OCD and School
Transitioning to College and Managing OCD
Jeanne M. Fama, PhD
The college years can be a time of excitement and growth: an opportunity to learn new things, meet new friends, and make plans for your adult life. But, college also brings challenges. Leaving familiar people, places, and things while trying to get used to new people, places, and things is stressful for many students. These adjustments can be particularly challenging for folks with OCD. The good news is that there are ways to plan for the challenges. Anticipating the obstacles you may encounter at college and practicing ways to deal with them ahead of time can help you to keep OCD and related anxiety in check and help you ease your transition to college.
While adjusting to a new college environment, individuals with OCD may experience an increase in obsessive thoughts and compulsive urges. Changes in physical surroundings, social life, and academic routines, may trigger new obsessions or, even, bring back obsessions that bothered you long ago. For example, changes in physical surroundings (e.g., new classrooms, cafeterias, and bathrooms) may be particularly tough for those prone to contamination concerns. You may experience urges to clean (or avoid) new and unfamiliar desks, chairs, computer keyboards, foods, utensils, sinks, toilets, showers, etc. This may be particularly true for those living in new dorm rooms/apartments, especially if they are living with new roommates who may have different routines, habits, and opinions about how to cook, clean, etc. Living away from home can also bring a sense of added responsibility. For some folks with OCD, increased responsibility can trigger obsessive worries about the safety of oneself and/or of others. These worries may be accompanied by urges to ensure safety by engaging in compulsive checking, like checking to make sure that doors and windows are locked, kitchen counters are clean, appliances are unplugged, etc.
Changes in social life often include meeting new classmates, club members, teammates, and roommates. Meeting new people can trigger different kinds of fears, including fears that others might notice your OCD/compulsions or fears about how others might perceive you generally. Meeting people from different backgrounds can lead some individuals to question their own backgrounds, values, and standards. For some folks with OCD, this can trigger obsessive questions like “What is ‘normal?;” “What is best?;” and “What is right/moral?” Also, while getting adjusted to the new social scene at college, you may see less of familiar family and friends. It is not uncommon to miss the comfort and support of those familiar with you, your strengths, and your struggles (including your OCD).
By the time you’re finishing high school you may feel as if you have your school routine down pat. When starting college, your academic routine will change. There will be new classes, responsibilities, and teachers. For example, at college, you may be assigned more reading than you were assigned in high school. You may be required to write longer papers and take different types of tests. You may find that your college professors have expectations about grading and homework that differ from those of your high school teachers. New academic challenges can trigger various concerns in those with OCD. You may experience perfectionistic thoughts about making mistakes; worries about accidentally cheating/plagiarizing; fears of not knowing enough, doing well enough, working hard enough, or studying in the "right ways." You may also notice increased urges to recheck your work, to reread/rewrite things, to procrastinate, and to avoid. Many students find college schedules to be more flexible than their high school schedules. For example, in college, up you may have more input than you did in high school about which subjects you will study and what times/days you will attend classes. Making decisions about class schedules, academic majors, etc. may trigger doubt and anxiety for folks who dislike decision-making in novel situations or who dislike uncertainty in general.
Changes in surroundings, social settings, and academic domains may trigger people in similar and unique ways. Whether your challenges are similar to those described above or unique, it is important to know that whatever challenges you face, college can still be (and often is!) a wonderful experience. Many, many people with OCD do quite well in college, enjoy it tremendously, and manage their OCD quite well. By anticipating potential difficulties and planning strategies to combat OCD ahead of time, you may be able to keep OCD at bay and anxiety away. Consider the following tips:
- Reflect on the past and anticipate the future. One way to prepare for the college transition is to reflect upon your personal history, consider ways in which OCD has affected you, and try to anticipate ways in which it could become problematic for you in your new environment. Here are some questions to consider: Looking back over your lifetime, which OCD symptoms have been most problematic for you? Can you identify things that trigger your OCD or make your OCD symptoms better or worse? For example, do your symptoms get worse during certain types of events? during periods of change? when you are alone or when you are with others? when you are very busy or when you have less to do? Given what you know about your personal history and triggers, try to predict which aspects of college (including changes in physical, social, academic settings) might be particularly difficult for you. Can you anticipate the types of things, places, people, activities that might trigger or intensify your OCD symptoms?
- Consider strategies that have helped your manage OCD symptoms in the past. Then, think about how you might apply these strategies when in college. The most effective treatments for OCD include medication and cognitive behavioral therapy. Treatment with medications such as SRIs and clomipramine helps lot of individuals with OCD. If medication treatment has been helpful for you and you plan to continue it, make sure you make arrangements to have your medications monitored and your prescriptions filled when at college. Also, remember that starting college means getting used to new schedules and this can throw people “off their games.” When adjusting to new routines, make it a priority to take your medications regularly as directed.
Cognitive behavioral therapy (CBT) has also helps lots of folks with OCD. CBT can teach you to change the unproductive thinking patterns and behaviors (e.g., compulsions and/or avoidance behaviors) that fuel OCD. If you have undergone CBT in the past, consider the kinds of anxiety provoking thought patterns that you noticed in the past. Remind yourself of the ways that you can change these kinds of thoughts. For example, do you have a tendency to believe things will turn out badly even when you have no reason to predict they will turn out badly? If so, be on the look out for these types of worrisome thoughts when you start college. Remind yourself even before starting college that most of your negative predictions do not come true. Once you arrive at college, stay on the look out. Try to refrain from making negative predictions. When you catch yourself making a negative prediction, remind yourself that it is unlikely to come true. If you have used exposure and response prevention exercises in the past, consider the types of exposure and response prevention exercises you have done successfully. In preparation for your transition to college, consider how you could change previously helpful exposure and response prevention exercises to address new concerns that might come up in college. Once arriving at college, be on the look out for urges to engage in new compulsions or avoidance behaviors.
If you are interested in treating OCD with medication, CBT, or both, consider how and when you will get the treatment you want when you get to college. Will you be able to continue with your current providers? If you will be attending school far away from current treaters, it might be a good idea for you to investigate OCD specialists near your new school. You may ask current treaters for referrals in the area in which you plan to attend school. You may also look through the International Obsessive Compulsive Disorder Foundation's list of treatment providers. Try to contact a few providers in advance to check on their availability and discuss payment and/or insurance options. For some of you, moving to a new area may give you a chance to engage with specialists not available to you where you currently live.
- Consider how changes in schedules and routines could affect OCD symptoms. Changes in sleeping, eating, exercising, commuting, socializing, and studying routines can lead to feelings of fatigue or physical stress that may indirectly intensify OCD symptoms. OCD can also be intensified by other feelings (e.g., excitement, sadness, or stress/anxiety about other “non-OCD things” like money, transportation, feeling lonely, etc.). Plan ahead ways to ensure that you take care of yourself by maintaining regular and healthy eating, sleeping, exercises routines, as well as some time to socialize and relax. Try to make your general well being a priority so that you are less vulnerable to OCD.
- Discuss with family and other supports ways they can be helpful during your transition without participating in reassurance seeking or other compulsive behaviors.
- Don’t forget to plan for school breaks and summer vacations! Just as arriving at school brings new challenges, leaving school after you have adjusted to it can also bring challenges related to changing environments and routines.
Adjusting to new environments and situations can make people feel uncertain and anxious. This may be especially difficult for those struggling with OCD, who may react to change and uncertainty with feelings distress and fears of being overwhelmed. Remember that feelings of newness and uncertainty decrease over time. Try to remember other things that initially felt scary (new schools, new classes, new friends, etc.), but no longer do. And remember that fear of or dislike for uncertainty are just that: fear and dislike. They are not signs that you will be unable to handle new things. They are often just initial reactions to all of the new things you’re encountering. Over time, new routines will start to feel familiar. Within a few weeks, most classes, internships, and routines will become more comfortable. Change and, hence, uncertainty, is part of college and life beyond college. Although it is scary, it is usually manageable. Indeed, it is often a precursor to growth, whether that be developing rewarding academic interests, career plans, or making lifelong friendships.