Atypical Presentation of Bipolar Disorder in Adolescents: The Role of Obsessive-Compulsive Features

Background: Although bipolar disorder (BD) typically begins in adulthood, early signs may manifest in different clinical forms. This article presents a case of an adolescent diagnosed with bipolar disorder who initially exhibited prodromal symptoms resembling Obsessive-Compulsive Disorder (OCD). Presentation of Case: A 15-year-old girl with insomnia, anxiety, palpitations, weight gain, and social issues was initially evaluated medically, then diagnosed with OCD due to sexual obsessions and compulsions, along with approval-seeking behaviors and body image concerns. She responded to sertraline, but after dose increase, she developed a manic episode, leading to stopping sertraline and starting olanzapine. Her mood stabilized, and her OCD symptoms improved, emphasizing the importance of assessing possible BD in early OCD presentations. Discussion: The findings underscore the importance of careful longitudinal assessment in adolescents presenting with OCD-like symptoms, especially when affective traits are present, to facilitate early detection and management of BD. Conclusion: Further research into the developmental trajectory and genetic links between OCD and BD is essential.