Making the transition to college can be a difficult one for many people [1]. For many young adults, this represents the first major transitional step into adulthood [2]. This generation is moving out and on their own into an entirely new environment, often times hours away from their parents. Young and transitional adults are given significant liberty which they were likely not granted in their parents’ homes [2]. The combination of academic stressors, any extracurriculars in which students may be involved, fostering new connections and friendships, taking on responsibilities outside of their childhood home and many other stressors can create a precarious time in a young person’s life [2].
Aside from all the life stressors that come about at this stage in people’s lives, psychological disorders tend to materialize around this period as well [3]. Many psychological disorders and mental illnesses that have remained latent until this period will make themselves more noticeable in young adulthood [3]. This means that on top of the social and transitional stressors that young adults are facing, they must also be wary of any symptoms that could suggest deeper mental and psychological issues.
Rather than going through the entire Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [5], it may be more sagacious to outline the top five mental issues that are afflicting college students in this day and age. To help break up these top 5, I have also delineated what steps we can take for ourselves and fellow students who may be suffering from each disorder.
Be Informed
Knowing what to look for is an easy first step in battling mental health issues in this age group. If you are a college or university student, it is of grave importance that you educate yourself on what the major issues could be, what they look like, and what to do should any of these issues begin to arise [4].
Depression
Depression is a disorder that has targeted the younger generation. According to the DSM-5, 18-29-year-olds experience depression at three times the rate that older adults experience it [5]. Depression ultimately results from a chemical imbalance in the brain but can be expressed and experienced by people in a range of ways, depending on many different factors [5, 6]. These symptoms could be physical, such as sleeping or eating changes, or even physical discomfort [6]. Symptoms can also manifest in an emotional way: feeling overwhelmed, as if one is “drowning”, or feeling hopeless and powerless are all good examples of this [6]. Having difficulties thinking, concentrating, or even having a negative cognitive bias can also be indicators of depression [6].
Anxiety
According to the Anxiety and Depression Association of America, anxiety disorders are the most common mental health issue in the United States today [10]. Although there are always some levels of stress experienced by students (let’s face it, pretty high levels at times), anxiety disorders can occur when this anxiety is at a level where it is consistently interfering with your daily life [5]. There is an extensive list of anxiety disorder with which one can be diagnosed, such as Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), and Panic Disorder [5].
Symptoms of general anxiety as well as anxiety disorders will manifest differently for different persons [6]. For the sake of information, I have included here some common ways that anxiety can present: irritability, difficulty concentrating, being afraid, stress (higher than that which should be normally experienced), racing or irregular heartbeat, shortness of breath, and dizziness [6]. Tension headaches are another good indicator of stress [6]. More severe symptoms of anxiety can even be mistaken for more serious conditions, like a heart attack [6].
Suicide
The feelings of helplessness or hopelessness can seem ubiquitous on a college campus at times. Stemming from the prevalence of depression and anxiety, suicide and suicidal ideation are alarmingly high on college campuses [12]. According to a recent article published by Haas, Hendin, and Mann [12], suicide is more common among college students than the general population. They also report that the literature is not able to provide a solid number of completed suicides in this population due to methodological limitations, but the data suggest that this number would be extreme [12].
Because of the extreme numbers in this population, being informed on the signs and the interventions are extremely important for our age group. We all have a role that we can play, and every bit is worth it to save a life [12]. Suicidal ideation can present in a myriad of ways, including a person giving away material things that were important to them, an overall lack of enjoyment in things they previously enjoyed, noticeable self-harm, or even as simple as a general change in behavior [6].
THE PHONE NUMBER FOR THE NATIONAL SUICIDE HOTLINE IS: 1-800-273-8255
Eating Disorders
Although mortality is most commonly associated with suicide, the deadliest mental disorder are actually eating disorders [6]. Eating disorders are a category of disorders that refer to a set of misperceptions and disordered mindsets surrounding a person’s body and/or food [5]. These disorders ultimately impact the way the person will eat. In turn, they will either gain or lose weight in an attempt to rectify their body dysmorphia [5]. Body dysmorphia is the severe belief that your body or something about it is horribly disfigured or exaggerated and must be rectified in some way [5]. Most commonly, eating disorders are thought to be when a person restricts their caloric intake either by starving themselves or by purging what they have eaten [5]. In addition, however, eating disorders can also include where the person eats enormous amounts of food, feeling as though they cannot stop [5].
It is also important to note that eating disorders can stem from a need for control [13]. In a setting where the student can feel as though there is nothing left under their control, being able to control their weight or at least the food they eat is the last objective [13]. One study [13] found that a perceived lack of control over the events in their lives led to more severe eating disorder symptoms. Taking into consideration that when deadlines start piling up or grades are posted, many students have reported feeling helpless, or as if they have no real say over the outcomes in their lives, eating disorders are rampant on college campuses.
Addiction
The final most common mental health disorder in college and graduate students is addiction [6]. College and university culture is often hailed for its close ties to party culture, especially in the realm of underage drinking, binge drinking, and recreational drugs. According to one common phrase “there is a time and place for everything, and it’s called ‘college’”. While university life is known for its lax rules and opportunity to experiment with intoxicants, there is also plenty of opportunity for this seemingly innocuous experimentation to turn a bit more extreme.
The National Institute on Alcohol Abuse and Alcoholism reported that about 20% of all college students met criteria for a diagnosis of an alcohol use disorder and that 40% of students engaged in binge drinking in the past month [14]. Besides alcohol, another report noted that more than 20% of college-aged individuals had used an illicit drug [15]. Research supports that most students who participate in most alcohol and drug use in their college years do not go on to be addicted [6]. There is yet a danger that students who have developed dependency in college may be able to mask it based on the culture of partying around them.
Be Wary
Knowing the symptoms is a good first step, but the major key is that you are looking out for those around you. Being able to identify when a person, including yourself, could be going through a psychological issue. Included here are some concrete signs to notice in people in your community.
Depression
As mentioned above, depression seems to target young adults in the college-age range [6]. This means that you need to be particularly aware of your friends and colleagues to ensure that they are not displaying any of these symptoms.
For example, if you notice that someone who used to go out to parties or school-sanctioned activities has been avoiding these of late, it may be a good idea to check in on them [6]. Best Colleges also suggests that you look out for your friends neglecting themselves or their relationships, skipping classes, or reacting with more negative emotions than typical [6]. In the same vein, if you notice that someone near you may be acting more apathetic in general, this can also be a good tip-off that something may be wrong [6].
Of course, you can’t have all the answers. Nevertheless, even if you aren’t sure, checking in with your friends can do a world of difference. Chances are they will be glad you did, even if they aren’t experiencing depression.
Anxiety
Since anxiety is so common in the collegiate setting, it can be difficult to differentiate the symptoms of an anxiety disorder from typical anxiety that is experienced by a student. Identifying the symptoms in a friend, especially one who is living in a stressful situation, can be immensely difficult. Still, being able to pick out some common signs that a person may be experiencing more anxiety than is typical should be necessary.
If you notice that someone in your social circle seems to live in constant fear of academic or social failure, more so than just what is typical, they may be suffering from an anxiety disorder [6]. Also, people who are suffering from anxiety disorders will commonly seem overly anxious or awkward in social settings [6]. They will also tend to display things such as difficulty concentrating or being distracted by guilt or stress that they are experiencing [6].
Finally, if you notice that a friend may be developing unhealthy coping habits to the stress or anxiety facing them in the academic setting, they may also be experiencing an anxiety disorder [6]. However, it is important that you have the assistance of a trained psychological professional when you notice that there may be unhealthy coping habits [6]. These can signal something like an anxiety disorder but can also indicate something else such as a substance use disorder or suicidality [6].
Suicide
First, when it comes to suicide, take any threat—no matter how trivial—seriously [17]. This is a person’s life, and it is important that you be overly cautious rather than not cautious enough. Even if a friend mentions it in passing and the comment could be thought of as a joke, checking in with your friend can still make a world of difference.
Asking a person directly is the best way to find out if they are thinking about suicide [6]. Instead of ‘beating around the bush’, it is best to cut to the chase and have a frank conversation with them [6]. Many people have a fear that asking a question like that directly might plant the idea in a person’s head. Research does not support this. More than just simply not planting the thought, it can be an important base step for the individual getting help should they need it.
Further, other major warning signs include, talking about death and having no reason to live, remove themselves from social situations, exhibit major changes in their behavior or appearance, regard their own life with little worth or act recklessly, and finally express that they are deeply hopeless [17]. This is by no means an exhaustive list. The best way to know for certain if a person is experiencing suicidal feelings is by asking them point-blank [6].
Eating Disorders
Best Colleges has posted a list of questions to help determine if you or someone you know might be suffering from an eating disorder [6]. These questions include whether you refuse to eat certain meals or plan to skip meals frequently, whether you have very strict eating habits that you feel somewhat guilty for breaking, or even whether you feel as if you lose control at times and eat large quantities of food and end up forcing yourself to vomit or work-out excessively [6]. If any of these statements apply to you or someone you know, professional help may be required.
Speaking from personal experience, a college student’s eating habits are frequently erratic or at least disordered in some minor ways. This is one of the ways that eating disorders are able to hide in plain sight in many college settings. For example, friends that used to go to the dining hall with you often may suddenly become too busy to go or tell you that they already went to eat earlier. Due to the flexibility of eating times, a person is able to avoid meals without any obvious displays needed to avoid the meals, in many cases.
Control is also a major factor that plays into the development of eating disorders [15]. Perfection is often the standard to which individuals are held in college. Perfectionism can be another warning sign for eating disorders. If you start to notice that yourself or a friend is particularly seeking control or feeling that they are not in control of their own life or situations in college, it may be a good idea to reach out to them.
Addiction
As mentioned above, chemical dependency or addiction can be common on college and university campuses, disguised as typical partying behavior [6]. In order to watch out for yourself and your friends, there are some common symptoms that have been published. The first of these is obvious intoxication [6]. If you notice that your friend is intoxicated more frequently than you would consider typical, or if they are telling you that they are intoxicated more frequently than they would like to be, this is a red flag [6]. Good ways to tell if a friend is drunk or high is if you notice bloodshot eyes, if they are slurring, or if they are suddenly less coordinated than they usually are [6].
In addition, if you notice that your friend is becoming more suspicious or paranoid for seemingly no reason, they may be suffering some effects of an addiction [6]. When coming down from many drugs, including alcohol, many people will experience anxiety and extreme fear [6]. In order to escape these feelings, many people will simply look for another fix [6].
Changes in appearance, financial stability, or even their activities can indicate a chemical dependence. Overall, if you begin to notice any major character shifts in your friend, it may be a good idea to investigate a little more closely if these changes are associated with any drug or alcohol use [6]. As always, though, please encourage your friend to seek professional help if you believe that they are suffering from addiction.
Be Proactive
There is a significant stigma surrounding mental health and psychological disorders, despite the fact that one in five college students will experience some sort of a mental health concern. [7]. Being proactive in your mental health and your friends’ mental health can help address some of these concerns.
One thing cutting across all different mental illnesses and psychological disorders is the stigma. Talking about the issues that you are experiencing, whether or not they are on a clinical level, can be a good bridge into opening up the conversation about mental health issues [4]. It shouldn’t just be your responsibility, however. University and college staff need to open up the conversation for incoming students [4]. As one student from a New Jersey college stated, “kids going to college need to realize it’s not a weakness” to reach out for mental health help [4].
Depression
While lowering the stigma attached to all mental disorders is a great start to encouraging individuals to seek help when necessary, there are certain ways to best handle each disorder in a unique way. When you or someone you know start to notice issues that could be depression, ask the person if you can accompany them to the college’s mental health center [6]. Working with a professional is the best way to address this, and to ensure that it really is depression, rather than another disorder commonly mistaken for depression, such as Bipolar Disorder [6].
Once you know that your friend or classmate has been diagnosed with depression, there are a few behaviors that you must avoid. The first, absolutely do not encourage your friend to “pull themselves up by their bootstraps”, “be tough”, or compare their plight with a “bummed-out” mood that you may have experienced [8]. Similarly, it is also important that you don’t try to confront or contradict your friend’s low mood [8]. Weisinger stated that when you end up contradicting your friend, you can just end up frustrating both yourself and your friend—you end up getting nowhere but distancing your own relationship [8]. As Ronald Podell noted, depression is one of those powerful disorders that can seem to be contagious [9]. The way your friend is feeling is just that—their feelings [8,9]. Make sure to keep conscious of your own emotions and that you keep some safety distance between yourself and the negative emotions [9]. This isn’t to say that you should separate yourself from your friend [9].
Much the opposite, individuals experiencing depression often need an open and understanding presence on which they can lean [8]. Opening up your relationship and ensuring that it is free from any hostility or negative emotions can serve as a great place for your friend to “be themselves”, or at least to relax from the pressure that they feel in social situations [8]. In order to do this, it is best to educate yourself on what can be done to cope with being close friends with a person with depression. It can be difficult, and it will require some measure of emotional fortitude on your part [8].
Anxiety
Although they frequently go hand-in-hand, addressing anxiety disorders can be somewhat different than depression. The first step here should be to educate yourself on what your friends’ anxiety looks like [11]. Talking to your friend about their symptoms and what seems to bother them the most is a great first step. It shows your friend that you care about what they are going through and that you are willing to put them first when seeking to help them [11].
In addition, you will likely note that anxiety will typically lead to some sort of avoidance behavior. This can be particularly dangerous as it will cause the person to feed their own anxiety; making it worse [11]. For example, if you notice that you or your friend has been avoiding making phone calls, making a request, or even beginning a task that might be intimidating [11], your friend might be exhibiting the avoidance signs of anxiety. It might be even more anxiety-inducing for you to step in and “force” them to complete or even being a task, they have been avoiding [11]. Instead, talk to them. Work with them. Let them know what you’ve been noticing and let them know that you want to help [11]. Speak to your friend and make yourself available to work on breaking down the daunting tasks into simpler ones or helping them come up with a reinforcement schedule that they think could help.
Finally, the most important thing you can do as a friend, as well as all other mental health issues, is to destigmatize the issue [11]. When your friend knows that you are not only there for them, but that you are actively standing without judgment, the symptoms of anxiety will lie to your friend and convince them that they are alone and that they are less because of these feelings. Even talking with your friend about your own personal experiences with anxiety on any level can be an enormous help. Most importantly, remember that this is not solely your responsibility. If they are willing, encourage them to seek professional help in a kind and supportive way.
Suicide
If you happen to know that a friend is considering suicide, the most important thing you can do for them is listen [17]. Comfort and support during an extremely difficult emotional time can be crucial [17]. There is no perfect script for working with a person who is suicidal—it is really just about showing the person that you are there to support them [17].
Making a safety plan should be a priority if a person confides in you that they are suicidal [6]. If they report to you that they are suicidal and that they have access to the means that they would use to kill themselves, a safety plan is necessary. If you do not feel qualified or comfortable implementing this, professional help is required. Studies have shown that to protect a person who is suicidal, removing the weapons or lethal means that they plan to use can be an effective strategy [6]. Again, however, if they are not interested in this option, professional intervention is necessary.
Following up with them and keeping in touch is an important way for them to know that they are wanted, supported, and accepted here [6]. Your contact may be an important lifeline for that person. This can also show that person that you can be trusted, should they ever feel suicidal again [6].
Working with a professional is often necessary in the case of suicide. Again, the phone number for the National Suicide Prevention Lifeline is 1-800-273-8255 and the link to the online-only chat is https://suicidepreventionlifeline.org/chat/. If you feel that you or someone you know is an imminent danger to themselves, you can call 911 and the police will safely bring that person to the hospital.
Eating Disorders
Dealing with a friend who has an eating disorder can be an extremely delicate situation [16]. The best way to begin the difficult conversation with your friend who you suspect of having the eating disorder is with “I” statements. Rather than “you’ve lost a lot of weight lately”, try to tell the person “I am concerned with how thin you’ve gotten” [16]. Be as careful as you can with phrasing. Remember that their objective is often to lose weight. You do not want to inadvertently reinforce their behavior.
The discussion will likely move naturally into an argument [16]. Do what you can to keep it civil and to avoid the argument [16]. Individuals who have eating disorders will often push you away by accusing you of being jealous, or that you may be attempting to sabotage their weight loss. You can assure them that you are there for their safety, but they will rarely believe that this is the case [16].
Even if you approach your friend in the gentlest way possible, it is still very likely that they will dismiss you or will respond angrily. No matter what the response, please remember that it is the disorder, not the friend. Anger, rejection, and denial are all major parts to eating disorders [16]. If the concerns persist, and if your friend continues to react to you in a similar way, it may be a good idea to reach out to campus authorities or a counselor [16]. Eating disorders can be a form of slow-motion suicide. It is extremely important that you intervene as early as possible. [16].
Addiction
Finally, proactivity is extremely important with addiction. The longer that you allow the addiction to persist, the more difficult it will be to retrieve yourself or your friend from its clutches. As I mentioned above, please feel free to contact your university counseling center or any other professional mental health services when you believe it to be necessary. Frequently, universities have policies set up to protect those who come forward requesting help, rather than punishing a person for acknowledging their shortcoming and asking for the necessary help.
In addition to seeking professional help when you believe it to be necessary, regulating yourself and reminding your friends to take it easy occasionally may be greatly appreciated in your future. While there is nothing wrong with the occasional drink, it is important that you and your friends do not become mired in a difficult situation.
This article is not exhaustive on all mental health concerns for college and university students. There is an incredible range of stressors and mental health issues plaguing we college and university students. Please know that you are not alone in your struggle and that there are people and resources out there for you. We are students of a profession based around helping others. As both human beings and emerging psychological professionals, remember to take care of each other.
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