When Obsessions Meet Deadlines: How Young Adults with OCD Navigate the Leap from School to Work

The transition from school to work or university is one of the most consequential passages in any young person’s life, a period when identities are renegotiated, routines are rebuilt and futures are charted. For young adults living with obsessive-compulsive disorder, or OCD, this passage can be fraught with obstacles that most of their peers never have to consider. A new explorative qualitative study from researchers at Uppsala University and the Karolinska Institutet in Sweden, published in BMC Psychiatry, offers one of the most detailed accounts to date of how people aged 19 to 29 with a diagnosed OCD experience this critical juncture, and the findings paint a picture of a system that often fails to meet them where they are.

OCD is a relatively common psychiatric condition characterised by intrusive, unwanted thoughts and repetitive behaviours or mental rituals performed to reduce the distress those thoughts provoke. It affects roughly one to two percent of the population, yet its impact on daily functioning can be profound. Despite this, the researchers behind the new study noted that remarkably little is known about how the disorder shapes the school-to-work or school-to-university transition, a process they abbreviate to STWT. Understanding these conditions, they argue, is essential for designing interventions that promote labour market inclusion for a population that often slips through the cracks between child and adult mental health services, schools, employers and welfare agencies.

To capture this lived experience, the team conducted semi-structured individual interviews with 21 participants, 14 women and 7 men, all diagnosed with OCD, with a mean age of 23 years at the time of the interviews. The interviews were analysed using reflexive thematic analysis, a qualitative method in which researchers systematically code interview transcripts and iteratively construct themes that capture patterns of meaning across participants’ accounts. This approach does not seek statistical generalisation; instead, it aims to surface the textures and dynamics of experience that quantitative surveys routinely miss, making it particularly well suited to a topic as personal and variable as managing a mental disorder during a major life transition.

The analysis generated two overarching themes. The first, described as navigating pathways into the labour market through studies or work while managing health, captures the delicate balancing act participants performed between pursuing education or employment and keeping their symptoms in check. The second, navigating pathways into the labour market through societal support, maps the external scaffolding, from healthcare and public employment services to social insurance agencies, family and friends, that participants either leaned on or found wanting. Together, the themes illustrate how symptoms and structural conditions interacted to shape, and in some cases significantly delay, the transition process.

What emerges most strikingly from the findings is the potential interplay between symptom burden and engagement in education or employment. Participants described how increased OCD symptoms and worsening mental health could interrupt studies or derail job prospects, while the demands of new environments, unfamiliar classrooms, open-plan offices, rigid schedules, could in turn exacerbate symptoms. This bidirectional dynamic meant that a setback in one domain cascaded into the other. When individual needs went unmet, whether for understanding from a supervisor, flexibility in deadlines or timely access to treatment, the transition could stall entirely, sometimes for extended periods during which participants withdrew from both work and study.

Yet the study is not simply a catalogue of difficulties. Participants actively developed their own coping strategies, drawing on personal routines, self-knowledge about their triggers and carefully chosen disclosures to manage the demands of new settings. They also used various forms of support: pedagogical accommodations in education, workplace-related adjustments, social support from family and peers, and societal support through public agencies. The researchers emphasise that these supports, when they worked, helped young adults overcome challenges while maintaining their mental health and well-being. The distinction between support that is flexible and individualised and support that is standardised and bureaucratic emerges as a recurring fault line in the participants’ accounts.

The implications for policy and practice are significant. The authors argue that the findings underscore the need for flexible, individualised support and coordinated efforts among relevant stakeholders, including healthcare providers, educational institutions, employers, the public employment service and the social insurance agency. In the Swedish context, where the study was conducted and funded by the Swedish Social Insurance Agency, these agencies form a welfare architecture intended to smooth transitions, but the participants’ experiences suggest that coordination between them often breaks down precisely when young people with OCD need it most. Healthcare services, the authors suggest, should address not only symptom management but also the new contexts and challenges embedded in the transition itself.

There is also a broader scientific takeaway. The study contributes to a growing literature on how mental disorders affect occupational trajectories, but it does so from a perspective that is rarely heard: that of the young adults themselves. By centring their voices, the researchers reveal mechanisms, such as the fear of disclosure, the cognitive load of managing rituals alongside coursework, and the exhausting negotiation of accommodations, that would be invisible in register-based studies of unemployment or sick leave. This mechanistic understanding matters because it points to concrete intervention targets: awareness training for teachers and employers, sustainable and supportive study and work environments, and integrated care pathways that follow young people across institutional boundaries.

The research also carries a message about timing. The late teens and twenties are a window in which educational and occupational trajectories are set, and delays during this window can compound, affecting income, social integration and long-term mental health. The study’s finding that unmet individual needs may delay or interrupt the transition suggests that early, proactive support, rather than crisis-driven intervention, could change outcomes for this group. Increased awareness of OCD among the professionals who staff schools, universities, workplaces and welfare agencies is, the authors argue, a prerequisite for improving inclusion in working life.

Published open access and approved by the Swedish Ethical Review Authority, the study is exploratory, and its authors are careful about scope: 21 participants in one national context cannot speak for everyone with OCD, and qualitative findings are hypotheses rather than prescriptions. But as a detailed map of a terrain that has been largely uncharted, the work is a valuable contribution. It suggests that for young adults with OCD, the path from school to work is not merely a matter of individual willpower or symptom severity, but of whether the systems around them can flex to accommodate the reality of their condition. When they do, the transition becomes navigable; when they do not, a treatable disorder can quietly become a career-defining obstacle.

Subject of Research: Experiences of young adults with obsessive-compulsive disorder during the school-to-work or university transition

Article Title: Young adults with OCD and their experiences of the school-to-work or university transition: an explorative qualitative study

Article References: Andersén, Å., Alaie, I., Carpentsier, B., Helgesson, M., & Holmlund, L. (2026). Young adults with OCD and their experiences of the school-to-work or university transition: an explorative qualitative study. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08714-6

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08714-6

Keywords: obsessive-compulsive disorder, school-to-work transition, young adults, qualitative research, thematic analysis, mental health, labour market inclusion, employment, education, societal support, BMC Psychiatry, Sweden