Clinical characteristics of comorbid obsessive-compulsive disorder and bipolar disorder in children and adolescents

Abstract

Objective: To explore bidirectional comorbidity between bipolar disorder (BPD) and obsessive-compulsive disorder (OCD) in youth and to examine the symptom profile and clinical correlates of both disorders in the context of reciprocal comorbidity and ascertainment status.

Methods: Two samples of consecutively referred youth (ages 6-17 years) ascertained contemporaneously for respective studies of BPD and OCD were compared using clinical and scalar assessment and structured diagnostic interviews.

Results: A total of 21% (17/82) of the BPD subjects and 15% (19/125) of the OCD subjects met DSM-III-R diagnostic criteria for both disorders. In the presence of BPD, youth with OCD more frequently experienced hoarding/saving obsessions and compulsions along with a clinical profile of greater comorbidity, poorer global functioning, and higher rate of hospitalization that is characteristic of BPD. Multiple anxiety disorders (> or = 3), especially generalized anxiety disorder and social phobia, were present at a higher frequency when OCD and BPD were comorbid than otherwise. In subjects with comorbid OCD and BPD, the primary disorder of ascertainment was associated with an earlier onset and more severe impairment.

Conclusions: An unexpectedly high rate of comorbidity between BPD and OCD was observed in youth irrespective of primary ascertainment diagnosis. In youth with comorbid OCD and BPD, the clinical characteristics of each disorder run true and are analogues to their clinical presentation in youth without reciprocal comorbidity, with the exception of increased risk for obsessions and compulsions of hoarding/saving and comorbidity with other anxiety disorders.

Fig. 1

Lifetime mania symptoms [Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version (K-SADS-E)]. BPD= bipolar disorder; BPD+OCD = bipolar disorder with comorbid obsessive-compulsive disorder.

Fig. 2

Lifetime obsessive symptoms [Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)]. OCD = obsessive-compulsive disorder; OCD+BPD = obsessive-compulsive disorder with comorbid bipolar disorder.

Fig. 3

Lifetime compulsive symptoms [Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)]. OCD = obsessive-compulsive disorder; OCD+BPD = obsessive-compulsive disorder with comorbid bipolar disorder.