Today, obsessive-compulsive disorder (OCD) is recognized as a common mental health condition with a high prevalence among young adults. OCD frequently co-occurs with mood, anxiety, and eating disorders and shares the hallmark feature of compulsive behavior with substance use disorder (SUD), with individuals with OCD also demonstrating higher rates of substance dependence. However, despite growing evidence of rising OCD diagnoses and increased substance use among college students, few studies have examined the co-occurrence of OCD with specific substances (e.g., alcohol, tobacco, cannabis) and the risk for disordered eating in this population. The current study aims to investigate the associations between OCD, substance use, and disordered eating risk among college students, while also exploring sex/gender differences.
The study analyzed data from 92,757 undergraduate students aged 18-24, enrolled in 216 colleges, collected through the American College Health Association-National College Health Assessment III (ACHA-NCHA III) between Fall 2021 and Fall 2022. Logistic regression model was employed to examine the risk of alcohol, cannabis, and tobacco use, as well as disordered eating, based on the presence or absence of OCD-related conditions. The analysis accounted for sex/gender differences, covariates, and school clustering to produce adjusted results.
According to the findings of the study, college students with OCD were more likely to have moderate-to-high levels of risk for alcohol tobacco, and cannabis use, as well as significantly higher risks of disordered eating behaviors, compared to students without OCD. Adjusted model analyses revealed that OCD was significantly associated with increased risks of substance use (tobacco aOR = 1.12, cannabis aOR = 1.11, alcohol aOR = 1.14) and disordered eating (aOR = 2.28), even after controlling for covariates such as stress, depression, and anxiety. Gender-stratified analyses showed that cisgender female students exhibited higher risks across all categories (tobacco aOR = 1.12, cannabis aOR = 1.13, alcohol aOR = 1.18, disordered eating aOR = 2.30), while Transgender and Gender Non-Conforming (TGNC) students demonstrated elevated risks for tobacco use (aOR = 1.24) and disordered eating (aOR = 2.14). In contrast, cisgender male students were found to be at higher risk only for disordered eating (aOR = 2.34). Notably, TGNC students had the highest predicted probability of disordered eating risk, while cisgender female students represented the group with the highest risk for comorbid conditions. These findings highlight the necessity of comprehensive mental health screening and tailored support systems for college students with OCD, emphasizing the importance of gender-specific interventions.
Takeaway: Young adult college students with OCD conditions exhibit significantly higher risks of alcohol, tobacco, cannabis use and disordered eating, particularly among cisgender females and TGNC students, highlighting the need for targeted mental health interventions and gender-specific support systems.