Hidden Bipolarity in OCD : Results from a collaborative survey with the French OCD Association.

Background : Clinical data is largely focused on depressive comorbidity in OCD. However in practice, treating resistant or severe OCD sufferers revealed many cases who seem to have an authentic OCD with a hidden comorbid bipolar disorder.Methods : The rate of bipolar comorbidity in OCD was analyzed in a epidemiological survey which we undertook among the members of the French Association of patients suffering from OCD (AFTOC in French). To explore mood comorbidity, we used structured self-rated questionnaires for major depression, hypomania and mania (DSM-IV criteria) and self-rated Angst’s checklist of Hypomania and Cyclothymic Temperament (developped by Akiskal and Hantouche). From a total sample of 780, 453 files (58 %) were returned and analyzed : 76 % had suffered from a major depression (83 % recurrent) and 17 % had attempted suicide.Results : According to DSM-IV definitions of hypomania/mania, 11 % of the total sample were classified as bipolar (3 % as BP-I and 8 % as BP-II). However, 20 % had been recognized as bipolar or cyclothymic before the survey and treated with mood stabilizers. Furthermore, the Hypomania Checklist of Angst showed that 30 % obtained a cut-off score = 10. Analysis on the self-rated questionnaire for Cyclothymic Temperament showed that 50 % scored = 10, and so classified as BPII1/2. Both thresholds for self-rated hypomania and cyclothymia were previously validated by Hantouche et al. (1998). Finally, our analyses showed that anger attacks and suicide behavior were mainly linked to comorbid bipolarity.Conclusion : These data extend clinical research on “bipolar OCD” entity which is largely under-recognized in clinical practice. Also, they implicate cyclothymia in hostility and suicide risk in this population. [Copyright &y& Elsevier]