Drug-Induced OCD: What? Drugs And Medications Can Cause Obsessive-Compulsive Disorder?

You may know obsessive compulsive disorder as as diagnosis in which sufferers experience relentless anxiety-driven thoughts that compel them to perform repetitive actions — washing their hands, lining things up, cleaning over and over again, or counting, for instance.

Though it's clear that OCD can turn life into a living hell in which the obsessions and compulsions play a central and incredibly time-consuming role, much remains unknown about the disorder. Obsessive compulsive disorder has a genetic component, and suffering trauma increases a person's risk of developing it as well. In some cases, however, medications, illicit drugs, or other substances can also induce OCD-like symptoms. 

If OCD triggered by a substance persists, a diagnosis of substance/medication-induced obsessive-compulsive and related disorder may be warranted. OCD induced by a substance or medication is just one of many obsessive-compulsive and related disorders described in the current version of the diagnostic and statistical manual of mental disorders.

What is substance/medication-induced obsessive-compulsive and related disorder, and how is this kind of OCD diagnosed?

Some substances can induce OCD-like behaviors in someone who has never had obsessive compulsive disorder before, either while someone is under the influence or while they are going through withdrawal.

Cocaine, amphetamines, and other stimulants (including the ADHD drug Ritalin) are known to have the potential to cause obsessive-compulsive thoughts and behaviors, but so do many other substances, including anti-epileptics, antipsychotics, lithium, and hypnotics. Research has documented, for instance, that it is possible to develop drug-induced obsessive compulsive disorder after suddenly quitting the antidepressant Venlafaxine, an act that would trigger acute withdrawal. Synthetic cannabinoid drugs have also been shown to induce OCD in some cases. 

Other substances, perfectly legal prescription medications and street drugs alike, could have the same effect, even if we don't know it yet. 

Someone who develops obsessions and compulsions while intoxicated would be diagnosed with substance intoxication if they saw a psychiatrist or psychologist. During withdrawal, obsessive thoughts coupled with compulsive behaviors would warrant a diagnosis of substance withdrawal. They wouldn't immediately be diagnosed with drug-induced OCD, because in many cases, the obsessions and compulsions will go away on their own after the intoxication has worn off, or withdrawal is complete. 

If the symptoms of OCD persist even beyond intoxication and withdrawal, however, a diagnosis of substance/medication-induced obsessive-compulsive and related disorder may be made, if the diagnostic criteria laid out in the fifth edition of the diagnostic and statistical manual of mental disorders are met:

• Symptoms of obsessive compulsive disorder are present: obsessive, intrusive, and unwanted thoughts that cause great anxiety, compulsive behaviors that the patients performs to keep the obsessive thoughts at bay. Skin-picking and hair pulling are examples, along with ordering items or checking things compulsively (such as going back to see if the stove is off 23 times). 
• There is compelling evidence that the symptoms appeared while intoxicated with or in withdrawal from a substance known to have the potential to cause OCD-like behaviors. This evidence may be found in the patient's history, lab results, or during a physical exam.
• The possibility that the OCD was not induced by a drug or medication is effectively ruled out by determining that the symptoms didn't start before exposure to the substance or a significant amount of time after withdrawal was complete.
• The OCD-like symptoms do not only appear during a state of delirium, which is also known to sometimes cause obsessive and compulsive symptoms.
• The symptoms must cause significant distress or impairment — in this, drug-induced OCD is similar to obsessive compulsive disorder; patients have to spend large amounts of time under the influence of obsessive thoughts or performing compulsions to be diagnosed, and the condition will lead to marked social problems or problems in the workplace.

If the diagnosis of substance-induced OCD is made, the clinician further specifies if the symptoms started while the patient was intoxicated, during withdrawal, or after they were exposed to a prescription medication. The specific drug that induced the symptoms will be noted, if known. If not, the disorder will remain "unspecified". 

How is substance/medication-induced OCRD treated?

The treatment of substance- or medication induced OCD will be determined on a case-by-case basis. If a person develops OCD-like symptoms shortly after starting one of many prescription medications known to sometimes trigger OCD symptoms, their medication will be switched. If the symptoms are caused by an illicit drug, detox treatment should be offered. If OCD-like symptoms strike during withdrawal, the withdrawal process should be managed carefully, and the person should be monitored to see of the symptoms subside after detox is complete. 

If you or someone you care about suddenly develops obsessive thoughts coupled with compulsive behaviors performed with the aim of alleviating the dark, unpleasant, and intrusive thoughts after exposure to or withdrawal from a substance, it's important to see a doctor. While the symptoms will often spontaneously go away after exposure to the substance ceases and withdrawal (where relevant) has been completed, the disorder can also become chronic. Invading every aspect of your life, it can be impossible to get the symptoms under control on your own even if you recognize that they are not rational. Thankfully, help is available — so don't continue to suffer alone.