Are Women With Obsessive-Compulsive Disorder at Increased Risk for Substance Misuse?

A population-based cohort study published in JAMA Network Open found evidence that those with obsessive-compulsive disorder (OCD) had a 3.7 fold increased risk of substance misuse.

Data from individuals (N=6,304,188) who were born in Sweden from 1932 to 1997 and had linked data in nationwide registers were evaluated for OCD, substance misuse, substance use-related disorders, and criminal convictions from 1997 to 2013. In addition, data for this study were sourced from the Child and Adolescent Twin Study in Sweden (CATSS) and evaluated for OCD, psychological disorders, and alcohol and drug use at 24 years of age.

The study population comprised 51.1% men, median age 30.5 (interquartile range [IQR], 15.0-46.4) years, 27,342 of whom had a diagnosis of OCD.

Compared with the general population, those with OCD were found to have an increased risk for substance-related deaths (adjusted hazard ratio [aHR], 2.33), sedative-related disorders (aHR, 1.72), any drug-related disorders (aHR, 1.28), opioid-related disorders (aHR, 1.22), other drug-related disorders (aHR, 1.20), acute alcohol intoxications (aHR, 1.13), any substance misuse outcome (aHR, 1.10), and alcohol-related disorders (aHR, 1.10).

Stratified by gender, the relationship with any substance misuse outcome, alcohol-related disorders, acute alcohol intoxications, opioid-related disorders, stimulant-related disorders, and other drug-related disorders were significant among women with OCD.

OCD was associated with decreased risk for substance-related convictions among the whole population (aHR, 0.54) in both men (aHR, 0.47) and women (aHR, 0.77).

In the CATSS dataset, among the 9230 individuals, OCD symptoms were associated with concurrent alcohol (β, 0.12) and drug (β, 0.12) use and longitudinal alcohol (β, 0.05) and drug (β, 0.11) use.

In the entire population, the correlation between OCD and substance misuse was .27 and the best fit model explained 55% of the variance for OCD and 57% of the variance in substance misuse, the investigators wrote. The relationship between OCD and substance misuse was explained by additive genetic factors (56%) and nonshared environmental factors (44%).

In the CATSS cohort, the correlation between OCD and alcohol dependence was 0.19, explaining 64% and 54% of the variance in OCD and alcohol dependence, respectively. Additive genetic factors explained 68% and nonshared environmental factors explained 32% of the covariance.

The major limitation of this study was that individuals had to seek care from specialists for their symptoms. Individuals who could manage their symptoms with primary care or at private clinics were not represented.

The study authors concluded, “In this Swedish population-based cohort study, OCD and obsessive-compulsive symptoms were associated with an elevated risk of substance misuse, challenging the notion that OCD is protective against developing substance misuse.” The study authors continued, “The associations of OCD and obsessive-compulsive symptoms with substance misuse were largely explained by shared genetics, but our findings are also compatible with an environmentally mediated relationship (eg, self-medication hypothesis).”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Virtanen S, Kuja-Halkola R, Sidorchuk A, et al. Association of obsessive-compulsive disorder and obsessive-compulsive symptoms with substance misuse in 2 longitudinal cohorts in Sweden. JAMA Netw Open. 2022;5(6):e2214779. doi:10.1001/jamanetworkopen.2022.14779