Substance/Medication-Induced OCD

Woman pulling out her own hair
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Substance/medication-induced obsessive compulsive disorder is the diagnostic name for drug-induced OCD. Obsessive-compulsive behavior is a group of seemingly uncontrollable and repetitive behaviors that are driven by obsessions. Obsessions are unwanted thoughts, urges or images that intrude on an individual's consciousness. They are associated with compulsive behaviors which are actions that the person feels compelled to carry out often in response to, and in an effort to control an obsession. These behaviors can be body-focused, for example, picking at one's own skin, or pulling out one's own hairs. Obsessions and compulsions can occur on their own or in combination and can be part of several different obsessive compulsive disorders, of which substance-induced OCD is just one.

Unlike the transient feelings and intrusive thoughts that everyone experiences from time to time, especially during times of stress, or the occasional habitual behaviors we also all engage in from time to time, substance-induced obsessive compulsive disorder is considerably worse and more difficult for the individual to control. Although substance-induced OCD is rare, the consequences can be severe.

The compulsions rarely have any realistic connection to the obsessions they are designed to neutralize or prevent. Rather, they form a ritualistic behavior that is designed to reduce anxiety but ultimately worsen the overall condition. And while some people with obsessive compulsive disorders are aware that the beliefs that are part of their obsessions are probably not true, some are less certain, and others are convinced that they actually are true, to the point where their beliefs are delusions.

When physicians or psychologists give a diagnosis of substance/medication-induced obsessive compulsive disorder, they check to make sure that the obsessions or compulsions were not there before the use of the drug thought to be responsible. This is because there are different types of obsessive compulsive disorders, and if the symptoms were there before the substance use, it probably isn't the substance/medication-induced type of OCD.

How Soon After Taking the Drug Can OCD Be Induced?

In some cases, almost immediately. There is even a category "with onset during intoxication," which means that the obsessive compulsive episode actually begins when the individual is high on the drug. It can also occur during withdrawal, during which severe mental problems are common. It is important that the person receives ongoing assessment as they move through the detox process, to ensure they are properly diagnosed and treated if symptoms persist.

Generally, the diagnosis isn't given if the person has a history of obsessive compulsive disorder without substance use, or if the symptoms continue for more than a month after the person becomes abstinent from the drug.

Obsessive compulsive behaviors can sometimes be part of delirium, which can also be substance-induced. If this is the only time that the symptoms are experienced, then the diagnosis of Substance/Medication-Induced Obsessive Compulsive Disorder is not usually given.

Finally, for the diagnosis of Substance/Medication-Induced Obsessive Compulsive Disorder to be given, there has to be some sort of significant impact that the obsessive compulsive behavior is having on the person's life, either by causing a great deal of distress, or by impairing some aspect of their life, such as their social life, their employment situation, or another part of their life that is important to them.

Drugs That Can Cause the Condition

Unlike many other substance- or medication-induced disorders, the number of substances that are recognized as causing obsessive compulsive is quite limited. They include:

  • Amphetamine-induced obsessive compulsive disorder
  • Other stimulant-induced obsessive compulsive disorder
  • Cocaine-induced obsessive compulsive disorder
  • Other substance-induced obsessive compulsive disorder
  • Unknown substance-induced obsessive compulsive disorder
5 Sources
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  3. Gahr M, Hiemke C, Kölle MA. Development of obsessive-compulsive symptoms following abrupt discontinuation of venlafaxineFront Psychiatry. 2020;11:32. doi:10.3389/fpsyt.2020.00032

  4. Raveendranathan D, Shiva L, Sharma E, et al. Obsessive compulsive disorder masquerading as psychosisIndian J Psychol Med. 2012;34(2):179–180. doi:10.4103/0253-7176.101800

  5. Phillips KA, Stein DJ. Other obsessive-compulsive and related disorders in DSM-5. In: Phillips KA, Stein DJ, eds., Handbook on obsessive-compulsive and related disorders. Arlington, VA: American Psychiatric Association Publishing; 2015.

Additional Reading
  • American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, fifth edition, DSM-5. American Psychiatric Association, 2013.

By Elizabeth Hartney, BSc, MSc, MA, PhD
Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada.