The essential features of substance/medication-induced obsessive-compulsive and related disorder are prominent symptoms of an obsessive—compulsive and related disorder (Criterion
A) that are judged to be attributable to the effects of a substance (e.g., drug of abuse, medica- tion). The obsessive-compulsive and related disorder symptoms must have developed during or soon after substance intoxication or withdrawal or after exposure to a medication or toxin, and the substance/medication must be capable of producing the symptoms (Criterion B). Sub- stance/medication—induced obsessive-compulsive and related disorder due to a prescribed treatment for a mental disorder or general medical condition must have its onset while the in- dividual is receiving the medication. Once the treatment is discontinued, the obsessive-com- pulsive and related disorder symptoms will usually improve or remit within days to several weeks to 1 month (depending on the half-life of the substance/medication). The diagnosis of given if onset of the obsessive-compulsive and related disorder symptoms precedes the sub- stance intoxication or medication use, or if the symptoms persist for a substantial period of time, usually longer than 1 month, from the time of severe intoxication or withdrawal. If the obsessive—compulsive and related disorder symptoms persist for a substantial period of time, other causes for the symptoms should be considered. The substance/ medication-induced ob- sessive-compulsive and related disorder diagnosis should be made in addition to a diagnosis of substance intoxication only when the symptoms in Criterion A predominate in the clinical picture and are sufficiently severe to warrant independent clinical attention
Obsessions, compulsions, hair pulling, skin picking, or other body-focused repetitive be- haviors can occur in association with intoxication with the following classes of substances: stimulants (including cocaine) and other (or unknown) substances. Heavy metals and tox- ins may also cause obsessive-compulsive and related disorder symptoms. Laboratory as- sessments (e.g., urine toxicology) may be useful to measure substance intoxication as part of an assessment for obsessive-compulsive and related disorders.
In the general population, the very limited data that are available indicate that substance- induced obsessive-compulsive and related disorder is very rare.
Substance intoxication. Obsessive-compulsive and related disorder symptoms may oc~ cur in substance intoxication. The diagnosis of the substance-specific intoxication will usu- ally suffice to categorize the symptom presentation. A diagnosis of an obsessive-compulsive and related disorder should be made in addition to substance intoxication when the symp- toms are judged to be in excess of those usually associated with intoxication and are suf- ficiently severe to warrant independent clinical attention.