Fear of having bipolar disorder

What is Bipolar related OCD?

Fear that you might be experiencing symptoms of bipolar disorder likely involves fears about experiencing symptoms of any severe and persistent mental illness in general. People who suffer from these fears find these worries distressing, and often ruminate on worst-case scenarios or the worst possible symptoms related to bipolar disorder occurring in themselves. Due to an intense hyper-focus on their experiences, moods, and behaviors, they are likely to interpret common, day-to-day feelings as potential symptoms of bipolar disorder. In reality, they are likely experiencing anxiety as a result of OCD.  Someone who is experiencing a fear of being diagnosed with or having bipolar disorder experiences unwanted, intrusive thoughts, images, or urges that cause them significant distress and anxiety, called obsessions. In an effort to rid themselves of these uncomfortable feelings, people with OCD often will perform rituals or compulsions. Compulsions are actions, either mental or physical, that serve to neutralize uncertainty or worry or prevent a feared outcome.  People with this form of OCD may frequently research online symptoms associated with bipolar disorder. They may attempt to compare their personality and experiences with those of someone who has been diagnosed with bipolar disorder, and they may ask their doctor or practitioners for excessive reassurance about whether they may be experiencing symptoms. They may believe that a diagnosis of bipolar disorder would mean that their entire life would be turned upside down, and ruminate often on what would happen to themselves and the people in their lives if they were diagnosed with bipolar disorder.

Bipolar related OCD – Common obsessions

• What if I have been misdiagnosed (with a different mental condition)?
• What if I am being treated for the wrong illness?
• What if I really have bipolar disorder and not OCD—and what if I really want to act on my other intrusive thoughts because of this?
• What if I lose control and do something I don’t really want to do? 
• What if I become suicidal in a depressive state?
• What if my intrusive thoughts about harming others are “real” and not a result of OCD, but are related to bipolar disorder? 
• What if I am so severely ill that I need hospitalization?
• What if people think I am crazy? 
• What if I lose my job because of these symptoms?

Common triggers

People with fears of experiencing symptoms of bipolar disorder or being diagnosed with it may be triggered by situations involving interactions with medical providers or mental health providers, or by discussions surrounding mental health in general. They may avoid reading or watching anything to do with the illness to prevent their fears from being triggered. They may be triggered by any adverse sensations involving their own mental health, including a heightened mood or energy, feeling slowed down or depressed, feeling moody or irritable, or any feelings that fluctuate widely, as they may interpret them as signs of bipolar disorder.

Triggers for people who are afraid that they may have bipolar disorder include:

• Hearing about symptoms of bipolar disorder
• Hearing about bipolar disorder in the news
• Hearing about misdiagnosed or untreated mental health conditions
• Physical sensations that they find scary (high anxiety, feeling irritable or angry, etc.)
• Conflict in which they feel they are “out of control” or acting in a manner that is not like themselves
• Being told they are “moody”
• Being told that they are acting “Bipolar”
• Feeling hyper or having a lot of energy
• Feeling slowed down and sad

How can I tell if I’m experiencing OCD fears related to bipolar disorder or if I really have bipolar disorder?

This is an excellent question. To know if you may be suffering from OCD versus Bipolar Disorder, you need to learn to recognize the OCD cycle.

The OCD cycle is composed of: 1) intrusive thoughts, feelings, images, or urges; 2) anxiety or distress that comes as a result; 3) compulsions performed to relieve the distress and anxiety brought on by the intrusive thoughts, images or urges. Understanding this cycle can help you distinguish OCD from other conditions. Something to keep in mind is that if you are feeling an intense urgency to know something immediately and with certainty, that is a red flag that OCD may be at work.

Intrusive thoughts can and do happen to everyone. Most people who do not have OCD are able to brush these thoughts off rather easily. However, people with OCD struggle to do this. They often believe that if they think something, it must mean something. This is where OCD holds its power. People with a fear of having bipolar disorder or being diagnosed with it need to learn to sit in the uncertainty they feel. Often, they may feel like they are experiencing symptoms of bipolar disorder when in reality, it is anxiety from OCD. 

Common compulsions

When people with a fear of having Bipolar Disorder experience intrusive thoughts, images, feelings, or urges that cause distress, they may engage in compulsions, which are physical or mental acts that one does to eliminate uncertainty or alleviate the distress caused by intrusive thoughts. Compulsions may provide temporary relief, but do nothing to keep obsessions from returning again and again, with even stronger urges to engage in compulsions. Performing compulsions often inadvertently strengthens obsessions and fears, reinforcing the idea that the obsessions posed an actual threat or danger. 

Here are some examples of common compulsions for people who fear being diagnosed or having symptoms of bipolar disorder:

• Repeatedly asking others for reassurance: Do you think I act like this?
• Googling/researching the symptoms of bipolar disorder
• Comparing themselves to someone who has been diagnosed with bipolar disorder
• Frequently confessing their symptoms to their care providers, looking for reassurance that they do not have bipolar disorder
• Hyper-focusing on their responses in interactions (am I acting moody, irritable, becoming easily angered, etc.?)
• Excessive reading on bipolar disorder
• Avoiding social interactions or spending less time with people they care about
• Substance use

How to treat bipolar fears in OCD

Fears of being diagnosed with or experiencing symptoms of bipolar disorder can be debilitating, but like all themes of OCD, it is highly treatable. By doing exposure and response prevention (ERP) therapy with an OCD specialist, you can find freedom from the OCD cycle. 

ERP is the gold standard treatment for OCD and many other anxiety disorders. It is backed by decades of clinical research proving its effectiveness and shows promising results within 12-25 sessions on average. With ERP, you will learn effective ways to accept uncertainty and sit with anxiety and discomfort, even when experiencing physiological sensations that are uncomfortable or distressing.

In ERP, you’re gradually and safely exposed to the thoughts and situations that are likely to trigger intrusive thoughts and anxiety about bipolar disorder. With your therapist’s guidance and support, you will learn how to resist the urge to respond to these feelings with compulsions. By doing this over time, you learn that you are able to tolerate anxiety and accept uncertainty.

Examples of possible exposures done to treat a fear of having bipolar disorder may include: 

• Watching videos about bipolar disorder
• Writing a script about the worst-case scenario resulting from a bipolar disorder diagnosis
• Creating and listening to a loop tape of triggering words/symptoms about bipolar disorder
• Reading articles about people who have bipolar disorder who were misdiagnosed

If you’re struggling with OCD, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

We look forward to working with you.