Greater Disease Severity With Comorbid OCD, Bipolar Disorder

Patients with obsessive-compulsive disorder (OCD) and comorbid bipolar disorder (BD) appear to have more severe disease, with a higher risk for suicide, and need specific treatment strategies, according to study results published in the Journal of Affective Disorders.

Mariana S. Domingues-Castro, MD, MS, of the Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, University Estadual Paulista, Brazil, and colleagues conducted a cross-sectional study involving 955 adult patients with OCD from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. They used the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Beck Depression and Anxiety Inventories, and the Structure Clinical Interview for DSM-IV Axis I Disorders to evaluate disease characteristics and severity in patients.

The lifetime prevalence of BD in the patient cohort with OCD was 7.75% (n=74). Of patients with BD, 42% presented with type I and 53% with type II; 5% had unspecified BD. Patients who suffered from both disorders had poorer insight, experienced more frequent sensory phenomena, and had greater severity of anxiety and depressive symptoms. These patients also were more likely to report suicidal ideation, suicide plans and attempts, and to have a more extensive family history of affective symptoms. Patients with both OCD and BD reported more psychotherapy and greater use of oxcarbazepine, sodium valproate, topiramate, lithium, clozapine, and olanzapine. The OCD/BD group also presented more frequently with anxiety disorders, including generalized anxiety disorder and panic disorder with agoraphobia. In addition, they were more likely to have eating disorders; impulse control disorders such as pathologic gambling, compulsive buying, compulsive sexual disorder, and skin picking; alcohol abuse and dependence; body dysmorphic disorder; and attention-deficit/hyperactivity disorder.

After logistic regression analysis, features that remained associated with BD in these patients were panic disorder with agoraphobia, impulse control disorders, and suicide attempts.

Although the study population was large, it came from a tertiary treatment center, where patients generally had more severe disease. Thus, these results may not be generalizable to the larger population.

Researchers suggested that clinicians should investigate impulsive behaviors in patients with OCD and comorbid BD. They further recommended that in patients with OCD and panic disorder/agoraphobia comorbidity, possible symptoms of BD should be evaluated and treated appropriately. Furthermore, patients should be monitored closely for suicide risk.


Domingues-Castro MS, Torresan RC, Shavitt RG, et al.  Bipolar disorder comorbidity in patients with obsessive-compulsive disorder: prevalence and predictors. J Affect Disord. 2019;256:324-330.