College Students and Mental Health: Part 1, Common Stressors

This is the first post in a three-part series in which I share my insights into college students’ behavioral health. In Part 1, I talk about what stressors students face. In Part 2, I examine coping skills students use to get through, and in Part 3, I share what parents can do to help.

In my practice before COVID, I mostly saw college students struggling with anxiety, depression and motivation. Those things haven’t changed. But now, I'm seeing some added stressors.

I see social isolation, struggle with online learning, and a different kind of relationship with parents. Because I also work with parents, I hear how they’re struggling as well. Parents expected their kids would graduate from high school, hang out for the summer, and then head off to college. The pandemic messed this plan up for millions, and now parents are stressed, too.

Over the years of working with college students, I’ve seen a steady increase in anxiety and depression. I’ve also seen more students struggle with motivation issues. Drug use has surprisingly stabilized, if not decreased. Overall, many students seem to not have that drive to push through the challenges of tests, homework, projects and the typical stressors associated with college. There seems to be a lack of grit. This is not a moral judgment or the musings of an old man in a rocking chair, fist held high in the air. It’s all based on observations within my practice and a review of college student mental health research.

Additionally, students are on social media 24/7. Comparing to others and the fear of missing out eats their brains and messes with their sense of belonging and self-worth. Snapchat and Instagram, among other apps, only amplify their struggle. I’ll talk more about all of this and the clinical perspective below.

One quick note before we move on. Throughout this first post, we examine mental health diagnoses, all of which are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This is the official, evidence-based listing of all mental health diagnoses, which I’ll reference several times. For more details on the DSM-5, check out my painfully long blog post on the manual and its history ​here​.

Anxiety

It will not come as a surprise that nearly every student I work with has anxiety. Some don’t use words like anxiety but describe symptoms that add up to anxiety (e.g., persistent racing thoughts, elevated heart rate, trouble sleeping).

I won’t go too deeply into diagnostic details here, but I will give you a sense of the basic types of anxiety and what it means for college students. It’s essential for parents to have a general understanding of whether their college student is experiencing something typical (such as stress over a group project) or something that requires more professional support.

Within the DSM-5, there are five types of anxiety disorders:

1. Generalized Anxiety Disorder — Chronic and excessive fear/concern, often with physical tension, even when there is little or nothing to provoke it
2. Obsessive-Compulsive Disorder — Recurrent, intrusive thoughts or repetitive behaviors
3. Panic Disorder — Unexpected and repeated episodes of intense fear and physical symptoms that include chest pain, racing heart, shortness of breath and dizziness
4. Post-Traumatic Stress Disorder — The brain’s response to a terrifying event in which significant physical harm was possible or occurred
5. Social Anxiety Disorder — Overwhelming fear and excessive self-consciousness in typical social situations

Generally speaking, a normal stress response is the perception that a situation is stressful — as if there is a gap between what the person can control and the desired outcome. Feeling nervous for a test is typical but doesn’t necessarily feel good. There may be a fear of failing. It’s not anxiety but a very appropriate response to a situation that doesn’t have a predictable outcome.

On the other hand, anxiety is the brain perceiving that the problem is not only something closer to a mortal risk but also that they have almost no control. There is also the belief that the situation is not finite but may last indefinitely.

So basically, stress is normal and actually helps activate us for a task. Anxiety is an unhealthy perception that a stressor is more severe and more permanent than reality would indicate. Anxiety is persistent, although at times it may be quietly pulsing in the background.

This may all seem harmless but can cause significant problems when our fear starts driving our behavior. Anxiety can make students avoid hanging out with friends, check their grades or attend class. Anxiety convinces us not to take any chances, to lay low, and to retreat from normal life so we don’t get hurt (or see something scary like a bad grade).

Another way to think of anxiety is that it’s the brain’s alarm system working overtime, not having an off switch, and misinterpreting regular stressors as significant threats. I think of it like walking into a dark room with the lights off. The person with a healthy perception might feel a bit nervous as they search for the light switch. The person with anxiety believes there is something dangerous in the dark despite intellectually knowing there are no monsters. Their focus narrows, their heart rate increases, and their fear takes over. Their brain gets more and more freaked out as they look for the light switch. The person with anxiety gets sucked in while the other person can recognize their fear but doesn’t have it take over their thoughts and choices.

The final difference between the two is that, once the person without anxiety leaves our metaphoric room, their fears subside and they go back to baseline functioning. In contrast, the person with anxiety feels that they never really left the dark room (or more accurately, the room never left them). No matter where they go or what they do, anxiety is always there.

Depression

Next up in our list of student struggles is depression. Each year around 30% of college students are diagnosed with depression, according to researchers.

Those are the students who contact a professional and get diagnosed. It’s probably an underestimate. Way more have depression than are diagnosed. Nearly every student I work with has some form of depression. Almost all of them have thought about suicide. Nearly all of them feel hopeless.

College students also rarely share with their parents just how depressed they feel. Parents may notice behavioral changes well before hearing that their son or daughter is hurting so much. More on this later in the blog series.

Depression is not the same as feeling sad or a response to a bad event. It’s the experience of feeling despondent for weeks/months/years at a time.

Eight specific depression disorders listed in the DSM-5, including:

• Disruptive Mood Dysregulation Disorder
• Major Depressive Disorder (including Major Depressive Episode)
• Persistent Depressive Disorder (Dysthymia)
• Premenstrual Dysphoric Disorder
• Substance/Medication-Induced Depressive Disorder
• Depressive Disorder due to another medical condition

Motivation

For over a decade, I’ve said that of all the challenges I work with college students on, motivation issues are the hardest to overcome.

There’s usually a history of being accused of laziness as if the student was morally deficient or just a slacker. However, research in the last few years has found there is a definitive neurological basis for why so many people struggle with motivation. Without going into too much depth, the essential brain chemical associated with motivation seems to be dopamine. Dopamine, once thought to be the "pleasure" chemical, turns out to be more of a "motivator" chemical. It’s the chemical the brain starts pumping when we need to be activated — for example, if we are stepping into the street and a bus nearly hits us, prompting us to jump back.

What’s the difference between laziness and motivation issues? Laziness is an avoidance of responsibility with intention. Laziness can be overcome with a little nudge and has more to do with choice and privileging other more exciting options.

Real motivation issues are a deep trench within which we feel stuck. I work with so many students who sincerely want to get stuff done but can’t get started or can’t complete a task.

Drug Use

Most of what’s being used by college-aged young adults are prescription drugs (though students may not be the one with the prescription) like Xanax, Klonopin, Valium and Ativan. These all are benzodiazepines and super addictive.

College students are also using weed (marijuana) and vaping, which create among other issues can lead to breathing problems and increased anxiety (yes, weed increases anxiety over the long term).

Though alcohol is still totally abused, it’s been on the decline. College students figured out years ago that professors aren’t big fans of students reeking of alcohol in class. Instead, weed (especially combined with vape pens) and pills were more convenient ways to get high without anyone knowing.

That’s it for Part 1, and our review of the most common behavioral health issues college students face. Next time we’ll talk about how students can develop healthy coping skills and get through the next semester.