OCD and Bipolar: Similarities & Differences?
Obsessive-compulsive disorder (OCD) and bipolar disorder share many symptoms but there is also a key distinction between the two.
OCD is an anxiety disorder characterized by disturbing and unwanted obsessions in the form of thoughts, images, urges, feelings, or sensations. This is followed by repetitive ritualistic behaviors done with the aim to alleviate the uncertainty and anxiety caused by these obsessions.
Bipolar disorder is a mood disorder that is characterized by extreme changes in mood, thoughts, and behavior.
The relationship between the two has been the subject of numerous studies and research carried out in 2015 found that those with bipolar disorder are more likely to exhibit symptoms of OCD, compared to those with no diagnosed mental health illness.
This does not mean that having one guarantees you will have the other.
However, the statistics show that anywhere up to 20% of those living with bipolar show lifetime comorbidity with OCD.
In order to receive accurate medical advice, diagnosis, or treatment, it is important to first identify the characteristics of each.
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What is OCD? A Brief Overview
There are two core components of OCD, obsessions, and compulsions.
The OCD cycle begins when the sufferer is triggered by an obsession and intrusive thoughts. These obsessions are very sticky and difficult to shake for an OCD sufferer precisely because they go against their values.
When those obsessions arise, the sufferer feels the need for certainty.
Instead, they doubt themselves. They can find themselves trapped in a loop of rumination:
- Why did I think this thought?
- What does this mean about me?
- What will happen if I don’t do something about it?
- How can I be sure it isn’t true?
These intrusive thoughts can be torturous and painful to live with for someone with OCD. This is why the sufferer then engages in compulsions.
Compulsions are the repetitive, ritualistic behaviors we then do in order to gain some sense of certainty (if only for a short while) and find relief from the anxiety.
The most overplayed representation of OCD in pop culture and media is the need to excessively wash hands or clean. But there are a vast array of subtypes that cover a great deal of context beyond contamination OCD – there is simply a lack of education and understanding at this time (although that’s changing!).
Examples of other OCD subtypes can include:
It is often difficult for those not suffering from OCD to recognize the link that a compulsive action has to an intrusive thought and not all compulsions are visible to others.
What is bipolar disorder?
Bipolar disorder is a chronic mood disorder that causes sufferers to experience severe changes in mood, activity levels, energy, and concentration.
People with bipolar disorder will have emotional highs (mania) where they experience feelings of extreme euphoria. And in contrast, extreme emotional lows leave them feeling lethargic, sad, and oftentimes, hopeless.
The severe shift in mood is known as an episode.
As with all mood disorders, an individual’s mood doesn’t necessarily match their circumstances and it will have a detrimental effect on a person’s ability to complete day-to-day functions.
Bipolar disorder is usually diagnosed in adolescence but it can occur at any age with symptoms varying over time and from person to person.
Mania/hypomania
Mania refers to an episode of extreme emotional highs that lasts for a week or more.
Hypomania is the milder of the two, lasting for only a few days and although the symptoms experienced are similar, hypomania is considered the more manageable of the two as the episodes are shorter-lived.
Although mania/hypomania represents the ‘highs’ of bipolar disorder, this isn’t to be confused with ‘feel-goods’. The highs are just as detrimental to a sufferer’s day-to-day life as the lows are.
Episodes of mania or hypomania can be identified by feelings of:
- Uncontrollable excitement
- Irritability
- Increased sexual energy
- Inflated self-esteem
- Impulsivity
Experiencing these feelings during a manic episode leads to changes in behavior such as:
- Sleeping less
- Acting aggressively
- Drug or alcohol abuse
- Increased levels of activity
- Reckless decision-making that puts your safety at risk
- Speaking much more quickly than normal
- Acting out of character
- Reckless purchases or money spending
Depression
The contrast to mania and hypomania is depression.
Depressive episodes can last anywhere from a couple of weeks to months at a time and are as equally disruptive as the mania.
The swing from high to low moods can be considerably jarring and leave the sufferer feeling like they have no control.
Depressive episodes leave individuals feeling:
- Sad, hopeless, and dejected
- Lethargic or low-energy
- Uninterested in anything
- Worthless
- Unable to concentrate
- Lacking in confidence
- Anxious
- Suicidal
The behavioral changes might look as follows:
- Shying away from social situations
- Ignoring friends
- Changes in sleep patterns
- Eating too much or not enough
- Less physically active
- Rumination (repeatedly focusing on negative thoughts)
- Drug or alcohol misuse
- Attempts to self-harm or attempt suicide
Mixed episodes
These episodes of mania/hypomania and depression can shift very quickly from one to the other or even occur at the same time. This results in unpredictable behavior and confusion, not only in its sufferers but for those around them.
Feeling recklessly impulsive and confident while hopelessly dejected can be difficult to explain and may cause individuals to act erratically.
Mixed episodes can also last from weeks to months and the prevailing evidence from medical reviewers shows that those who suffer mixed episodes are at a greater risk of attempting suicide compared to those who suffer episodes in isolation.
Types of bipolar disorder
Bipolar disorder is broken down into multiple categories for diagnosis:
- Bipolar 1 – at least one episode of mania lasting longer than a week. This can be preceded or followed by hypomanic or depressive episodes.
- Bipolar 2 – at least one episode of depression and hypomania but not mania.
- Cyclothymia – an experience of multiple hypomanic and depressive episodes over a two-year period although the severity of the symptoms does not meet the criteria to be considered bipolar 1 or bipolar 2. When diagnosing teenagers, the period of time required is reduced to one year.
- ‘Other’ – This diagnosis is reached if symptoms do not fit into any of the above or if they are experienced alongside other medical conditions.
Shared symptoms of OCD and bipolar disorder
The symptoms shared by both OCD and bipolar disorder include:
- Changes in energy levels
- Changes to sleep patterns
- Erratic and sudden mood swings
- Rumination (repetitive negative thoughts during a depressive episode)
- The strain on both home and work life
- Distressing thoughts
- Anxiety
- Some symptoms of depression
There is a clear overlap and someone with OCD can exhibit symptoms of bipolar disorder without a specific bipolar disorder diagnosis (and vice versa), though these may only be experienced during periods of mania or depression.
Differing symptoms
Symptoms that are caused by OCD but not bipolar disorder include:
- Obsessions – For example, someone who has intrusive repetitive thoughts may be up all night, crying, unable to leave the house, fearful of what might happen if (insert fear)… This is a symptom of OCD, not bipolar disorder.
- Compulsions – For example, someone may engage in repetitive behaviors such as repetitive checking, reassurance seeking, or staring compulsions. This could appear to be a manic episode to the untrained eye, but it is in fact a symptom of OCD.
Symptoms that are caused by bipolar disorder but not OCD include:
- Mania/hypomania – Even though people with OCD have good days and bad days, this is not the same as a manic episode experienced by those with bipolar disorder.
- Depression – Likewise, it is very common for someone to live with OCD and depression. OCD is a very difficult disorder to live with and can lead to periods of hopelessness. This is also quite different from a depressive episode experienced by someone with bipolar. This is why it’s so important to receive the correct diagnosis because many confuse the two but they are very different.
- Psychosis (in certain cases)
To the untrained eye, a person suffering from obsessions and compulsions associated with OCD may appear to be having a bipolar episode. However, this is why it’s very important to receive a thorough assessment so that you can are treatment for the correct disorder.
If someone with OCD is having racing intrusive thoughts or performing repetitive ritualistic compulsions, it can be common for them to be misunderstood as having bipolar disorder.
If you suspect yourself of having one or the other, or both, you must be thoroughly assessed so that an appropriate treatment plan can be made for you. For someone living with both OCD and bipolar disorder, it is imperative that their bipolar be treated before they begin treatment for OCD as it will affect their OCD recovery.
If you feel like your symptoms are better understood as obsessions and compulsions and you would like to have a thorough assessment from someone from our team to receive the correct diagnosis and treatment, please submit a submission form HERE (for those based in California).
What is it like living with both disorders?
Living with OCD or bipolar disorder independently from each other can be challenging. If you are experiencing both it may bring some additional challenges.
It is completely understandable, therefore, that someone would feel overwhelmed when faced with a life of both.
The good news is there are science-based treatment modalities for both OCD and Bipolar disorder. Thanks to many years of research, we also have medications that are proving to be highly effective for those managing both OCD and Bipolar disorder.
Please speak with your medical professionals to determine a medication plan that will be helpful for you.
The more knowledge and understanding you have, the better equipped you will be to manage both.
How OCD impacts bipolar symptoms
OCD symptoms can exacerbate depressive episodes and increase the severity of bipolar symptoms.
The fear and uncertainty triggered by those obsessions can, during a bipolar depressive episode, only add to the feelings of hopelessness and despair felt by the sufferer. It feels like another thing to manage and another thing that they don’t feel able to deal with.
The uncertainty and self-doubt that arise during the OCD cycle contribute to great doubt and uncertainty surrounding bipolar symptoms.
Rumination (repetitive and unhelpful ‘problem-solving’ thoughts) is a symptom of each and when experienced as a result of OCD, it can cross over and latch on to bipolar symptoms as well.
It is essential that the person with bipolar has been assessed by a medical professional to make sure the symptoms of bipolar disorder are treated before they begin treatment for OCD.
How bipolar impacts OCD symptoms
During a depressive episode brought on by bipolar disorder, negative thoughts and low emotions as a result of OCD are increased.
Anxiety levels are also heightened with the introduction of bipolar disorder which can lead to increased obsessive thoughts and subsequent compulsions.
That said, there is evidence to suggest checking compulsions are reduced compared to someone with OCD in isolation and theories suggest that OCD symptoms are less severe during mania/hypomania episodes and heighten during depressive episodes.
Are OCD and Bipolar connected?
Currently, scientists are not sure where the connection lies between the two conditions. However, there are some things that we can consider…
Genetics: Like OCD, there could be a genetic factor involved in the onset of bipolar disorder. Research suggests that there are a number of genes shared by both disorders. While this is not definitive, it is something that researchers continue to explore.
Intrusive thoughts and obsessive thinking: Intrusive thoughts and some form of negative obsessive thinking feature heavily in both disorders and this could be down to a commonality between the two.
Anxiety: As with obsessive thinking, anxiety and anxious thoughts appear with both conditions. This could also be a commonality that connects the two conditions.
Treatment for OCD and Bipolar Disorder
When you’re in the middle of living with not only one condition but two simultaneously, it’s not difficult to see why someone may begin to lose hope. But there is hope. The saving grace is that extensive research has been conducted on the most effective treatment for OCD and bipolar individually, as well as in co-occurrence.
Treatments for bipolar disorder
Treatment for bipolar disorder needs to be long-term. It is a chronic illness and should therefore be carried out even during episode-free periods.
- Medication
Mood stabilizers will typically be introduced to control symptoms fast and are sometimes used in conjunction with other medication to be most effective.
Antidepressants can sometimes be used as a medication for bipolar disorder however, in many cases they contribute to cases of mania and hypomania. Because of this, certain mood stabilizers tend to be the first option.
This should not be taken as medication advice, please speak to your medical professional to receive the appropriate medication plan for you.
- Psychotherapy
A form of talking therapy will take place alongside the use of mood stabilizers. The type of therapy will depend on what best suits you and your needs. There are many different types of psychotherapy available, including:
- Psychoeducation is designed to teach your condition so that you are better placed to identify triggers.
- Cognitive behavioral therapy (CBT) helps with the management of symptoms by helping you identify negative thoughts and behavioral patterns.
- Interpersonal therapy is designed to highlight how your thoughts and behavior impact your relationships with other people and the effect those relationships have on you in return.
Treatments for OCD
As with bipolar disorder, Treatments for OCD need to be long-term to reflect the long-term nature of the condition.
- Psychotherapy
Cognitive Behavioral Therapy (CBT) is used for many psychological problems, including OCD. Exposure and response prevention (ERP), a type of CBT, involves the gradual exposure to obsessions whilst resisting the urge to engage in compulsive behaviors as a coping tool. This method of treatment is designed to help you change your relationships and respond to those obsessions.
- Medication
Typically a form of antidepressant known as selective serotonin reuptake inhibitors (SSRIs) are shown to be helpful when prescribed alongside psychotherapy.
Medication should only be taken if prescribed by a mental health professional.
Treatment for both together
The treatment of bipolar disorder takes precedence when both disorders are being treated together. It’s important that a person’s mood is stabilized before treatment for OCD begins. This follows research suggesting OCD treatment is ineffective if symptoms of bipolar disorder are not dealt with first.
The psychological treatments listed above for each disorder remain effective but due to the heightened risk of substance abuse, self-harm, and erratic behavior in those diagnosed with both, closer monitoring is required.
It is important to ensure that you seek assistance from a specialist who is highly qualified in both disorders, as having the two together can contribute to complications in therapy if you aren’t under the correct guidance.
We have a qualified team of elite clinicians based in California, who can assess and treat OCD. We are able to rule out Bipolar disorder however if you have additional bipolar symptoms we would refer you to specialists who come highly recommended in the treatment of Bipolar disorder.
We will be able to treat your OCD in conjunction with any other bipolar treatment you receive elsewhere.
If you would like to see how we might be able to help you with an appropriate assessment, please submit an inquiry form here.
