withdrawal or severe intoxication; or there is other evidence suggesting the exis-
tence of an independent non-substance/medication-induced obsessive-compul-
sive and related disorder (e.g., a history of recurrent non-substance/medication-
related episodes). 
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance causes clinically significant distress or impairment in social, occupa-
tional, or other important areas of functioning.
Note:  This diagnosis should be made in addition to a diagnosis of substance intoxication
or substance withdrawal only when the symptom s in Criterion A predominate in the clinical
picture and are sufficiently severe to warrant clinical attention. 
Coding note: The ICD-9-CM and ICD-10-CM codes for the [specific substance/medica-
tion]-induced obsessive-compulsive and related disorders are indicated in the table below.
Note that the ICD-10-CM code depends on whether or not there is a comorbid substance
use disorder present for the same class of substance. If a mild substance use disorder is
comorbid with the substance-induced obsessive-compulsive and related disorder, the 4th
position character is “1,” and the clinician should record “mild [substance] use disorder”
before the substance-induced obsessive-compulsive and related disorder (e.g., “mild co-
caine use disorder with cocaine-induced obs essive-compulsive and related disorder”). If
a moderate or severe substance use disorder is comorbid with the substance-induced ob-
sessive-compulsive and related disorder, the 4th position character is “2,” and the clinician
should record “moderate [substance] use disorder” or “severe [substance] use disorder,”