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Learn the signs and symptoms of depression, anxiety, eating disorders and others — and find resources that lead to a happier and healthier college career.

This guide helps to identify the signs and symptoms of common mental health issues for college students and where and when to seek help. Left untreated, these issues can become debilitating for students, so whether you feel you are experiencing these issues or find yourself concerned for a friend or peer, it is important to take action now.

Research conducted by the National Alliance on Mental Illness on mental health on college campuses shows that:

While there are certainly growing concerns over other mental health issues affecting college students today, this article covers the prevalent issues of depression, anxiety, suicide, eating disorders and addiction. Our guide is not a substitute for treatment, but it will help you find resources that lead to a happier and healthier college career.

Please note that in any situation, it may be difficult for you to approach a friend regarding these illnesses. People do not like to be told when they are sick, what they are feeling or what to do. When it comes to several of these conditions, it is important that you, as a friend, are aware of what’s happening, but know that the decision to get professional help is ultimately your friend’s choice. You should be supportive and patient, but adding too much pressure to a friend with any of these diseases could make it worse.

If you find that you’ve developed one of these mental health ailments, try to remember that your friends are looking out for your best interests. They want you to be well, and they are not attacking you. Talking about your problems with someone close to you may seem like a daunting task, but try to let them help you until you are ready to seek the professional help you need to get better.

Depression

Depression among college students wears many faces, and, in a survey conducted by the Association for University and College Counseling Center Directors, 36.4% of college students reported they experienced some level of depression in 2013. Depression is the number one reason students drop out of school, and is a gateway issue that, if left untreated, could lead to other symptoms or suicide. Depression is a common but serious illness that leaves you feeling despondent and helpless, completely detached from the world. It interferes with your life, making it difficult to work, study, sleep and eat.

Depressive illnesses are disorders of the brain and are likely caused by a combination of genetics, biological, psychological and environmental factors. According to the American Psychological Association, there has been a significant increase in the number of students seeking help for serious mental health problems at campus counseling centers since the mid-1990s, with depression at the forefront of the concerns.

Symptoms

Symptoms for depression differ from person to person. It is caused by a chemical imbalance in our brains, so the way one displays depressive signs is not, necessarily, the way symptoms emerge in others. There will be similarities, but how each person reacts and behaves is determined by how they handle change, where they are in their lives and their proclivity to becoming depressed. Symptoms of depression may include, but are not limited to:

We all face some of these issues from time to time, but that does not automatically mean you or your friends are depressed. However, if you begin to experience these symptoms with some regularity, or several symptoms consecutively, you may want to consult your school’s mental health center. Identifying these issues in others can be tricky, as students often downplay or simply never talk about something deeply bothering them, often due to insecurities, fear of standing out or embarrassment.

Incoming college freshman are often told that college is the best four years of their lives. You have a new independence to do what you want, within legal bounds, and are free to explore who you are and what interests you most. But with that are many factors, like making friends, getting along with roommates or choosing classes for a specific semester, where you may feel you have little to no control.

The stresses of being away from home, managing coursework and finding your path can lead to intense feelings of inadequacy. You may feel helpless, as if you are just going through the motions, especially when you realize you’re not having the collegiate fun everyone insisted you would. These feelings, left unchecked, can lead to depression. With that in mind, it is important to understand how to both recognize the signs of depression and how to keep yourself healthy.

Recognizing the Signs

Recognizing the signs of depression in yourself and others can be tricky. Everyone has off days, or times when they become overwhelmed with life, but most well-adjusted people will bounce back in short order. Those days when you or your friends feel down or less excited about getting out of bed should not be cause for alarm. However, when days become weeks, and simply getting out of bed becomes a struggle, there is real cause to worry.

What Should You Do If You Start To Notice Signs of Depression in Your Friend?

If you begin to notice signs and symptoms of depression in a friend, there are several steps you can take to get them help. Here are some signs of depression to look for:

It almost goes without saying that you won’t have all the answers, but you can be a good listener when they attempt to discuss their issues. Offering words of encouragement shows your friend you are a source of support rather than one of criticism or judgment. Avoid telling your friends to “cheer up” or “snap out of it.” Many who are depressed are aware of their condition, and telling them to get over it, even with good intentions, is not helping. They often don’t have control over how they feel during their downward turns.

It is important to seek help from professionals for any level of depression, so if you feel your friend is at risk, encourage them to seek help and offer to accompany them, be it to a student health center or a doctor’s appointment. While talking through their issues with you may be helpful, it is not a substitute for treatment; depression can worsen or lead to a number of other mental illnesses if left untreated.

How Do You Know if You’re Depressed?

It’s important to understand your own susceptibility to depression. Knowing how you handle stress, feelings of isolation, homesickness and heartbreak may help you realize when you’re becoming depressed. For many who are already depressed, however, it’s difficult to look inward. Depression can be a cycle of dark thoughts and feeling worthless, and soul searching or self-awareness may not always be possible, but it is important that you try.

Ask yourself the following:

If you answered yes to any of the above, you may want to contact your primary healthcare provider or your student health center for a mental health assessment. If you feel comfortable speaking with a friend or relative about your concerns, have someone help you research treatment options and accompany you to your campus health center. A support group could also be beneficial; the Depression and Bipolar Support Alliance has a geographical locator for support groups in your area. The Anxiety and Depression Association of America also offers a set of useful support tools.

Depression Resources

Those who suffer from depression often feel as if they are alone and have no one to turn to. That is never the case. The following organizations are dedicated to providing resources for those living with depression:


Anxiety

In moderation, stress and anxiety are a part of most people’s lives. Simply experiencing these feelings does not mean you have an anxiety disorder. Anxiety disorders occur when anxiety interferes with your daily life, halting your ability to function, and causing an immense amount of stress and fearful feelings. The Anxiety and Depression Association of America (ADAA) reports that anxiety disorders are the most common mental illness in the U.S.; they affect 40 million adults over the age of 18, yet only one-third seek and receive treatment. The ADAA goes on to say that nearly 75% of those affected by an anxiety disorder will experience their first episode before the age of 22. Anxiety disorders can include, but are not limited to:

Symptoms

Symptoms of anxiety disorders can be mistaken for everyday stress or written off as someone worrying too much. Panic attacks may be mistaken as a physical ailment, such as a heart attack or tension headache, depending on how your body responds to the increased levels of certain chemicals. Symptoms manifest differently in each person, so what is true for you won’t be true for a friend. Common symptoms for anxiety disorders may include:

The causes of anxiety disorders aren’t completely understood, but they could include genetics, naturally occurring brain chemicals, life experiences or stress. If you experience extreme anxiety around exams, it may simply be test anxiety. There are generally affordable treatment options available to students on campus, and the ADAA has a list of low cost treatment plans and resources available to you. With the number of ways to get help, there is no reason you shouldn’t.

Recognizing the Signs

One of the most important things to remember about anxiety disorders is that brief and occasional flashes of anxious feelings or behavior do not automatically indicate a mental illness. If the anxious feelings persist, or if they begin to manifest in obsessive behavior or an overwhelming sense of fear, it is time to seek help for yourself or your friend.

What Should You Do if You Start to Notice Signs of an Anxiety Disorder in a Friend?

College students must deal with a variety of stressors. Such sources of stress don’t necessarily cause anxiety disorders, but they can worsen the symptoms. While anxiety disorders are the most common mental illnesses affecting the U.S. today, identifying signs in others can be difficult, as symptoms can seem like normal stress or anxiety, depending on your own perceptions of what constitutes stress. It can be hard to separate yourself from your own biases, but it’s important to first recognize how much experiential variance there is for an illness as common as anxiety.

Your friend may be suffering from an anxiety disorder if they:

If you believe someone may have an anxiety disorder, be an active listener when they are feeling stressed or anxious, and help them research next steps. Avoid criticizing or belittling the severity of their anxious symptoms and encourage coping strategies that avoid the issues or cause further anxiety. Encourage your friend to visit your campus health care center and seek help from a professional. If your friend is reluctant to seek treatment, you can consult a mental health care provider for suggestions moving forward.

How Do You Know if You Have an Anxiety Disorder?

While every college student might get anxious and experience stress around exams, if you begin feeling riddled with guilt or experience frequent anxiety or panic attacks, this could be cause for concern. Distinguishing the difference between regular stress and a disorder can be difficult, so it is best to consult your healthcare provider if you feel you might be developing an anxiety disorder. Here are some questions to ask yourself:

If you answered yes to any of the above questions, you may want to consult your primary healthcare provider or contact your student health center for a mental health assessment that can help determine if you are experiencing an anxiety disorder. The ADAA has put together a list of coping techniques to help students living with anxiety. Anxiety disorders are highly treatable, and if you feel you are suffering, take your mental health seriously and contact a professional today.

Anxiety Resources

The following organizations are excellent resources for students suffering from anxiety disorders. Each organization provides information on the different forms of anxiety and resources that explore approaches to coping.


Suicide

College can be a stressful time. Feelings of guilt, hopelessness and despair can build when students don’t take steps to cope with stressors. Suicide is defined as the act of deliberately taking one’s own life, and it is the second leading cause of death among college students. In a 2011 report from Centers for Disease Control and Prevention, there were 39,518 suicides reported in the U.S., making it the 10th leading cause of death that year.

Statistics show that 10% of college students has thought about or made a plan to commit suicide. There are over 1,000 suicidal deaths on college campuses in the U.S. every year, as reported by Emory University. It’s important to note that most students who are suicidal suffer from depression or other mental illnesses. Many students experience frustration and doubt, but sometimes those thoughts gain a frightening momentum, bringing students to a place where they seriously consider ending their lives.

Recognizing the Signs

Though it sometimes seems like a desperate act, one that came without warning, there are often clues that tell when someone has reached that level of hopelessness that makes them believe taking their life is the only way out. The signs aren’t always as clear in everyone, and they differ from person to person. Common suicidal warning signs include:

A majority of college students who take their lives have a diagnosable and treatable mental illness. Causes for suicidal behavior vary drastically but can include:

What Should You Do if You Start to Notice Suicidal Behavior in Your Friend?

If you are concerned a roommate, friend or peer is suicidal, contact your campus counseling center immediately. Students who are suicidal often communicate their intent to those around them, so be aware of signs of depression and do not take their actions lightly; you could save a life.

Here are signs to watch for in students with suicidal behavior:

If any of the behaviors listed above are present in your friend, it’s important you talk to them about your concerns as soon as possible. They could be in a fragile state, so approach them with patience and help them seek out a mental health professional. If you’re unsure how to approach your friend, you can consult online suicide prevention programs for specific advice; if you feel the situation is an emergency, it may be best to immediately call 911 or another urgent care service.

How Do You Know if You Are Suicidal?

Suicidal thoughts often stem from a preexisting mental condition. Depression, which makes your outlook on life bleak, can lead to suicidal thoughts. Feeling completely overwhelmed and helpless from anxiety may also lead you down this path. Mental illnesses left untreated can have dire conclusions. Here are some questions to ask yourself:

If you answered yes to any of these questions or are having thoughts about killing yourself, tell a friend or call your mental health center. Suicide is a preventable tragedy, and if you’re feeling alone or hopeless, it’s important you seek help.

Suicide Prevention Resources

There are many resources available to you through your student health center on campus or through the following organizations dedicated to preventing suicide:


Eating Disorders

Millions of college students – both women and men – develop eating disorders during their college years, and a vast majority does not seek help or don’t realize the extent of their issues.

Eating disorders are extreme behaviors, emotions and attitudes that revolve around food and weight issues. These disorders cause serious mental and physical problems that can result in life-threatening issues when left untreated. According to statistics provided by the National Association of Anorexia Nervosa and Associated Disorders (ANAD):

Though the numbers do not often reflect the number of males who suffer from eating disorders, they are nearly as likely to develop a disorder as women. Due to cultural views of eating disorders, however, they don’t often seek treatment; bulimia and anorexia are seen as women’s issues.

Common eating disorders include:

Symptoms

The signs and symptoms of eating disorders vary by person and condition; many depend on the mental state of the individual suffering from the disorder. However, there are several red flags that are common factors for anorexia, bulimia and binging.

Many college students do not seek treatment for their eating disorder, nor do they believe they’ve developed a problem. Eating disorders are potentially life threatening and can contribute to serious health issues if not treated properly, including:

Recognizing the Signs

We all have days where our self-image isn’t the best. We look in the mirror and sigh because all we see are our flaws. We sometimes don’t eat, forget to eat, or eat junk when we’re stressed or have an over-full schedule. Though there are signs you can watch for in yourself and your friends to determine an eating disorder, you should remember that few and random occurrences of each do not mean someone is at risk.

When the random complaints about weight become all a friend can focus on, or when you notice you’ve started skipping meals and binging on junk food and then feeling guilty afterwards, you may want to approach this topic. If you’re worried the behavior in a friend may have been going on long before you noticed, ask them gently about their eating habits. If you fear your friend won’t respond well to your concern, or you’re worried they will react poorly, you can contact a professional who will walk you through how to broach the subject. It may not be easy for you to get your friend to talk about their problems because no one likes to be told they’re sick.

What Should You Do if You Think Your Friend is Developing an Eating Disorder?

Eating disorders aren’t just about eating and weight; they come with underlying stress management and self-esteem issues. Many college students with eating disorders don’t seek treatment because they are unaware of the severity of their disorder, or they might be avoiding treatment by refusing to acknowledge they have a problem. When caught at an early stage, eating disorders are highly treatable, so it’s important to let your friend know your concerns shortly after you notice signs of a disorder.

Here are some signs to look for that could indicate an eating disorder:

If you answered yes to any of these questions, your friend could be developing an eating disorder. Many college students and young adults a negative body image during their college years. While this is certainly a sensitive time, don’t let worries underscore the importance of valid concerns. If you need help approaching your friend, consult the National Eating Disorder Association, and get matched with someone trained to assist friends and family address eating disorders with their loved ones.

How Do You Know if You Have an Eating Disorder?

Recognizing that you have an eating disorder is often the first step to recovery. Many who develop a disorder feel a pressure to be thin or a certain weight, have a distorted or very poor body image, or the stress in their lives makes them feel out of control. In order for you to see these things in yourself, you must be willing to take a long, hard look at your behavior, moods and health. Here are some questions to ask yourself:

If you answered yes to any of these questions, or believe you have an eating disorder, do not delay seeking treatment. Eating disorders can become life-threatening, and it’s important to receive treatment as soon as possible.

Eating Disorder Resources

If you need assistance helping a friend through an eating disorder, or if you need to understand more about them before you come to terms with the fact that you may have one, the following list of resources are a good place to start. Each organization provides information on getting help for yourself and a loved one.


Addiction

Partying and engaging in alcohol and drug use has become commonplace on many college campuses throughout the U.S., but for some students, what starts as a social tradition can become a full-fledged addiction. An addiction is defined as a dependency and repeated abuse of a substance such as drugs or alcohol. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that:

Between 1993 and 2005, there was a 93% increase in the use of stimulants like Ritalin and Adderall on college campuses. These drugs have become popular for the boost of energy and concentration they provide around exams. In the 2012 National Survey on Drug Use and Health by the U.S. Department of Health and Human Services, it was reported that 21.3% of young adults between 18 and 25 used illicit drugs. Of that same age group, 3.8% admitted to using psychotherapeutic drugs for non-medical purposes.

Symptoms

Many students who participate in alcohol and drug use in college do not develop an addiction, but they will feel the side effects of withdrawal or prolonged use of the substances. Those who do become dependent on alcohol or drugs could show the following signs:

If you begin to experience one or several of the symptoms above, you may be at risk. Genetics contribute to your likelihood of developing an addiction, especially if there is a history of alcohol or drug abuse in your family. If you find yourself turning to drugs or alcohol more frequently to absolve feelings of stress or sadness, contact your student health center to learn more about addiction and the next steps available to you on campus. It is important to know and understand that addictions need to be taken seriously and treated effectively with the assistance of a professional healthcare provider.

Recognizing the Signs

Recognizing the signs of addiction can be difficult, especially if you’ve never witnessed or experienced them first-hand. It’s not always clear when alcohol or drug use has turned from recreational to habitual, and those who don’t want to admit they have a problem will use tactics that evade and undermine your worry.

What Should You Do If You Believe Your Friend Has An Addiction?

Engaging in alcohol and drug use in college is incredibly commonplace, making it more difficult to identify signs of an addiction from the outside. Many students don’t believe, or refuse to admit, they’ve become addicted to a substance due to the pervasive drug and alcohol use and abuse on college campuses. However, if you are concerned, there are ways to determine if your friend has developed an issue.

Ask yourself the following:

Drug and alcohol addicts often conceal their symptoms or downplay their addiction, so it’s important you express your concerns when you notice the warning signs. The earlier they seek and receive help, the greater chance they have at a successful return to sobriety. When they are sober, tell your friend you’ve noticed their excessive drug or alcohol use. Emphasize the positive sober behavior you admire and the destructive drunk or high behaviors you’re concerned about. Do not be accusatory or judgmental, as this might cause your friend to withdraw and further ignore their issues. Offer to go with them to seek treatment at your student health center, and consult resources online.

How Do You Know if You’ve Developed a Drug or Alcohol Addiction?

College is a great time to meet new friends and engage in social activities, but if your drug or alcohol use has been negatively affecting your everyday life, you may be at risk for developing an addiction.

If you’re concerned, contact your mental health care provider to take an assessment, and ask yourself the following questions:

If you answered yes to any of these questions, or believe you have an addiction, consult your student health care center today and find out what your options for treatment are on campus. Addiction is a serious growing crisis for college students today, and can be effectively treated with the help of a trained healthcare professional.

Addiction Resources

Consult these resources available to you to find out more about curbing your addiction today:


Glossary of Treatments

Treatment for any of the conditions found in this guide should be discussed with your healthcare provider. Do not begin a medication regimen without first consulting your doctor or therapist. These professionals will help determine your dosage or if you can find recovery through therapy. Please remember that not all treatments work for everyone; only by talking to a professional can you determine the proper choices to consider.

Psychotherapy – Depression, Anxiety, Suicide, Eating Disorders and Addiction

Psychotherapy involves talking to a professional therapist, counselor or Psychologist to find the root cause of a problem, learn ways to cope, and avoid relapsing into unhealthy habits and tendencies. There are two overarching branches of psychotherapy: Cognitive-Behavioral Therapy (CBT) and Interpersonal Therapy (IPT). CBT involves altering internal perceptions. Therapists who use CBT work emphasize positivity in their patients’ lives. IPT focuses on external factors that may cause individuals to fall into a depression or develop an addiction. IPT counselors work on pinpointing toxic relationships and offer ways to make them better or end them safely. Under psychotherapy treatment, you will also find the following forms of therapy included or overlapping: family therapy, psychodynamic therapy, DBT therapy and EMDR therapy, to name just a few approaches.

Medication – Depression and Anxiety

Often reserved for severe cases, antidepressant and antianxiety medication are prescribed by a healthcare provider or licensed Psychologist to patients who aren’t responding to psychotherapy alone. In many cases, antidepressants are given to those with anxiety disorders, but it is recommended that those on medication continue to talk through their problems with a professional. It is important to be patient when beginning a new medication; you might not feel the effects until your body has had a chance to fully acclimate to the new chemicals.

Support Groups or Group Therapy – Depression, Anxiety, Suicide, Eating Disorders and Addiction

This kind of treatment works with small groups of individuals suffering from similar conditions; groups are led by one or two Psychologists. Sharing your experiences with others who understand what you’re going through and where you’ve been ― and hearing their stories as well ― can help you realize you’re not as alone as you once thought. These groups become support systems able to help you put your fears, concerns and actions into perspective. The groups can also be a way to befriend people who will help you if you find yourself relapsing into old, unhealthy habits.

Inpatient Treatment – Eating Disorders and Addiction

Inpatient treatment occurs with patients in a hospital or rehabilitation center 24/7. For the extent of their care, patients live in close proximity to nurses and doctors who are able to help them get better. People suffering from eating disorders or addictions that have reached an extreme level are often admitted into a treatment facility in order to get better. In many ways, inpatient treatment is similar for both illnesses; patients are supervised during the day, attend group and individual counseling sessions and receive treatment that will teach them healthier ways to cope. Inpatient care for eating disorders often involves monitored meals to help with weight gain or the adoption of proper eating habits.

Outpatient Treatment – Eating Disorders and Addiction

Outpatient care allows patients to live at home and go to a treatment facility during the day. Some outpatient treatment is more intensive and requires patients to be at the hospital or rehabilitation center for several hours, while others require patients to visit counselors for a few hours every other day or so. For addicts, outpatient treatment consists of longer sessions with counselors – between two and four hours – to prevent relapse. Those with eating disorders also meet their therapists, but some are required to meet with nutritionists and dieticians to plan meals. More intensive outpatient care for individuals with eating disorders can last between eight and twelve hours and consist of two monitored meals.

Detoxification Programs – Addiction

When overcoming addiction, the withdrawal process can be intensely grueling. Detoxification programs, which usually consist of medically-managed withdrawal, help patients through this trying time; they are, in effect, the first step to recovery for addicts. Cleansing the body of all toxins does not fix the problem, so one of the above steps is often included in addiction rehabilitation to prevent relapse.


Know Your Rights as a Student

There has been much discussion on the lack of effectiveness or support from universities on the growing mental health crisis on campus. Both schools and students have the same goal of getting mental health treatment to students in need, but both are having a difficult time finding middle ground. Students are becoming increasingly aware of the fact that more and more of their peers are being reprimanded for reporting their crises to healthcare center professionals, sometimes being kicked off campus and forced into hospitalization, even though their crisis didn’t necessarily require them to do so. A recent Newsweek exposé related the story of a Princeton student whose rash decision to overdose, a clear sign of mental distress, was met by the university’s decision to force the student to withdrawal, sticking his family with a hefty bills for his few weeks of attendance at the school.

The Americans with Disabilities Act (ADA), and other federal disability laws, prohibits discrimination against students whose psychiatric disabilities “substantially limit a major life activity.” It also mandates that colleges and universities provide students with “reasonable accommodations,” such as less school work and extended deadlines, provided they can meet nondiscriminatory academic and behavior standards. The ADA also stipulates that the student’s disability must not pose a significant risk of harm that cannot be mitigated by reasonable accommodations.

Many universities are coming under fire for what is perceived as an improper response to a growing mental health crisis, stating they must abide by U.S. health laws and regulations, while also working to create a positive mental health community for their current and future student bodies. While colleges must abide by certain rules and regulations to keep students living on campus safe from harm, this does not give them the right to discriminate against mental illness, so take a moment to better understand your rights as a student via the following governmental resources:


In Conclusion

It is important to take your mental health seriously and to seek help if you think you or a friend is at risk. If someone you’re related to has suffered from a mental illness, know that your genetics could be a factor in your development of a mental condition. Research your mental health treatment options on campus, and get involved with support groups, or consult your student health center to learn more about student wellness. Take charge of your life on campus, and take the first step towards a healthy college career.