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The prevalence of Obsessive compulsive disorder among children and adolescents is in the range of 1% to 3%. Growing evidence documents the frequent co-morbidity between Obsessive Compulsive Disorder and Bipolar Disorder in adults. However, there has been limited research on anxiety in pediatric Bipolar Disorder. EHC, a 10 year-old boy in the fourth grade was referred from his pediatrician. At the initial evaluation, he was very irritable and was walking the floor. He did not make eye contact and wanted to go outside. When he was speaking he was swallowing his saliva. When asked why he did this, he said he did not want to transform his saliva to the person in front of himself Although EHC was a good student, he was currently having difficulty in school because of his OCD symptoms. Though his relationship with his friends was good, he was grown away from them. In addition, he supposed he was like Einstein. He did not eat and sleep enough some times during last 6 months. His parents said that he was always rigorous but also very nervous last 3 months. Fluoxetine 20-40 mg/day was initiated but two weeks later, he was very hyperactive, impulsive and irritable. Then fluoxetine was discontinued. Initially, a dose of 2.5 mg/day of aripiprazole was given and increased up to 10 mg/day. His symptoms were recovered 3 weeks later. We present this case because this is a complicated case with multiple diagnoses: Obsessive compulsive disorder and bipolar disorder.