1. Home
  2. »
  3. College Resource Center
  4. »
  5. Mental Health in College: Recognizing Warning Signs and Getting Help

Mental Health in College A Student’s Guide to Recognizing Disorders, Seeking Help and Promoting Wellness

Going to college is a dream for millions of Americans, yet those with psychiatric disabilities may question if it’s even a possibility. While mental illness may add extra considerations to the process of attending college, there are many options available to turn this goal into a reality. Current college students utilize campus mental health services more than any generation before them, showing that students are taking charge of their mental health and that colleges have services in place to help. In this guide, learn more about common mental illnesses, support systems, and how to request accommodations.

Reviewed by: Dr. Michael Alcee

Meet the Expert

Insider Perspective

Written By:

The State of Mental Illness on College Campuses

Mental illness is a serious issue on today’s college campuses, and the statistics below give readers a sense just how much these students depend on comprehensive support mechanisms at their schools.

A study by the American Psychological Association (APA) found that approximately 86 percent of students with a psychiatric disability left school without completing their degrees.

Source

Some 80 to 90 percent of college students who commit suicide had not received assistance from their college’s counseling center.

Source

In an APA study of 275 faculty members, 56 percent said they didn’t know how to work with students who had ‘hidden’ disabilities.

Source

Almost a third of all college students said they had been so depressed in the previous year that they struggled to function.

Source

Mental Health Issues Affecting College Students

Only in recent decades has mental illness lost some of its taboo status. For centuries the topic was swept under the rug, but as society has evolved, it’s become part of the national conversation. Half a century ago, college may have seemed impossible to students with psychiatric disabilities, but today’s campuses are rapidly working to improve and expand mental health services and create environments that are welcoming to students coping with mental illness. In addition to having on-campus psychiatrists and counselors, nonprofit organizations are also starting to develop campus chapters. Below are some of the common mental illnesses seen on college campuses.

Addiction and Substance Use Disorders

Like other forms of addiction, overdependence on drugs and other substances is due to a complex brain disease that causes individuals to continue overusing substances even though this behavior causes harm to themselves and to those around them. Statistics show that approximately 80 percent of college students have abused alcohol, while the abuse of drugs like Xanax and Valium increased by 450 percent between 1993 and 2005. The causes of addiction are multi-faceted and intertwined, and include genetic predispositions, environmental factors, and the use of drugs that are known to be highly addictive.

Substance abuse in college can quickly derail a student’s future if it goes unchecked, but it doesn’t have to be that way. Learn more by reviewing our guide about Substance Abuse in College.

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a common medical condition characterized by differences in brain development and activity that can affect how a person behaves. A study in the academic journal Neurotherapeutics found that approximately 25 percent of all college students with disabilities have been diagnosed with ADHD – either as a child or once they entered college. Researchers are still trying to understand the underlying causes of ADHD, but the latest studies suggest that there could be a genetic connection. Studies have also shown that boys are three times more likely to be diagnosed than girls.

  • Inattention.

    Individuals with ADHD are frequently distracted and typically have a hard time staying focused on a single task.

  • Disorganization.

    Those with ADHD may find it difficult to keep their homes or workspaces organized and may struggle with meeting deadlines or following through with activities.

  • Hyperactivity.

    Sitting still for long is hard for individuals with ADHD, and they are often fidgety or restless, making sedentary activities like reading or writing challenging.

  • Impulsivity.

    Acting without thinking is a common symptom of ADHD and can manifest in things like talking out of turn, speaking too loudly, or not being able to keep to a budget.

Anxiety Disorders

There are multiple types of anxiety disorders, and while some are less severe, they can all affect a student’s ability to thrive in college. A 2013 study found that anxiety is the most common problem among college students who seek mental health help, with approximately 42 percent presenting with concerns in this area. Research on causes is still ongoing, but most scientists believe anxiety disorders develop from a combination of factors such as brain chemistry, genetics, life events and personality.

  • Generalized Anxiety Disorders.

    The most common form of anxiety, GADs are usually identified by chronic bouts of anxiety, excessive tension and nervousness, and feeling consistently worried or on edge.

  • Obsessive Compulsive Disorders.

    OCD causes people to become completely preoccupied with something – to the point of obsession – and subsequently develop compulsions around that thing. Individuals with OCD feel a strong need to engage in a certain behavior (like turning lights off and on, straightening pictures, or counting road signs), even if they can’t articulate their reasons for doing so.

  • Post-traumatic Stress Disorders.

    As the name suggests, PTSD is a form of anxiety disorder that results from either directly experiencing or witnessing a physical or emotional life trauma. Individuals with PTSD typically have triggers that cause fear or stress and may have panic attacks about something similar happening again.

Bipolar Disorder

Individuals who have bipolar disorder (formerly called manic-depressive disorder) experience dramatic shifts in their mood, energy levels, and ability to even face the outside world. There are several different types of bipolar disorders; some are relatively mild while others require hospital care. Exact numbers on how many college students are affected by bipolar disorder are unavailable, but the Depression and Bipolar Support Alliance states that the median onset age for this disease is 25, meaning that many cases will develop during the college years. Causes of bipolar disorder are still being researched, but scientists believe it’s due to a combination of genetics as well as the physical operations that are specific to an individual’s brain.

  • Mania or Hypomania.

    If someone is experiencing a manic episode, they are typically uncharacteristically upbeat, have increased energy, are more self-confident than usual, need less sleep, are very talkative, become easily distracted, and tend to make poor decisions.

  • Major Depressive Episodes.

    Someone experiencing a major depressive episode feels empty, sad, hopeless, and may even contemplate suicide. They lose interest in everyday activities, stop eating, experience insomnia, are restless, and battle intense feelings of worthlessness.

Eating Disorders

Although uninformed individuals may think eating disorders are a lifestyle choice, the reality is that they are documented psychiatric illnesses that are extremely dangerous and can prove fatal if left untreated. Eating disorders result from distorted perceptions of body image coupled with obsessive behavior involving food. The Multi-Service Eating Disorders Association found that 15 percent of women aged 17 to 24 have some type of eating disorder, while 20 percent of college students said they have or had an eating disorder. Many factors can contribute to the development of an eating disorder; some of these include irregular hormones, genetics, body dysmorphia, peer pressure, stress, and trauma.

  • Anorexia Nervosa.

    Anorexia is characterized by an individual’s overwhelming fear of weight gain and their constant need to limit food intake. Individuals with anorexia also have an unrealistic view of their bodies and can’t see that they are severely malnourished.

  • Bulimia.

    Bulimia is a cyclical disease that revolves around binge eating and then purging food through forced vomiting or taking laxatives/diuretics, and over-exercising. Individuals with bulimia are typically highly secretive, and even close friends or family may not know that the person is suffering, creating feelings of shame and guilt for those with the disease.

  • Binge Eating Disorder.

    Binge eating disorder follows the same binging pattern as bulimia but does not include the purging. Individuals with BED lose control of their eating and can consume tens of thousands of calories in one sitting. These individuals are at risk of becoming obese, and of developing related problems such as cardiovascular issues.

Depression

More formally known as major depressive disorder, depression is a medical illness that causes feelings of sadness, loneliness, and the inability to go about life. Data from the 2013 National College Health Assessment found that approximately one-third of all college students had trouble functioning due to depression within the previous 12 months, and many also had increased anxiety due to the depression. Like other mental illnesses, researchers don’t precisely understand what causes depression, but they believe that biological differences, brain chemistry, hormones, and inherited traits all play a role.

Suicide

Individuals diagnosed with depression or bipolar disorder can experience intense feelings of hopelessness, worthlessness, and sadness – to the extent of thinking about suicide. Controlling the symptoms of a mood disorder can be a long, daunting process. To learn more about the many resources available on university campuses, read our guide to Suicide Prevention in College.

Get Help!

The National Suicide Prevention Lifeline is open 24/7 and can be reached at 1-800-273-8255. You can also call 911 for immediate local help.

  • Seasonal Affective Disorder.

    As the name suggests, SAD is a form of depression that is typically tied to fall and winter, as days become shorter and sunlight is limited. Individuals typically come out of seasonal affective disorder once the seasons change but may need assistance managing it during the colder months.

  • Dysthymia.

    Dysthymia is usually characterized as a mild form of depression that lasts at least two years. Individuals with this type of depression are the least affected when considered along the spectrum, but still may require long-term lifestyle changes, medication, and therapy.

Self-Injury

Unlike a suicide attempt, self-injury typically isn’t used as a means of ending one’s life but rather as a way of causing self-harm. Common forms of self-injury include cutting, burning, or otherwise mutilating the surface of the body. A 2006 study by Cornell and Princeton universities found that 20 percent of female and 14 percent of male college students said that they have self-harmed themselves in one or more ways, although only seven percent sought medical help. According to information from Mayo Clinic, the causes leading to self-injury include an inability to deal with psychological pain in healthy ways, or having trouble regulating and expressing emotions.

  • Scars.

    The self-injured may show signs of old cuts, piercings, carvings, or burnings on their body.

  • Clothing.

    Individuals may habitually wear long sleeves or pants, even in hot weather, to cover up parts of their body that have been injured, either recently or in the past.

  • Instability.

    Self-injuring people may find it difficult to convey their emotions or talk about what they’re feeling, and they may demonstrate instability in their behavior and emotions.

Sleeping Issues and Disorders

Sleep issues involve any type of disorder that prevents an individual from falling asleep or makes it impossible for them to stay asleep for a reasonable length of time. A study of almost 2,000 college students during the 2007-08 academic year concluded that more than a quarter were at risk for a sleep disorder. There are many different types of sleep disorders, so nailing down causes is easier said than done, but some of the most common include medical issues, psychiatric disorders, and environmental problems.

  • Narcolepsy.

    Individuals with narcolepsy experience extreme sleepiness or drowsiness during times when they typically don’t sleep. This can be accompanied by sleep attacks, sleep paralysis, hallucinations, and, in some cases, an inability to control muscles.

  • Obstructive Sleep Apnea.

    OSA is the most common form of apnea and is characterized by the upper airway being partially or totally blocked during sleep. Because of this, the muscles in the diaphragm and chest must work harder to pump air into the lungs. Individuals with OSA are often startled awake by gasping, snorting, or jerking of the body.

  • Primary Insomnia.

    Unlike secondary insomnia, primary insomnia causes trouble sleeping although it is not connected to another health condition. People with this sleep disorder often struggle to fall asleep and stay asleep, wake up before they are fully rested, and feel tired right after they rise.

Schizophrenia

Schizophrenia only affects one percent of the population, but higher numbers are seen in college students, as this is the age range when the disease typically first presents itself. The majority of men who have schizophrenia see onset during their late teens to early twenties, while it emerges in women a bit later, when they are in their late twenties and early thirties. Schizophrenia is a serious, incurable psychiatric disease that causes individuals to experience hallucinations, delusions, cognitive issues, lack of motivation, and trouble producing clear thoughts. Some of the causes researchers have identified include genetics, brain chemistry, and environment.

  • Disorganized thoughts.

    These thoughts typically manifest themselves in speech that is disorganized to the point of not being understandable.

  • Delusions.

    Delusions occur when someone is convinced something is real when it’s not. Examples may include feeling like you’re being followed, that something bad is about to happen, or that someone is harming you.

  • Hallucinations.

    Similar to delusions, hallucinations occur when someone affected by schizophrenia believes they are seeing or hearing things that don’t exist. The moment feels as real as any other to them, making it impossible to distinguish what is real and what is not.

Accommodations & Academic Adjustments for Students with Mental Illness

Tens of thousands of students on college campuses receive accommodations each academic year for a variety of reasons. It’s a relatively common practice, so students shouldn’t feel uncomfortable asking for help, or that they’re putting a burden on academic or administrative staff. In fact, institutions that receive state and federal funding are required to provide reasonable accommodations and adjustments for students with mental illnesses and disabilities as outlined in the Americans with Disabilities Act (ADA) and the Individuals with Disabilities Education Act (IDEA). Keep reading to learn about various types of accommodations, and what your rights are.

Knowing Your Rights

Any secondary or postsecondary school that receives public funding must provide reasonable accommodations. While Section 504 of the Rehabilitation Act of 1973 deals with elementary, middle, and high schools, the ADA and IDEA acts address college students and adults.

Interested in learning more about general rights for college students with disabilities? Check out this guide that addresses common questions and concerns.

The Realities of Mental Illness in College

Psychiatric disabilities and mental illness can interfere with learning, especially when students don’t have a plan in place to manage their condition. While no two individuals with mental illness are the same, it helps to understand the realities for these students, and how mental illnesses can impact their college success. Aside from managing the other pressures of college, those with psychiatric disabilities often contend with a whole host of additional frustrations, distractions, and debilitating symptoms. Some of the more common are outlined in this section.

Almost every drug prescribed to treat mental illness has at least one negative side effect that can disturb a student’s everyday life. Some of the most common side effects include nausea, sleepiness, blurred vision, headaches, dizziness, tics and tremors, seizures, and changes in vision.

Unlike normal pains like headaches that usually subside with rest and a bit of pain medication, those with mental illnesses may experience chronic aches or pains that are immune to treatment.

The majority of college professors use attendance policies to ensure students aren’t missing more than 10 percent of classes, but what happens when a student experiencing depression, panic attacks, or a bipolar episode can’t get to class? Excused absences can cover these issues, but students may be required to show proof to have the absence recorded as excused rather than unexcused.

Students who either weren’t aware of a mental illness or didn’t make plans for how to best take care of themselves before coming to college, may reach a breaking point if they don’t advocate for themselves. Walking around campus with the burden of a psychiatric disability can be all-consuming; don’t be afraid to voice your need for accommodations, personal health days, specialized housing, or specific meal plans.

Because symptoms associated with psychiatric diseases can often be unpredictable (e.g. panic attacks, hallucinations, narcolepsy), some students may feel the urge to shut themselves off from friends and family to avoid what they feel is embarrassing or shameful.

On top of feeling like they don’t have a support system, some students elect not to disclose their mental illness. While that choice rests with the student, they should remember that it’s not necessary to go it alone. Professors, administrations, and health clinic professionals are there to help you succeed.

Types of Accommodations

A number of accommodations are available specifically to help students with psychiatric disabilities navigate their course load and achieve success. Schools like the University of Washington provide in-depth information on what’s available, and your school may have something similar available through the Office of Disability Services. Some services include:

  • Preferred seating.

    This type of accommodation allows students to sit where they will be most comfortable, such as near an exit, making it easier for them to leave class if necessary.

  • Additional breaks.

    Students who struggle to focus or experience extreme drowsiness can benefit from being allowed to come and go during the class session.

  • Separate exam rooms.

    Students who suffer from test anxiety, panic attacks, or other disabilities that make exam day particularly stressful can be given a separate, quiet room.

  • Written exams and presentations.

    Rather than requiring a student with anxiety or panic disorder to give an oral exam or presentation, professors can accommodate their disability by letting them submit the assignment in writing.

  • Use of tape recorder.

    Students with ADHD, narcolepsy, or other disabilities that make it difficult to stay focused can benefit from recording the lecture and then listening to it later.

  • Deadline extensions.

    Students dealing with depression, insomnia, high anxiety, or many other forms of psychiatric disabilities may not be able to turn in an assignment by the due date. Professors can give them extra time to complete the assignment after they’re feeling better.

  • Completing work at home.

    If coming to class seems too overwhelming, in some cases professors may email materials to students, so they can review the topics and complete assignments without having to attend the lecture.

How to Request Academic Accommodations

The process for requesting accommodations is likely to be slightly different at each college, but generally includes the following steps:

  • Identify who to speak to

    The majority of colleges have offices devoted to disability services, but students can also check with the campus health center or with a college mental health counselor.

  • Fill out an application

    This can usually be done online and submitted to the office or department that handles such requests.

  • Provide documentation

    Before an accommodation request can be honored, students need to submit the paperwork that formally documents their psychiatric disability. This is usually supplied by your doctor or a psychiatrist/psychologist/counselor.

  • Schedule an appointment

    Once the paperwork has been approved, students need to meet with a representative from the office to discuss the type of accommodations that may be helpful. In general, accommodations which are deemed “reasonable” are approved quickly. If an accommodation isn’t approved, students can discuss the issue further to explore alternatives or appeal the decision.

I would argue that while the number of students experiencing mental disabilities hasn’t increased, more students are getting diagnosed and treated, and identifying themselves as someone with a mental health issue. As the stigma of mental health decreases, more people will be open about their conditions, where previously they might have remained undiagnosed.

Dr. Sal Raichbach, PsyD

Finding Mental Health Support On- and Off-Campus

Managing mental illness while in college can feel like a never-ending balancing act, but students don’t have to do it on their own. A wide range of support groups and resources are available both on campus and in their local communities to help them cope.

Counseling centers.

Cornell College and Amherst College provide excellent examples of the type of counseling services students should look for on their own campus. Individual and group counseling, medication management, and urgent care services are all commonly available.

Disability centers.

Disability centers – such as those at Rutgers University and Wheaton College – often work hand-in-hand with counseling centers to provide complementary services. Some of these include assessment screenings for psychiatric disabilities, approval of accommodations, and academic coaching/accountability.

NAMI On Campus.

The National Alliance on Mental Illness maintains campus clubs at hundreds of colleges throughout the country and provides a range of services. In addition to offering a space where students with psychiatric disabilities can meet, the group also raises mental health awareness; educates faculty, staff and students; and advocates for comprehensive campus services.

Campus mental health centers.

The Center for School Mental Health at the University of Maryland is a great example of how programs can provide indirect services that ultimately benefit and support students with mental health issues. Georgia Tech is also leading the way: the school recently pledged $1 million in funds to support the creation of new mental health programs and support systems.

Campus advocacy groups.

Campus advocacy groups are vitally important in raising awareness about the issues students face, and in lobbying campus leaders to provide adequate services. Some of the meaningful programs to come out of these efforts include the University of Michigan’s MiTalk and Campus Mind Works, and Columbia University’s Go Ask Alice! team.

Online support communities.

In addition to campus-based support groups, there are online groups for students who may not want to have face-to-face discussions. The Mental Health America organization has a support group and discussion community, while Active Minds provides a similar service.

Apps.

Scheduled counseling sessions and group activities are important components of ongoing mental health, but some students need more frequent, day-to-day support. Depending on the severity of their symptoms, students may benefit from apps such as Breathe2Relax (iOS/Android) or Headspace (iOS/Android).

Online mental health education and advocacy.

Students and their families looking to learn more about psychiatric disabilities or support resources can find more information via a variety of online education and advocacy groups. Some of the ones to check out include Cure Alliance for Mental Health, the U.S. Department of Health and Human Services’ mental health portal, the Depression and Bipolar Support Alliance, and the Brain & Behavior Research Foundation.

Confidential online resource centers.

Some students are ready and willing to openly discuss their psychiatric disabilities while others prefer to be anonymous when they seek help. A range of discreet online resources are available, through portals at ULifeline and the JED Foundation.

Treatment locators.

Despite all the best campus- and community-based resources available, some students may find that they need more intensive care – and that’s okay. The Substance Abuse and Mental Health Services Administration offers a behavioral health treatment services locator, as does Choices in Recovery and Mental Health America.

Mental health is a hot topic for colleges and universities, and more resources than ever are being dedicated and used by the student population. For example, student with a severe anxiety disorder might not have been able to even attend college in the past. Now, with on-campus resources and advances in treatment, they have that option.

Dr. Sal Raichbach, PsyD

Online Learning for Students with Mental Illness and Disabilities

Online learning has grown exponentially in the previous decade, and hundreds of colleges and universities in America now offer both individual courses and full degree programs that can be completed without ever visiting campus. Because some students with psychiatric disabilities may be unable or uncomfortable attending traditional, on-campus programs, distance learning can be a great alternative.

Why might online learning be a good option for students with mental illness?

Depending on the individual student’s needs and the severity of their psychiatric disability, online learning can be an ideal way to strike a balance between managing their illness and still attending college. Many colleges now offer courses asynchronously, meaning students don’t have to be online at a specific time to listen to lectures or interact with their peers. Rather, course material is available 24/7 in pre-recorded and digital text formats, so students can complete assignments and review lectures at times that best suit their schedules. They also don’t have to worry about navigating campus, sitting in a classroom, taking tests with others, or giving oral presentations.

It depends on the college. While some larger institutions have taken great strides in ensuring that every student – regardless of whether they attend on campus or online – has access to counseling and disability services, it’s not universal. Students should consult with potential schools to learn what services they make available to online students, and how they are accessed.

Disclosing a disability to professors is a decision that every student must make for themselves. While some are open about their disability, others are quite private — either way is okay. Disclosing a disability to a professor can be beneficial, as they will often be empathetic and offer to help.

Finding a good online program if you have a mental illness relies heavily on research. While institutions like the University of South Carolina provide dedicated mental health support to all online students, other schools may not be as progressive. Before enrolling at any college or university, it’s a good idea to email the counseling center or office of disabilities to find out which services they make available to distance learners.

To learn more about online degree programs, check out this guide.

Amanda Hill: Overcoming My Psychiatric Disability & Conquering College

Amanda resides in Nashville, Tenn., and has worked as a proposal writer for a healthcare information technology company for the last seven years. She attended Belmont University from 2006 to 2012, completing her master’s degree in English Writing. Through her a career as a writer and her personal experiences, she’s developed a passion for building relationships and human connections.

When did your panic attacks start and how did they impact your studies?

I was about eight years old. One day it just hit me, and things didn’t feel “normal” anymore. It’s been off and on ever since. During my junior year of college, my anxiety got really bad. It started to affect every part of my life. This is when it developed from anxiety to panic disorder, which meant I had panic attacks over the course of the day, one wave after another, until my body exhausted itself enough to feel relaxed but also drained. That semester I had to drop out of a few classes to really regain a lot of myself.

What triggers your anxiety?

My anxiety is often triggered by times of extreme change, like moving or family issues, where my environment feels different. I’m also a late reactor, meaning I can keep it together during the actual shift and then as I settle into a routine with those changes, the growing pains affect me, and it takes me longer to adjust.

The thing about anxiety is while it may start with an actual fear or worry, once you have one panic attack it’s a ripple effect. You start worrying about worrying. Maybe you started worrying about not being okay, and then the anxiety became the thing you were worried about – a self-fulfilling prophecy.

What resources did you use to manage college while dealing with your illness?

I found a therapist who gave me tools that really worked for my way of thinking, which was to break down the anxiety in steps and phases to isolate the physical feelings of an actual panic attack. I also made the decision to go on a low dose of Lexapro. Also, even though I chose therapy and medicine, the best long-term solution for me has been exercising. Diverting my energy into something more productive made my panic attacks far less severe.

What were your personal challenges and saving graces?

One of my biggest challenges was trying to bottle everything up and tie it in a perfect little bow so no one saw what was going on. For a time, it worked to pretend nothing was happening. I would be sitting in a living room with people, having an anxiety attack, and no one could tell. But my anxiety was never triggered from social interactions. I’ve always been extroverted, and often my anxiety attacks were triggered from being completely by myself.

Talking it out with people around me was and is my saving grace. I, like many, was ashamed of how I felt, which is a huge part of the stigma associated with mental illness. I was so wrong. Opening up to people, whether it was my mother or my therapist, changed the course of my college experience and saved me from falling even deeper into a hole. I came out of that experience knowing how to best manage my mental health for the rest of my life.

What tips do you have for other students attending college with a psychiatric disability?

Speak up and realize that pretty much every single person deals with a mental health issue in their lifetime. Our lives depend on connecting to each other emotionally, and our mental health is an integral part of that. Talking to a professor about your struggles can help. Chances are they will get down in the trenches with you and help you figure it out.

Also, take a step back if you need to. I never thought I would need to take a few steps back on my education in order to manage my mental health, but it was completely necessary. I will never regret decreasing my workload during that time yet persevering to continue my education. We all hit a point where we need to lay out our issues and pick up the pieces, and that is completely okay.