,

  3. hes in his twentys now and I am worried hes drifted away from his family over ten years all this because he was fostered and I was slagged of as a bad mum, our social servicezx are piss poor and have possibly wreked my sons life and other kids, why do we take this shit

  4. I am worried my sons with a crowd that are possibly telling him what to do, how to do and when to do and hes been dragged from his loving mum

  5. how can I help him, if im being kept out his life, ive read up that I shudnt be distracted if he has this disease I shud help make him see were hes going wrong, he needs me according to books not friends he doesn’t know oh god how can help him if I cannot see him

  6. I have read that taking a kid from a loving family, that have cared proper for the kid, they no they was wrongly taken an that s wat causes it

  7. stop cruelty child kidnappers social services taking kids of poorly mothers an fucking up lives

  8. I have bipolar II. I also have a history of self-harming, which for me is not a coping method or stress-reducer. I go for years without self-harming, then I will start having intrusive thoughts about it that get more and more urgent and I am “compelled” to do it. This plays out over many months usually. I have only lately come to understand that it is a form of OCD for me. Couple with bipolar disorder however it can have catastrophic consequences, as the impulses trigger memories of trauma, guilt, self-hatred, and can result in very dangerous acts of self-harm. They look sudden and unexpected but they result from a long period of obsessive thoughts that compel me to them. So thanks for validating the OCD-bipolar connection.

  9. caitlin johnson says:

    I have lived with manic depressive bipolar disorder and ocd. I do get thoughts of suicide regularly. But I have learned quickly that I am to dammed awesome to act on it. So even if thoughts occur it no longer matters. It took years to train my mind into remembering that simple fact. I turned alot of it around. When I feel a rage coming on. I clean.and for weeks I would clean up to three times a day. Unfortunately I still have a ritual (chuckles) that has happened every night for 15 years. I do the same routine. (Ritual) I lock my doors. Turn off coffee pot. Check to night clothes. Check on kids then repeat this act between 2-4 times before I can go to bed. It’s something I can’t stop and to be honest I don’t really see that (ritual) as all that bad. Except when I wake up in the middle of the night to repeat it. Everything I do is in 2 and 4. Every bite of food every step. I count everything in doubles. I know most take meds for the problem and definitely those who r as severe as I am. But I refuse. I talk everything out with my husband. Even if I can’t control the money hoarding obsession I have. We learned to lock up bank cards and checks from me when my manic episodes happen. I think the difference in how I cope so well is. Because I know if it is supposed to be wrong I run like a bat out of hell in the opposite direction. My onset isn’t a months build up. But happens in a snap of the fingers. And the spouses of those with this disorder. Lesson to live on.. never say calm down.. of we wanted to be calm we would be.. it’s taken more as an aggressive behavior towards us then a helping hand. I hope this helps somebody

  10. David Schnell says:

    I know that I am bipolar.. And OCD!!! I have hurt many women, some very good women, I admit that I think I am better than anyone! I also have a very narcissistic side of me!!! Please email me any information on this debilitating disease…. All the women in my life always leave… I need HELP!!!!
    Look forward to receiveing any info.

    Anonymous

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