Many studies have found that addiction and mental health disorders are heavily intertwined and have a complex relationship – including obsessive-compulsive disorder (OCD). OCD is an anxiety disorder, where intrusive and upsetting thoughts frequently consume an individual’s mind. For example, a person may have recurring “obsessive” thoughts about getting seriously ill from bacteria. To ease the anxiety that these thoughts cause, people with OCD “compulsively” carry out behaviours to ease the stress of the disorder. For example, they may wash their hands repeatedly until the skin becomes raw.

Due to the nature of the condition, without the proper support and treatment OCD can sometimes transform into serious addiction-disorders. Addiction is a chronic dysfunction of the brain that involves reward, memory, and motivation systems. This leads to individuals not having control over their behaviour and is most commonly associated with substances, though can also be linked to a range of activities. 

The repetitive compulsions people with OCD carry out may seem like a type of addiction to an observer, however, they are different. Compulsions are actions a person feels they must do to avoid feelings such as anxiety or fear. They may also feel as though bad things will happen if they don’t carry them out. Contrastingly, addiction involves reward driven behaviour, possibly providing pleasure, escapism, or excitement. Addictions usually provide temporary enjoyment while being harmful overall. That’s not to say compulsions and addiction cannot occur simultaneously, though compulsions are not generally addictions.

The Link Between Addiction and OCD

Research has shown that addiction is more prevalent among people with severe mental health conditions, including OCD. A 2019 study which observed 38,157 veterans with OCD found over one third also had a substance abuse disorder – most commonly tobacco, alcohol, and cannabis.

A new study, published in 2022, has further delved into the relationship between addiction and OCD and uncovered more about how the two disorders go hand-in-hand. Researchers asked 150 individuals attending an OCD clinic information about their symptoms and this data was compared to 131 individuals without OCD. It was found that 70% of people with OCD also had symptoms of addiction, whereas the disorder impacted only 58% of individuals without. Internet addiction had the most prevalent difference: impacting 29.3% of people with OCD and 3.1% without.

Though this relationship may, by no means, be linear. One study in 2021 found a U-shaped relationship between addiction and the severity of OCD, where people with mild or severe symptoms were more at risk than those in the middle of the spectrum. This adds further complexity to understanding and treatment options. 

Why are OCD and Addiction Connected?

Although we don’t know for sure, several theories suggest why the conditions are linked. These include:

  • Self-medication: to find temporary relief or escapism, people may “self-medicate” with substances to cope with their OCD symptoms. OCD is also an under-reported disorder where professionals could step in and provide support and medication, so people turn to substances to find relief themselves.
  • Substance side effects: during use or after they wear off, certain addictive substances can amplify negative mental health symptoms.
  • Intersecting risk factors: factors such as early stress and trauma can change the chemical composition and structure of the brain, increasing vulnerability to addiction and OCD. Similar genetic factors have also been shown to increase the risk for both conditions.
  • The relationship between compulsiveness and impulsiveness: there is an intersectional relationship between compulsiveness and impulsiveness. Compulsivity means acting upon a premeditated irresistible urge, whereas impulsivity is acting on instinct without thought. The 2022 study found that individuals with OCD and behavioural addictions had a higher level of impulsivity compared to their non-OCD counterparts. The previously mentioned 2021 study also found people with more severe OCD have higher levels of impulsivity, possibly explaining their higher addiction rate.  
  • Impacting overlapping regions of the brain: some studies have shown that OCD and addiction are both involved in the reward processing part of the brain; however more research is needed to definitely confirm this.

How to Treat OCD and Addiction

Addiction and OCD are both treatable conditions and with the correct professional support, symptoms can significantly improve. As both disorders can reinforce each other, it is important to carry out simultaneous therapies. Treatment methods can include:

  • Talk therapy: this kind of therapy helps individuals understand the motives and root cause of their behaviour, teaches them ways to address instinctive thoughts, and works on developing helpful coping mechanisms.
  • Medication: sometimes medication can help manage OCD symptoms, though how to approach treatment hugely differs on an individual basis. 
  • Medication-assisted treatment (MAT): medication such as methadone may be prescribed by a doctor to someone with an opioid use disorder to reduce cravings and withdrawal symptoms.
  • Support groups: support groups can provide practical strategies and a sense of understanding to people who have gone through similar experiences to themselves. There are also more structured programs that offer an alternative approach.  

Generally, the rule when it comes to treating both OCD and addiction is the sooner the better, as this reduces the risk of severe symptoms and complications in the long-term. Doctors and mental health professionals are the best equipped to create a treatment plan for people with these conditions. Individuals should seek professional help if they:

  • find it difficult to stop certain behaviours even if they desire to not do it
  • have uncontrollable upsetting thoughts
  • are in treatment but their symptoms worsen or new ones manifest
  • are experiencing physical withdrawal symptoms when they stop taking a substance
  • were recovering but started to experience symptoms again 

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