260 Obsessive-Compulsive and Related Disorders
ally suffice to categorize the symptom presentation. A diagnosis of an obsessive-compulsive
and related disorder should be made in additi on to substance intoxication when the symp-
toms are judged to be in exce ss of those usually associated with intoxication and are suf-
ficiently severe to warrant independent clinical attention.
Obsessive-compulsive and related disorder (i.e., not induced by a substance). Sub-
stance/medication-induced obsessive-compulsive and related disorder is judged to be
etiologically related to the substance/medi cation. Substance/medi cation-induced obses-
sive-compulsive and related disorder is dist inguished from a prim ary obsessive-compul-
sive and related disorder by considering the onset, course, and other factors with respect
to substances/medications. For drugs of abuse, there must be  evidence from the history,
physical examination, or laboratory findings  for use or intoxication. Substance/medica-
tion-induced obsessive-compulsiv e and related disorder arises only in association with in-
toxication, whereas a primary obsessive-compulsive and relate d disorder may precede the
onset of substance/medication use. The presence  of features that are atypical of a primary
obsessive-compulsive and relate d disorder, such as atypical age at onset of symptoms,
may suggest a substance-induced etiology. A primary obsessive-compulsive and related
disorder diagnosis is warranted if the sympto ms persist for a substa ntial period of time
(about 1 month or longer) after the end of the substance intoxication or the individual has
a history of an obsessive-co mpulsive and related disorder.
Obsessive-compulsive and related disorder due to another medical condition. If the