Expert Contributors

  • Ross Aikins
    Ross Aikins


  • Scott Carroll
    Scott Carroll, MD

    Eating Disorders

  • Melissa Cohen
    Melissa Cohen, LCSW

    Stress & Anxiety

  • Dr. Kevin Doyle
    Dr. Kevin Doyle


  • Dr. Damon Raskin
    Dr. Damon Raskin


  • Steve Schlozman
    Steve Schlozman, MD

    Suicide & Depression

  • Michele Tedder
    A. Michele Tedder, MS Nursing

    Suicide & Depression

According to a study by the Higher Education Research Institute at UCLA, emotional health issues have become more common among entering freshman. In 2014, the proportion of students who said they felt frequently depressed rose to 9.5 percent. These students reported missing class more frequently than their non-depressed classmates and also reported feelings of disengagement. For students reporting emotional trouble, the transition to college life can be challenging. From newfound freedom to the rigors of college-level coursework and everything in between, the pressure and stress can take its toll. The following guide is designed to help college students identify, address and get help for mental health issues.

Mental Health Issues Affecting College Students

Suicide & Depression

If a suicide attempt seems immediate, call 911. If the threat is urgent, you can also call the National Suicide Hotline at 1-800-273-TALK, 1-800-SUICIDE, your local crisis center, dial 911, or take the person to an emergency room. Remove guns, drugs, knives, and other potentially lethal objects from the vicinity but do not, under any circumstances, leave a suicidal person alone.

It’s important to approach the issues of depression and suicide in a holistic, thorough and in-depth manner, so we’ve created a Suicide and Depression Awareness Guide for Students.

Please see our guide, where you’ll find our suicide prevention resource tool along with suicide warning signs, in-depth commentary from our experts and more.

Stress and Anxiety

Because stress and anxiety can show up or become worse during the college years, we’ve created a Student Guide to Surviving Stress and Anxiety in College & Beyond.

Please be sure to check out this comprehensive guide to find out more about stress and anxiety in college and learn about resources and tools available to manage and treat stress and anxiety.

College Addiction

Alcohol and drug abuse at college has become a significant public health problem, resulting in injuries, assaults, sexual abuse and deaths. In addition, drinking and drug use is often associated with academic issues, unsafe sex and drunk driving.

For in-depth information on a variety of college addiction issues, including prescription medication abuse, please visit our Guidebook to Addiction on College Campuses.

Eating Disorders

Eating disorders affect both women and men and are often triggered by major life transitions, such as going away to college. College students are particularly susceptible for a variety of reasons. The National Eating Disorders Association (NEDA) reports that full-blown eating disorders typically begin between 18 and 21 years of age, which is exactly the time many of those affected would be attending college.

To learn about the different types of eating disorders, warning signs and where to get help, please visit our Student Eating Disorders Awareness Guide.


Self-injury is when an individual deliberately harms his or her body without the intent to die from suicide. It is a way for those who engage in the behavior to deal with overwhelming emotions. The consensus among mental health providers in college settings is that incidents of self-injury have increased over the past several years, possibly because of the lack of coping mechanisms and more stressful situations young people face.

Incidents of self-injury are increasing rapidly among young adults. Individuals who practice self-injury behaviors routinely cut their skin with razor blades, scissors and other sharp objects until they bleed. Sufferers explain that causing physical pain is a release—that it’s a way to break through the numbness felt with depression and the pain from self-loathing, emptiness, rage and guilt.

The release from self-injury is temporary, because it doesn’t address the underlying issues. In addition to the physical scars, the act of cutting is isolating, which perpetuates many of the emotional issues. It is also easy to accidentally cause serious injury by misjudging the depth of a cut. Not treating the wounds properly may also lead to infection. On top of those issues, cutting can become an addiction.

Cutting isn’t the only self-injury behavior. Other ways individuals intentionally hurt themselves without attempting suicide include:

  • Burning or scalding
  • Head banging
  • Throwing body against walls
  • Breaking bones
  • Pulling hair out
  • Sticking objects in skin
  • Preventing wounds from healing
  • Swallowing poisonous substances

Symptoms of Self-Injury Behavior

People who harm themselves often hide scars, cuts and bruises with clothing, making it difficult to notice. In addition to unexplained wounds or scars, flags to look for include:


You may observe frequent disappearances to bedroom or bathroom for long periods of time.


They may get angry quickly and snap at you for what seems like no good reason.

Frequent “accidents”

They use stories about accidents to explain physical marks and wounds.

Blood stains

You may find stained clothing and bedding, along with bloody tissues and towels.

Covering Up

They may wear long sleeves and pants despite warm weather.

Sharp Objects

You may notice the sudden appearance of cutting tools such as razors, bottle caps, straightened paper clips and needles.

Self-Injury Treatment and Prevention

If you are practicing self-injury behavior, the first thing you need to do is get help. Admitting your problem can be scary, but it’s important to find an adult you can trust. Contact your campus counseling center.

If you’re not sure where to turn, call the S.A.F.E. Alternatives information line in the U.S. at (800) DONTCUT for referrals and support for cutting and self-harm.

Counseling also allows individuals to get to the root of what is causing the pain in the first place before it leads to major depression, substance abuse and suicide. Anti-depressants are prescribed to help with depression, if needed. Therapy can also help you find out what your triggers are so you can avoid them.

In addition to addressing the root of the problem, treatment for self-injury also involves finding replacement behaviors to stop the cutting and learning new coping mechanisms. Some people find wearing a rubber band to snap when they get the urge to cut can be helpful. Drawing on the skin in red felt tip marker and applying ice to mimic the cutting sensation are other replacement behaviors.

Other replacement behaviors include:

  • Keeping a journal
  • Vigorous exercise such as kick boxing
  • Listening to music
  • Punching a pillow
  • Taking a bath
  • Tearing up a magazine

Helping a Friend or Roommate Who Self-Harms

Finding out that someone you care about is harming himself or herself can be quite a shock. If your friend or roommate is self-harming:

  • Acknowledge your own feelings

    It is normal to feel disgusted or scared but don’t judge. Your friend is probably already feeling guilt and shame.

  • Express concern

    Ask how you can help and listen carefully.

  • Encourage treatment

    Offer to help your friend set up an appointment with student services and to take him or her.

  • Whether you are in crisis or you have a friend in crisis, you can’t handle it alone

    Check with the student counseling center for information about crisis intervention support.

Resources for Self-Injury Awareness and Support

American Academy of Child & Adolescent Psychiatry: Self Injury in Adolescents

Includes a downloadable and printable document on the basics of self-injury. Includes how to recognize self-injury and where to seek out additional help.

International Society for the Study of Self-Injury

The ISSS is dedicated to advancing scientific understanding of self-injury and promoting assessment, treatment, education and policy.

Mayo Clinic: Self-Injury/Cutting

Offers in-depth information on self-injury, including symptoms, causes, treatment and risk factors.

National Alliance on Mental Illness: Self-Harm

Visitors will find information on therapeutic ways to deal with self-injury and ways to deal with stress without engaging in self-harm.

S.A.F.E. Alternatives

Provides educational and treatment resources, a professional network, webinars, lectures and more to help bring an end to self-injurious behavior

The Cornell Research Program on Self-Injury and Recovery

The program is dedicated to generate new research and understanding in self-injury. The site offers project information and provides links and resources to further help.

The Wall Street Journal: 5 Facts About Teen Self-Injury

Offers myths and facts about this “unfortunate coping strategy of our youth in the 21st Century.”

ULifeline: Cutting

ULifeline is an online resource for college mental health. The site offers an evaluation tool, resources, and more on self-harm.

Bipolar Disorder

Also known as manic depression, bipolar is an affective disorder involving unusual shifts in mood, energy and behavior. It is common to have dramatic fluctuations between a normal mood and depression or elation. Bipolar disorder makes it difficult for college students to perform academically and can have a strong effect on personal relationships.

There are two types of bipolar disorder:

Bipolar I

Repeated episodes of depression and mania—a severely elevated mood state that causes disruption to the individual’s functioning

Bipolar II

Recurrent depressive episodes with at least one episode of hypomania—less severe than a manic episode

Symptoms of manic and hypomanic episodes mania may include:
  • Excessively euphoric mood
  • Extreme irritability
  • Inability to focus
  • Rapid speech and jumping between topics
  • Decreased need for sleep
  • Aggressive behavior
  • Provocative behavior
  • Risky behavior
  • Denial that there is a problem
Symptoms of the depressed phase of bipolar disorder include:
  • Sadness
  • Social withdrawal
  • Lack of interest or pleasure in any activity
  • Loss of appetite
  • Physical complaints
  • Agitation
  • Fatigue
  • Hopelessness
  • Neglect of hygiene
  • Suicidal thoughts

Sometimes people with bipolar disorder experience a mixed episode, which includes symptoms of mania and depression at the same time. Feelings can include sadness and hopelessness together with agitation and high energy. If bipolar disorder becomes severe, it is possible to have symptoms of psychosis, such as delusions and hallucinations. Cyclical mood swings with less severe symptoms can signal a milder form of bipolar disorder called cyclothymia.

Bipolar I and II Treatment

There is no cure for bipolar disorder, but it is possible to manage your symptoms with treatment and lead a healthy productive life. Ignoring bipolar disorder will likely worsen symptoms and cause rapid-cycling between manic and depressive episodes.

Treatment of bipolar disorder involves medication and psychotherapy. Psychiatrists usually prescribe a class of medications called mood stabilizers, such as Lithium or Depakote. Anti-depressants may be used in conjunction with mood stabilizers but patients must be closely monitored to ensure they don’t trigger a manic or hypomanic episode.

You can manage your symptoms by focusing on:


In addition to keeping you physically healthy, eating a balanced diet increases mental and emotional stamina. Contact campus nutritional services to find out if your school offers nutritional counseling.


Lack of sleep is a trigger for manic and depressive episodes. There are so many social activities going on in the evenings when you are in college that it can be challenging to create a regular sleep routine, but it’s very important.

Avoid alcohol and drugs

Alcohol and drugs are also triggers for episodes of mania and depression. Avoiding them will help you to manage your symptoms.

Helping a Friend or Roommate with Bipolar Disorder

If your friend or roommate has symptoms of bipolar disorder:

  • Offer help

    If your friend has not been diagnosed, help him or her find a therapist.

  • Be understanding

    Regular sleep patterns and avoiding drugs and alcohol are an important part of managing bipolar disorder. Support your friend in these efforts.

  • Be patient

    Manic and depressive episodes are difficult to deal with when you live with someone who has bipolar disorder. Make sure to find outlets for your own stress.

  • Whether you are in crisis or you have a friend in crisis, you can’t handle it alone

    Check with the student counseling center for information about crisis intervention support.

Bipolar Disorder Resources

Bipolar Lives

Provides users with a self-test, treatment and support resources, symptoms to look for, and tips to help college students deal with bipolar disorder.

Depression and Bipolar Support Alliance (DBSA)

DBSA provides hope, help, support and education to improve the lives of people who have mood disorders. The website includes wellness options and peer support information.

Depression and Bipolar Disorder

Florida Institute of Technology published this brochure about depression and bipolar disorder treatment. It includes advice for seeking help.

University of Michigan Depression Center: Bipolar Disorder in College Students

Offers advice for college students on recognizing the signs and dealing with bipolar illness and depression.

Psychotic Disorders/Schizophrenia

Schizophrenia is part of a group of psychotic disorders that alter the ability to think, respond, communicate and behave clearly. Psychotic disorders are usually treatable.

There are a number of mental illnesses considered psychotic disorders in addition to schizophrenia, including:

Schizoaffective disorder:

Symptoms of schizophrenia and a mood disorder

Brief Psychotic disorder:

Short periods of psychotic behavior usually triggered by a stressful event

Delusional disorder:

Delusions that involve real-life situations that could be true (i.e. being followed, having a disease, being conspired against) for an extended amount of time.

The exact cause of psychotic disorders is unknown. Some experts believe the nerve cell receptors in brains of people with schizophrenia do not work properly when interacting with a brain chemical called glutamate, which can lead to abnormal thinking and perception.

Researchers have also discovered several factors that play a role. Many psychotic disorders run in families, which suggests that there is a genetic tendency. There are also many environmental factors that are involved, including major life changes such as going away to college, stress and drug abuse.

Symptoms of Psychotic Disorders

Symptoms can be severe enough to make meeting the ordinary demands of life impossible. Students with a genetic risk for schizophrenia are at risk for triggers because of the stress associated with being in college, such as being away from home for the first time and the increased academic demands. Symptoms of psychotic disorders vary and may change over time. The two major symptoms are delusions and hallucinations.

Delusions are persistent organized beliefs that remain despite evidence to the contrary. For example, a person with schizophrenia may believe they are being followed around campus, even though there is no reason to believe so and no evidence.

Hallucinations are sensory perceptions of things that are not really there in real life. Examples include hearing voices, feeling like you are being touched, smelling odors or funny tastes in your mouth.

Other examples of psychotic symptoms include:

  • Mood swings and mood symptoms such as depression or mania
  • Confused thinking
  • Disorganized speech
  • Poor personal hygiene
  • Slowed movements
  • Strange or dangerous behavior
  • Inability to express emotion
  • Irrational response to loved ones
  • Strange body positioning

Treatment of Psychotic Disorders/Schizophrenia

If you are having symptoms of psychosis get help immediately. There are no physical tests for psychotic disorders such as schizophrenia. If symptoms are present, doctors will first rule out a physical reason. Mental health professionals trained to diagnose and treat mental illnesses use interview and assessment tools designed for making a diagnosis.

Unless people with psychotic disorders are in danger of hurting themselves or others, or need stabilization, mental health professionals treat them as outpatients. Treatment includes antipsychotic medications and psychotherapy. Antipsychotics are not a cure, but can help manage symptoms such as delusions and hallucinations.

Helping a Friend or Roommate with a Psychotic Disorder

If your friend or roommate has symptoms of a psychotic disorder:

  • Talk

    Express concern, listen and support.

  • Get help

    Early intervention is important. Help them find a therapist and set up an appointment.

  • Be patient and accepting

    Living with someone who has bipolar disorder can be challenging.

  • Become educated.

    Learn all you can about psychosis and treatment.

  • Help maintain a structured and supportive environment.
  • Whether you are in crisis or you have a friend in crisis, you can’t handle it alone

    Check with the student counseling center for information about crisis intervention support.

Resources for Schizophrenia and Psychosis

Center for Early Detection, Assessment & Response to Risk: Early Signs of Psychosis

CEDAR published this guide for understanding early signs of psychosis. The guide includes answers to common questions about psychosis.

Headline News: Schizophrenic Harvard Student Pens Cry for Help

An article about a student at Harvard seeking support for schizophrenia in college.

Helping a Person with Schizophrenia published this guide about supporting people with schizophrenia. The guide includes tips for monitoring medication.

National Alliance on Mental Health: About the First Episodes of Psychosis

National Alliance on Mental Illness published this article about the onset of psychosis. The article includes warning signs and risk factors.

Raise: Recovery After an Initial Schizophrenia Episode

A research project of the National Institute for Mental Health (NIMH) seeking to positively change the trajectory and prognosis for those who have had an initial schizophrenic episode.


The transition from high to college is challenging for all students, but especially for those with Attention Deficit Hyperactivity Disorder (ADHD). Multiple distractions, high academic expectations and a new independence are difficult to manage when you have ADHD, which involves the inability to focus or control behavior out of the normal range for a person’s age and development. There are three types of ADHD:

ADHD Hyperactive-Impulsive Type:

Individual has hyperactivity and impulsivity

ADHD Inattentive Type:

Individual only has attention issues

ADHD Combined Type:

Individual displays hyperactivity, impulsivity and inattentiveness

Although researchers don’t know what causes ADHD, there appears to be genetic links. Prenatal issues such as smoking and alcohol-use during pregnancy and prematurity may also contribute to ADHD.

While ADHD is not a learning disability, it can still interfere with learning and behavior. However, some people with ADHD also have a learning disorder.

Symptoms of ADHD

  • Inattention to details
  • Careless mistakes
  • Daydreaming
  • Not listening when spoken to
  • Not following directions
  • Failure to complete activities
  • Poor organizational skills
  • Loses things needed to complete tasks (notebooks, uniforms, textbooks)
  • Forgetfulness
  • Fidgeting
  • Unable to sit still during class
  • Restlessness
  • Difficulty being quiet
  • Always “on the go”
  • Excessive talking
  • Blurts out answers
  • Difficulty waiting
  • Interrupting
  • Impatience
  • Difficulty with waiting

ADHD Treatment

ADHD is treated with therapy to address time management and organizational skills. Therapists also help people with ADHD to handle emotional issues such as anxiety and depression.

Some people with ADHD find medication works well to manage their symptoms. The Food and Drug Administration (FDA) has approved two types of ADHD medication: stimulants and non-stimulants.

Study at the same time each day.
Wear earplugs to tune out distractions.
Use a daily planner.
Use a smartphone or tablet to remind you of appointments and tasks throughout the day.
Play a white noise machine to block out distracting noises.
Develop a strict eating, exercise and sleeping schedule.
Manage transitions by setting aside extra time to prepare for tasks.
Break large projects into smaller tasks that are easier to manage.
Contact your campus disability center or counseling center to find out whether you qualify for accommodations.
Sign up for study skills programs and other academic support services offered at your college or university.

Helping a Friend or Roommate with ADHD

Living with someone who has ADHD involves certain challenges. It is important to deal with these issues when they first arise instead of waiting for them to build up. In addition:

  • Set physical parameters

    Define which space is yours and which is your roommates.

  • Discuss any changes to routine

    For example, if you will have visitors or overnight guest, let your roommate know ahead of time.

  • Keep common areas organized

    Try to keep shared spaces free of clutter and keep loud music to a minimum.

ADHD Resources

ADDitude: Strategies and Support for HDHD & LD

ADDitude magazine provides information and advice from leading experts and practitioners. The website includes answers to questions about ADHD, a community of individuals who share tips and experiences and first-person life stories.

Attention Deficit Disorder Association

The Attention Deficit Disorder Association is a non-profit organization that provides resources and support for people with ADHD. The website includes information and networking activities.

CHADD: Young Adults with ADHD

Includes several special section including “How to Select the Right College,” “Brilliant Minds with Learning Differences” and “A Professor’s Perspective: ADHD and College.”

National Alliance on Mental Illness (NAMI): Fact Sheet on Attention Deficit/Hyperactivity Disorder

NAMI is a grassroots mental health organization dedicated to building better lives for Americans affected by mental illness. This fact sheet includes signs and symptoms of ADHD.

National Resource Center on ADHD: Succeeding in College

Offers frequently asked questions from college students with ADHD and their parents, along with information on educational rights, scholarships and tips for students with ADHD to succeed in college.

Sleep Issues

There are so many benefits to sleep. Sleep restores energy, fights physical and emotional illnesses and strengthens memory. It is also necessary for normal motor and cognitive function. Unfortunately, college students are getting less sleep than they need. Most students get an average of six hours of sleep a night, or even less. The college years are often a time of sleep deprivation. Lack of sleep affects your health and mood as well as your safety.

The average adult needs 6-10 hours of sleep a night, but the amount varies. If you find yourself sleeping an extra two hours per night on weekends, it can be a sign you aren’t getting enough sleep during the rest of the week.

Consequences of sleep loss for college students include:

  • Feeling stressed
  • Weight gain
  • Illness
  • Increased risk of depression and anxiety
  • Automobile accidents
  • Lower GPA
  • Decreased athletic performance

The Connection between Sleep and Mental Illness


People with depression tend to feel fatigued on a regular basis, unable to engage in daily responsibilities without feeling burdened. They either get too much sleep as a way of escaping or too little sleep from insomnia.


Sleep is also difficult for people who have anxiety. Persistent, racing thoughts make it difficult to fall asleep. Even if they are able to fall asleep, it can be impossible to go back to sleep if they wake up during the night.

Sleep Disorders

There are several types of common sleep disorders:

  • Primary Insomnia

    Being unable to fall asleep 30 minutes after going to bed, three or more nights per week for four weeks. If you suspect you may have primary insomnia, see your physician.

  • Narcolepsy

    An inherited condition of excess sleepiness that causes temporary loss of muscle control and/or uncontrollable sleep attacks. Physicians treat narcolepsy with medication but there is no cure.

  • Obstructive Sleep Apnea

    This is when the soft tissue of the upper airway collapses repeatedly during sleep and cuts off breathing for short periods of time before the airway opens abruptly and noisily. Since your sleep is constantly interrupted, it leads to excessive sleepiness throughout the day. People don’t usually know they have sleep apnea until someone else tells them.

Signs of a Sleep Disorder

You may have a sleep disorder if:

  • It is difficult to fall asleep and you wake up during the night for several weeks.
  • You fall asleep at inappropriate times, even after a good night’s sleep.
  • Nightmares and night terrors frequently interrupt your sleep.
  • Sleep-walking is an issue.
  • Someone has told you that you stop breathing while you area asleep.

Make an appointment with a physician to rule out a medical reason. If you suspect your sleep problems are related to anxiety or depression, visit the school counseling center.

Setting a Sleep Routine

To manage any sleep disorder, it helps to establish a sleep routine. By creating a ritual that helps your mind and body wind down at the end of the day, you prepare yourself for sleep. Some things you can do to create a sleep routine are:

Go to sleep and wake up at the same time every day- even weekends- to get control of your circadian rhythms.
Avoid caffeine and alcohol 3-4 hours before bedtime.
Don’t eat within 2-3 hours of your bedtime.
Exercise each day but complete your workout at least 2 hours before bedtime.
Take a hot bath each night before bed.
Make sure sleep environment is dark, quiet, cool and comfortable.
Invest in a comfortable mattress and pillows.

Sleep Disorder Resources

Brown University: Sleep

Brown University’s Health Services published this article about sleep and college students. It includes advice on getting more sleep and a list of resources.

National Center on Sleep Disorders Research

The National Center on Sleep Disorders Research is located within the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health. The website includes public and patient information about sleep disorders.

National Sleep Foundation

The National Sleep Foundation is a membership organization. The website includes sleep articles, tools and tips.

SUNY Geneseo: Hot Topics! College Students and Sleep

The State University of New York at Geneseo published this article about college students and sleep. It includes strategies for combatting insomnia.

UGA Health Center: Sleep Rocks!

The University Health Center at the University of Georgia published this guide about the importance of sleep in college. It includes reasons why people need sleep and suggestions for getting more sleep.