258 Obsessive-Compulsive and Related Disorders
substance use disorder (e.g., after a one-time heavy use of the substance), then the 4th
position character is “9,” and the clinician should record only the substance-induced ob-
sessive-compulsive and related disorder.
Specify if (see Table 1 in the chapter “Substance-Related and Addictive Disorders” for di-
agnoses associated with substance class):
With onset during intoxication:  If the criteria are met for intoxication with the sub-
stance and the symptoms develop during intoxication.
With onset during withdrawal:  If criteria are met for withdrawal from the substance
and the symptoms develop during, or shortly after, withdrawal.
With onset after medication use:  Symptoms may appear either at initiation of medi-
cation or after a modification or change in use.
Recording Procedures
ICD-9-CM. The name of the substanc e/medication-induced ob sessive-compulsive and
related disorder begins with the specific subs tance (e.g., cocaine) that is presumed to be
causing the obsessive-compulsive and related symptoms. The diagnostic code is selected
from the table included in the criteria set, wh ich is based on the drug class. For substances
that do not fit into any of the classes, the co de for “other substance” should be used; and in
cases in which a substance is judged to be an etiological factor but the specific class of sub-
stance is unknown, the category “u nknown substance” should be used.
The name of the disorder is followed by the sp ecification of onset (i.e., onset during in-
toxication, onset during withdrawal, with onse t after medication use). Unlike the record-
ing procedures for ICD-10-CM, which combine the substance-induced disorder and