How does OCD affect college students?
OCD is a common and frequently misunderstood mental health condition that impacts students on college campuses across the country. The obsessions and compulsions that characterize OCD can interfere with our ability to function in various aspects of our lives, leading to significant distress. Dr. Holly Betterly MD, Board-Certified Psychiatrist in Weston, FL, sheds light on the ways in which OCD can present in college students, and how these symptoms may impact academic performance.
This post is provided for educational purposes only, and is not intended as a substitute for professional medical advice. If you have questions, always reach out to your doctor for more information.
Struggling with your mental health? Reach out for professional support. Dr. Betterly is a board-certified psychiatrist in Weston, FL dedicated to helping you overcome depression, anxiety, and OCD. She offers appointments at her office in Weston, FL, conveniently located in Weston Town Center, as well as via telehealth for patients across Florida. Request an appointment today to start your journey to better mental health.
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What is OCD?
Obsessive Compulsive Disorder, or OCD, is a common and often misunderstood mental health condition.
When people think about OCD, they often think of someone who has a preference for cleanliness and organization. The reality is that OCD is much more than a desire to keep things tidy. OCD is a serious psychiatric disorder that can significantly interfere with day to day life, limiting one’s ability to function and causing major distress.
OCD is characterized by the presence of obsession, compulsions, or both.
Obsessions: recurrent, distressing, unwanted intrusive thoughts, images, or urges
Compulsions: repetitive, often ritualistic behaviors performed in an attempt to alleviate distress and anxiety
How do obsessions and compulsions fit together? Let’s take a look at the Cycle of OCD.
Intrusive thoughts can be distressing, leading to feelings of anxiety and discomfort. When these uncomfortable feelings arise, we may look for ways to get rid of them. For people with OCD, this could involve performing a compulsive behavior in an attempt to reduce feelings of discomfort. Engaging in a compulsive behavior may provide some temporary relief from anxiety, but this relief is short-lived. With time, the obsessive thought returns, and along with it the associated feelings of distress, leading us to again engage in the compulsion, perpetuating the vicious cycle.
Here’s an example. After touching a doorhandle on the way into the grocery store, you experience an intrusive thought that the doorhandle was contaminated with germs, and worry that you will get sick. You begin to notice feelings of dread and anxiety rising up through your body, accompanied by a compelling urge to go wash your hands. You abandon your shopping cart and rush to the restroom to wash your hands. You feel better afterwards, returning to your cart, but by the time you make your way through the produce section, the doubt comes creeping back in- did I get all of the germs off? Was the water hot enough? The distressing feelings return, and you again feel an urge to go wash your hands.
OCD is diagnosed by a mental health professional, such as a psychiatrist or a psychologist. Learn more about how OCD is diagnosed.
While OCD is not curable, there are many effective, evidence-based treatments available for managing the symptoms of OCD. These may include specialized forms of therapy, such as Exposure Response Prevention (ERP), as well as prescription medications, such as SSRIs. Learn more about medications used to treat OCD.
How many college students are affected by OCD?
A 2011 study from the Journal of American College Health examined the occurrence of OCD and its associated symptoms in college students, finding that 5% of college students reported clinically significant obsessive-compulsive symptoms.
More recent data from the American College Health Association’s Spring 2024 National College Health Assessment (NCHA) found that 6% of college students reported that they had ever been diagnosed with a disorder from the Obsessive-Compulsive and Related Conditions category of the DSM. It’s important to note, however, that this category also includes conditions such as hoarding disorder and body dysmorphic disorder, so we don’t know how much of that 6% is representative of OCD specifically.
The NCHA data found that of those who had been diagnosed with one of these conditions, almost two in three students had sought treatment for their condition within the past year.
Of those who sought treatment, the survey results indicate:
12% of students used medication
30% of students used therapy
46% of students used a combination of both
10% of students used no treatment
How does OCD affect college students?
OCD is not a one-size-fits-all condition. While those living with OCD share the experience of obsessions and/or compulsions, the symptoms can look very different from one person to the next. It’s important to remember that each person’s experience with OCD is unique.
With that said, let’s take a look at just some of the many different ways that OCD may manifest itself during our college journeys.
Perfectionism/ Need for “Just Right”
Some people with OCD may experience obsessions related to a need for things to be “just right”, pursuing an excessive or unrealistic degree of perfection. When it comes to college, this may look like:
Spending excessive amounts of time writing and rewriting an essay to make sure that it thoroughly answers the prompt
Rewriting an assignment over and over because of a need for one’s handwriting to be immaculate
Restarting a homework project from the beginning because of a spelling error, feeling powerless to cross it out, correct, and move on
Conflict with your roommate due to an overbearing urge to keep your room organized “just so”
Running out of time during chemistry lab sessions due to a need to measure out substances to an unnecessarily precise decimal
Contamination
When we transition to life on campus, we often find ourselves spending a significant amount of time in shared spaces. We may be living in a dorm with a roommate, sharing a bathroom with an entire floor of students, eating our meals in the campus dining halls, and attending lectures in auditoriums filled with hundreds of other people. For those who experience contamination-related symptoms of OCD, the thought of the potential germs in these settings can be distressing. This may lead to excessive amounts of time being spent engaging in cleaning compulsions, such as:
Showering multiple times per day
Running through bottles of hand sanitizer
Wiping down shared surfaces, such as doorhandles, desks or tabletops
Bleaching the dorm bathroom before each use
Avoidance
For those with contamination-related OCD symptoms, compulsions aren’t just limited to cleaning- another common compulsion is avoidance behaviors. This may look like attending lectures exclusively online from your dorm room bed due to concerns about potential contamination in the lecture hall, or missing out on in-person courses. It could also mean avoiding interaction with others out of fear that you may spread contamination, or failing your chemistry lab due to an inability to touch the necessary chemical reagents because you fear that they may poison you.
It’s very common for people with OCD to experience distressing, disturbing, and unwanted intrusive thoughts related to the people in their lives. These thoughts could include, for example, the thought of pushing your friend into oncoming traffic, making inappropriate sexual advances towards a peer, or calling your professor a derogatory name in the middle of lecture. It’s important to remember that intrusive thoughts are unwanted by nature- experiencing these thoughts does not mean that you agree with them, that you wish to act on them, or most importantly, that you are a bad person.
It’s not uncommon for those who experience these types of upsetting obsessive thoughts to avoid the individual in question, as their presence may trigger feelings of distress and anxiety. On college campuses, this type of avoidance can lead to challenging situations, such as skipping lab to avoid your partner, or dropping a course to avoid a certain professor.
Confessing
Another common compulsion in OCD is an urge to confess to perceived wrongdoings or mistakes. In the college setting, an example of how a confessing compulsion may present could include sending lengthy, excessively detailed emails to your professor about why your assignment was turned in after the deadline, or why you missed a class session.
Social Relationships
OCD can interfere with many different aspects of daily life, including our ability to maintain social relationships. Concerns about contamination may limit our ability to attend in-person events. Disturbing intrusive thoughts may lead us to avoid important individuals in our lives. Another common way in which OCD can impact our social relationships is through compulsive reassurance-seeking.
When we think about the obsessions seen in OCD, a common theme is the presence of doubt and an inability to tolerate uncertainty. This may show up in our social relationships through fears about whether our girlfriend or boyfriend really loves us, or whether our friend really forgives us after a disagreement. We may ask them over and over again to reassure us of their love and acceptance, leading them to feel frustrated and irritated.
Time Management
As we saw in the above examples, the symptoms of OCD can take up a significant amount of our time. Whether we are rewriting our assignment over and over, repeatedly leaving the lecture hall to wash our hands, or standing outside of the dining hall for excessive amounts of time due to a fear of contamination, OCD symptoms can make it difficult to get things done. Time management can be a big challenge for college students, especially considering the adjustment required as we transition from the rigid schedules of high school to the often far less structured learning environment of college.
How does OCD influence educational attainment?
As we saw in the previous section, the symptoms of OCD can make it difficult to function in day to day life on campus, interfering with our ability to attend classes, complete homework in a timely manner, or maintain social relationships, to name just a few. It should come as no surprise then that OCD can negatively impact on our academic performance.
A 2017 study published in JAMA Psychiatry explored the association between OCD and educational outcomes. This study, funded by the International OCD Foundation (IOCDF), found that OCD can have a detrimental effect on educational performance.
With respect to the impact of OCD on higher education, some study findings included:
Those with OCD were 28% less likely to start a university degree, and 41% less likely to finish it
Those with OCD were 48% less likely to complete postgraduate education
Why is my OCD worse at college?
The transition to college can be a big adjustment for many people. Moving out of your parents house and into the dorms, juggling a challenge course load, building your new social circle- and oftentimes, doing so far away from your support system back home. For those with mental health conditions, this piling on of new stressors all at once can overwhelm our coping skills. This can lead old symptoms to return, new symptoms to emerge, or existing symptoms to worsen.
Young adulthood is oftentimes the chapter of life during which mental health conditions begin to present themselves for the first time. When it comes to OCD, there are two peak periods in which symptoms begin to emerge for the first time- the first during childhood, and the second during the late teens to early adulthood, often around the age of 20. It’s therefore not uncommon for people to develop symptoms of OCD for the first time while they are away at college.
How do I find treatment for OCD at college?
Whether you’ve been dealing with OCD for some time now, or you’re just beginning to notice some concerning symptoms, know that you don’t have to face OCD alone throughout your college journey.
When it comes to finding treatment for OCD, a great place to start is the Student Counseling Center or Student Health at your school. These services are often included in the school’s tuition and fees, meaning that you may be able to access services free of charge. Check out your college or university’s website to explore on-campus mental health resources.
If your school doesn’t offer mental health resources, or you prefer not to receive care through your school, you can find a mental health professional in the local community, such as a psychiatrist or a psychologist. The International OCD Foundation (IOCDF) provides a free search tool for finding a professional near you.
Located in Florida? Dr. Holly Betterly is a board-certified psychiatrist who specializes in OCD. She has worked with college students at the undergraduate, graduate, and professional degree levels, and has experience working at the student counseling center of a major university. Dr. Betterly offers telehealth appointments for patients across Florida, as well as in-person office visits in Weston, FL. Request an appointment today to start your journey to better mental health!
