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Dr G: OCD and Bipolar I
monkeybee posted:
Hi Dr G,

How often do Bipolar and OCD co-occur? If you have true obsessive thoughts but only when manic or depressed, is it still considered OCD? Does OCD intensify and worsen Bipolar? Why?

Joseph F Goldberg, MD responded:
Dear Sarah,

Estimates vary, but in large population studies (e.g., the Epidemiologic Catchment Area Survey), about 1 in 5 people with bipolar disorder also had OCD. In the NIMH STEP-BD study of bipolar disorder, it was about 1 in 10 people. About half the time, the OCD has its onset before the bipolar disorder. True comorbidity means 2 disorders. It would be hard to diagnose a 2nd condition only in the midst of a full manic episode or full depressive episode; the time to consider an additional diagnosis (like OCD, or ADHD, or alcoholism) is when the mood symptoms of bipolar disorder are in remission. In general, it is not better to have 2 ailments than one, and having any anxiety disorder (like OCD, or generalized anxiety disorder, or panic, or PTSD) brings its own problems to the table and so the overall clinical picture becomes more complicated. Risk for poor outcome (e.g., suicide attempts) is higher, and functioning can be poorer. Response to medicines for either condition may be less than if only one disorder were present. I don't know of any research specifically to suggest that OCD symptoms cause more severe depressive symptoms per se (apart from suicide risk) or more mania symptoms (e.g., more sleeplessness, higher energy, faster speech).

Dr. G.

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