The Psychology of Change: Why Individuals with OCD and ADHD Struggle to Adapt, and How It Impacts Mental Health

In a world where change is inevitable, many individuals encounter challenges adapting. But for those with mental health conditions like Obsessive-Compulsive Disorder (OCD) and Attention Deficit Hyperactivity Disorder (ADHD), changes can be particularly distressing, leading to a sharp decline in mental health. Recent studies underscore the difficulty individuals with these conditions face in managing transitions, suggesting that their unique neuropsychological traits make tolerance for change significantly lower, often exacerbating symptoms and overall well-being.

1. The Rigidity of Routine: A Shield Against Anxiety in OCD
OCD, characterized by unwanted repetitive thoughts (obsessions) and ritualistic behaviours (compulsions), thrives on routine. For individuals with OCD, routines serve as a method to control anxiety, providing a predictable framework in an otherwise chaotic world. Changes to this routine can dismantle the mental and emotional “safety net” that people with OCD rely on. Psychologist Dr. Jonathan Abramowitz, a leading researcher on OCD, describes routines as “anchors that keep intrusive thoughts at bay.”

In a 2021 study published in The Journal of Anxiety Disorders, researchers observed that changes in daily routines, such as the onset of the COVID-19 pandemic, intensified symptoms in individuals with OCD by up to 50%. This impact was even more pronounced in people with contamination obsessions or those reliant on public spaces to complete rituals. The abrupt closure of public facilities and heightened sanitation measures disrupted their coping mechanisms, leading to increased distress, depression, and in extreme cases, a reluctance to leave the house at all.

2. ADHD and the Struggle for Stability Amid Chaos
For those with ADHD, change often triggers overstimulation, which can overwhelm their already heightened sensitivity to environmental and situational shifts. ADHD is marked by impulsivity, distractibility, and difficulties with executive function, which includes planning, organising, and adapting to change. The dopamine dysregulation in ADHD brains contributes to this, as individuals with ADHD often rely on external structures to stay on track. A change, therefore, can be like removing the guardrails.

A 2022 study in Frontiers in Psychology found that adults with ADHD who experienced major life changes, such as relocating or job transitions, were more likely to experience intense anxiety and depressive episodes. The study also showed that unstructured changes like shifting deadlines or unpredictable work schedules exacerbated symptoms of inattention, leading to missed deadlines, which further harmed self-esteem and mental health. For instance, during the COVID-19 lockdowns, the sudden shift to remote work left many with ADHD struggling, as they lost the external structure provided by the workplace.

3. The Cognitive Science of Resistance to Change
Neuroscience helps us understand why these conditions make change particularly destabilising. People with OCD often have an overactive amygdala, the part of the brain responsible for the fight-or-flight response. When faced with change, this overactivity amplifies their anxiety. On the other hand, individuals with ADHD have underactive prefrontal cortexes, impairing their ability to manage unexpected shifts in tasks or routines.

In a 2023 study published in Nature Neuroscience, researchers found that brain scans of individuals with OCD showed significantly higher activation in the amygdala and prefrontal cortex during tasks requiring flexibility compared to neurotypical individuals. This heightened activity translates to real-world behaviours; even a small, unpredictable change, such as a detour on the way to work, can trigger an anxiety spiral for someone with OCD. For ADHD sufferers, brain activity related to impulse control and decision-making is less activated, making abrupt changes feel overwhelming and leading to frustration, impulsivity, or shutdown.

4. Extreme Reactions: When Change Leads to Crisis
The impact of change on individuals with these mental health conditions can sometimes lead to extreme reactions or crises. For example, research from Psychiatric Times highlighted cases during the COVID-19 pandemic where individuals with OCD developed agoraphobia due to the sudden shift in environmental cleanliness standards. One individual reported spending several hours each day cleaning surfaces compulsively, fearing contamination from outside germs, and ultimately stopped leaving their home altogether.

In another case, individuals with ADHD faced a dramatic mental health decline with the abrupt shift to remote learning. The lack of face-to-face support and structured schedules led to an academic crisis for many students with ADHD, some of whom were so overwhelmed by the unstructured environment that they were unable to complete coursework or attend classes. For one college student, the transition to online classes and the removal of in-person support from professors and peers led to academic probation and worsened depressive symptoms.

5. Strategies for Supporting Stability in the Face of Change
Recognising the impact of change on those with OCD and ADHD, mental health professionals recommend several approaches to create a buffer for these individuals:

Structured Transitions: Gradually introducing changes, when possible, can help mitigate anxiety. For those with OCD, mental health professionals recommend “exposure and response prevention” (ERP) therapy to gradually desensitize individuals to the unpredictability of change. In ADHD, consistent external reminders and structure can assist in easing the transition.

Environmental Modifications: Creating predictable environments, such as a dedicated workspace for those with ADHD, helps provide a stable foundation. For those with OCD, cognitive behavioral therapy (CBT) approaches that focus on modifying obsessive thought patterns can support resilience.

Community Support: Regular check-ins and emotional support can make a significant difference. Many organisations, including the International OCD Foundation and CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), offer resources and support groups for navigating life changes.

In conclusion, while change is difficult for most people, it can be profoundly destabilising for individuals with OCD and ADHD. These conditions make adapting to the unexpected a challenge that can quickly spiral into mental health crises. By understanding the neuropsychological roots of these reactions and implementing structured support systems, society can better accommodate and support individuals with these conditions, allowing them to navigate life’s inevitable changes with greater confidence and resilience.