Combined Pharmacological and ACT-based Treatment of Bipolar I Disorder With Aggressive Obsessions

We describe a 36-year-old man with bipolar I disorder (BD-I) who presented with egodystonic aggressive obsessions toward his pregnant partner and unborn child, alongside marked manic symptoms, anxiety, and checking behaviors. Treatment combined pharmacological stabilization with 16 weekly sessions of acceptance and commitment therapy (ACT)-informed intervention incorporating exposure and response prevention (ERP), followed by six follow-up sessions through month 18. Manic, depressive, and obsessive-compulsive symptoms declined across assessments. Checking, avoidance, and reassurance seeking decreased, while the patient resumed an active role as partner and father. The formulation distinguished intrusive thoughts from intent, guided proportionate risk management, and linked exposure to parenting values.