Did you know that one of four college students was diagnosed with a mental health disorder in the last year? College students are experiencing anxiety, depression, alcohol abuse, and other mental health issues at alarming rates in a landscape of growing academic, social, and financial pressures. As a college mental health psychiatrist for over two decades and a mother of two twenty-somethings, Marcia Morris has witnessed the ways problems can derail students from their goals, while parent interventions at critical junctures can help get students back on track.
The Campus Cure: A Parent Guide to Mental Health and Wellness for College Students is a first aid guide to your child’s emotional health, preparing you to handle the mental health problems and emotional ups and downs many young adults experience in college. With anecdotes and the latest scientific literature, this book will increase your awareness of common problems, pressures, and crises in college; illustrate how you can support your child and collaborate with campus resources; and provide stories of hope to parents who often feel alone and overwhelmed when their child experiences a mental health problem. While you have the passion to help your child, this book will provide you with the tools to guide your child toward health and happiness in the college years.
|Publisher:||Rowman & Littlefield Publishers, Inc.|
|Product dimensions:||6.20(w) x 9.10(h) x 0.70(d)|
About the Author
Marcia Morris, MD, is a psychiatrist at the University of Florida with over 20 years of experience providing care to university students. She is currently an Associate Professor with the College of Medicine Department of Psychiatry and Associate Program Director of Student Health Care Center Psychiatry. Dr. Morris writes a parenting blog for Psychology Today called “College Wellness: Promoting Happiness and Health in the College Years” (https://www.psychologytoday.com/experts/marcia-morris-md). In articles and talks, she promotes preventive care and comprehensive treatment for mental illness in the college years and beyond. Her articles have been published in the New York Times, the Tampa Bay Times, The Conversation, Psychiatric Times, and Clinical Psychiatry News. She has appeared on Huffington Post Live and co-hosted a monthly radio show, Family Matters, on WOCA 96.3 FM/1370 AM in Ocala, Florida. A board-certified psychiatrist and Fellow of the American Psychiatric Association, she has published original research on suicide as well as obsessive compulsive disorder. Dr. Morris has made several presentations on college mental health, eating disorders, anxiety and depression at national professional meetings.
Read an Excerpt
The College Years Are Now the Age of Anxiety
The phone rings at 3 a.m. and you know it can't be good news. You hear your daughter's voice — she is breathing heavily.
"Mom, I think I'm having a heart attack."
Your daughter, Sara, a sophomore in college, tells you she is in the emergency room. She was studying late in the library when suddenly she could not catch her breath and had crushing chest pain. Feeling like she was going to pass out, she asked the librarian to call an ambulance. She starts to cry. "I've spent all of this week preparing for two tests tomorrow, and now I'm going to fail. And I'm upset because I just found out this guy I was seeing is hooking up with my roommate. I feel like my life is falling apart."
You listen to Sara sob from several hours' drive away. What would you do?
If you are a parent of a college student, you will get a call at some point late at night when your child's anxiety levels are sky high. For young adults today, the college years are truly the age of anxiety. Anxiety has surpassed depression as the most common mental health diagnosis in college students. Data from the spring of 2016 American College Health Survey tell the story of extreme anxiety on campus. One of six college students were diagnosed with or treated for an anxiety disorder in a twelve-month period. Three of five college students reported at least one episode of overwhelming anxiety and almost one of ten college students had panic attacks in the past year. In this landscape of anxiety, it is no surprise that one of four college students reported anxiety negatively impacted their academic performance.
Anxiety has become the bread and butter of college mental health. It is now the top reason students visit college counseling centers, affecting 57 percent of students seen. To help students better cope with anxiety, the center where I work offers several groups a year that teach mindfulness meditation techniques. In fact, my university celebrated its first Mindfulness Day last year and offered stress-reducing activities throughout campus.
WHY IS ANXIETY THE NEW NORM ON COLLEGE CAMPUSES?
Any student starting college would have some apprehension. He or she is away from parents and the structure they provide, taking challenging courses, meeting new people, and making his or her own decisions. But there is something different about today's college students. It's as if they are always swimming in a sea of anxiety.
At my own alma mater, Harvard University, pressure levels seem to have soared. When I went to my college reunion last year, I spoke with classmates whose children were currently students on campus. Their children were far more stressed out than we ever were. If we got a B, or even a C, we were still confident we would get a job or go to graduate school. We were less worried about finances. Our annual tuition, including room and board, was $11,000, a far cry from the $50,000 and more that students are now paying. Today, many students wonder if they will ever earn enough money to pay off their massive student loans. They fear for their economic future.
Finances, in fact, are the second most significant challenge that students face. Academics, not surprisingly, come first. When asked to endorse items that were traumatic or very difficult to handle in the past year, almost one-half of students endorsed academics and one-third finances. Intimate relationships, sleep problems, family problems, and career-related issues also caused significant stress in almost one-third of college students.
What is shocking is that half of the students endorsed three or more items as traumatic or difficult to handle. Students are feeling overwhelmed by multiple pressures. As a parent, you can help your child contain, manage, and reduce anxiety when confronting these pressures. Here is the story of what one mother did when she received a distress call from her daughter.
SARA'S STORY: A TALE OF EXTREME ANXIETY
When Alice receives the 3 a.m. distress call from her daughter, Sara, she wakes up with a start and her heart races. Alice worries she herself is going to have a panic attack; she hasn't had one in years, but she takes a few slow, deep breaths just in case.
Sara starts crying, and Alice says, "I think you're having a panic attack, not a heart attack. I had my first panic attack in college too."
"This feels different, Mom, like I'm about to die. Here, speak with the nurse."
The nurse confirms Alice's view, telling her the medical work up did not reveal any heart or lung problems. "She can visit the campus counseling center for her treatment. Don't worry, she'll be fine." Should I drive up or not drive up to visit Sara, Alice wonders. She gets her answer later that morning.
Sara calls her again, pleading, "You need to come right away and get me. I want to go home. I don't feel well. My chest hurts and I can't eat. I tried to have breakfast but I threw up. I'm too anxious to leave my room." Alice cannot convince Sara to visit the campus counseling center. She cancels her work day and begins the three-hour drive to campus.
Alice finds her daughter in her dorm room with a packed suitcase, looking gaunt and tired. Sara tells Alice she has been skipping meals, too anxious to eat. Alice is tempted to take her home, but then says, "Before you decide to leave school, give treatment a chance. I took medication for anxiety when I was in college, and it made a big difference." Sara reluctantly agrees to go to the campus counseling center as long as her mother comes with her.
As the on-call psychiatrist that day, I meet with Sara and her mother in my office. Sara is anxious to the point of extreme discomfort, shifting in her chair, not making eye contact, looking like she is on the verge of tears. Despite her distress, I feel very hopeful; the presence of a caring parent who knows when her child needs help usually tells me this young adult will have the support she needs to recover.
Sara haltingly begins to talk. "I really don't want to be on medication, but my mother thinks it's a good idea. Last night was not my first panic attack. I've been having panic attacks a few times a week since the semester began, but somehow I powered my way through them. Last night was different. The chest pain was so bad, I thought I was having a heart attack. Maybe I should see a cardiologist."
I tell Sara she could see a cardiologist, but the emergency room doctors thought the pain was related to anxiety and stress. Was she feeling especially stressed out lately?
Sara bursts into tears. "I'm majoring in biomedical engineering, but I'm not sure I want to do this for the rest of my life. It's too much work now. I think my boyfriend broke up with me because I didn't have enough time to spend with him. I see my roommates partying on weeknights and I'm lucky if I have time to go out on a Saturday night. I've been so anxious lately it's hard to eat and sleep. Maybe I should just go home right now."
I acknowledge Sara's heavy workload as an engineering student, but I advise her not to make any changes in her major under the influence of extreme anxiety. In fact, Sara is getting all As and enjoys the material she is studying. Sara is feeling distressed but is not suicidal in any way. Sara decides to stick with her major a bit longer.
I tell Sara I want her to do cognitive behavioral therapy to learn how to decrease her anxiety, but I also recommend she take a daily medication because her anxiety is so high. I prescribe her sertraline, an antidepressant that is also helpful for anxiety. Sertraline is a selective serotonin reuptake inhibitor (SSRI), which works by raising serotonin levels in the brain. I start her on a low dose, as she is already nervous about taking medication. I explain that the effect of sertraline gradually increases with time.
Alice looks at me. "Since sertraline may not work right away, would you consider prescribing a medication like lorazepam? I remember lorazepam being helpful for me when I was in college." Although I prescribe lorazepam infrequently due to the risk of abuse on a college campus, I agree with her mother's suggestion. Sara has no history of substance abuse and would likely benefit from using it short term until the sertraline takes effect.
For the next month, Alice visits Sara every weekend, knowing Sara is still feeling shaky about staying in school. Her mother's calm and reassuring manner helps Sara give treatment time to work. Sara also checks in with her parents daily.
Over the next several months, she battles her anxiety with great determination, doing individual and group therapy to learn specific anxiety management techniques. She diligently practices these skills, using breathing techniques and meditation to prevent full-blown panic attacks. She continues to take sertraline, no longer needing lorazepam.
Sara allows herself time to pursue nonengineering activities, even if that means getting an occasional B instead of her usual A. Then Sara takes a big risk and does something that she has always dreamed of: she forms a small band with two other engineering students and they perform at local venues. Sara is the lead singer. After her performances, she hangs out with friends. Sara tells me she has a passion for music, and listening to music is the perfect antidote for anxiety.
About a year after her ER visit, Sara feels she is ready to taper off the sertraline. Sara, the frightened and trembling sophomore, is now a calm and confident junior. Our work together ends until she reappears in my office during her last semester of senior year.
"I don't know what to do," she says. "I've been offered my dream job, but it's far from where my parents live. What if I need their help?" I then ask Sara to review how far she has come in coping with her anxiety. As for her parents, she now sees them infrequently, sometimes forgetting to call them until her mother texts, "Haven't heard from you in a few days. Everything okay?" And everything is fine. Sara now sees that life's possibilities are open to her, and she is ready to pursue them.
Sara had one of the most severe cases of panic disorder I have seen, but through her hard work and family support, she also had one of the best recoveries. I don't know if Sara's road to recovery would have been as smooth without the support of her mother.
THE FIVE THINGS SARA'S MOTHER DOES RIGHT
1. Recognizes the seriousness of Sara's symptoms and comes to her when she needs it the most. Sara's anxiety paralyzes her to the point that she cannot take steps to help herself.
2. Reveals her own struggles with anxiety. Anxiety has a strong genetic component and tends to run in families. By telling Sara about her own challenges, she normalizes and destigmatizes Sara's experience of anxiety, which is common in the college years.
3. Promotes medication, which may not be right for everyone but makes sense in this case, and therapy as tools to address Sara's anxiety. I have spoken to many parents over the years who have doubts about the value of medication or therapy. Sara's mother, with her own history of anxiety, understands that sometimes it takes multiple tools to recover from severe distress.
4. Remains hopeful and confident. She could have allowed Sara to come home, which might have reduced anxiety for both mother and daughter in the short term, but instead offers Sara a plan for staying in school and addressing her symptoms.
5. Provides follow-up support. Even as she encourages Sara to stay in school, she makes extra visits and phone calls to help her. She tapers these contacts as Sara becomes more calm.
Sara's story is an example of extreme anxiety, but there are other kinds of anxiety that can be distressing to college students. How do you know when normal anxiety goes too far?
ANXIETY: AN ALARM THAT WON'T TURN OFF
What is anxiety? Healthy anxiety is a warning signal that we need to do something. For example, college students should have some anxiety at least a few days before a test. Their worry or sense of discomfort will motivate them to study.
Maladaptive anxiety is a signal that won't go away even as you take action to reduce your anxiety. It's like an alarm that won't turn off. In a full-blown panic attack, you could have a feeling of dread along with uncomfortable physical symptoms like a rapid heartbeat, a feeling of lightheadedness, rapid breathing, tunnel vision, tingling sensations, or nausea. Symptoms peak in about ten minutes and could last as long as thirty minutes.
A panic attack is the worst kind of anxiety because by the time it starts it is hard to stop. Certain parts of the brain, including the amygdala, become overactive, causing the sympathetic nervous system to set off a fight or flight reaction. Normally, the parasympathetic nervous system kicks in and acts like a brake to the high level of activation. With a panic attack, the brake does not get applied in time.
Anxiety comes in many forms. The following are different kinds of anxiety disorders that college students experience.
Sara's story gives us a good idea of what panic disorder is. It means someone has recurrent unexpected panic attacks followed by at least a month of fear of having another one. Some students who have panic disorder will stop going to class, not wanting to feel trapped in a lecture hall if a panic attack occurs. Many of my patients with panic disorder get so anxious that they get nauseous, and they can have trouble eating, like Sara did. The constant fear of having another panic attack can make it hard to concentrate in school, and grades can be impacted.
Social Anxiety Disorder
Think of terms like "shyness" and "performance anxiety." College students with social anxiety get stressed out in situations in which they feel they are being judged, like in a social setting or a lecture hall. They might have trouble speaking up in class or get so anxious during an exam that they forget the material and fail. They might also feel anxious at a party where they don't know anyone and turn to alcohol to feel more relaxed.
We all might get socially anxious at times, so when does social anxiety cross the line into becoming a disorder? When symptoms occur for more than six months, cause major distress, and interfere in day-to-day functioning. A student with social anxiety disorder might have trouble making friends because he or she is too anxious to talk to new people or his or her grades might decline because he or she gets paralyzing anxiety during exams.
Generalized Anxiety Disorder
College is the perfect breeding ground for generalized anxiety disorder. Students face constant deadlines, unclear expectations from professors, and pressure to succeed from parents. They may have difficulty sleeping, feel tired or irritable, have muscle tension, and have trouble concentrating. The anxiety never turns off — it's as if an alarm keeps ringing at a low level, reminding the student to study more, do better, and make more friends.
For the anxiety a student commonly experiences to be considered a disorder, the anxiety must be distressing and last for at least six months. It interferes with school, relationships, or both. Many of my patients with generalized anxiety disorder get irritable when they are anxious and may argue with a loved one. If your child is arguing with you, the underlying emotion might not be anger but anxiety.
DOES TECHNOLOGY TRIGGER ANXIETY?
In the previous section, I talked about anxiety as an alarm that won't turn off. Many of our technological devices are miniature alarms, constantly pinging, vibrating, and beeping to let us know we have received texts, e-mails, and Facebook posts. Are they sources of anxiety?
College students have told me about the impact of technology on their anxiety levels.
I was traveling in Europe this summer and visited some places without cell phone reception. I felt so much more relaxed without the constant texting. Sometimes I feel like my life would better if I didn't have a cell phone at all.
I was trying to fall asleep last night, but then I got a text from a woman I just broke up with. We texted back and forth for two hours, and I started to have a panic attack. I finally blocked her from texting, but then her roommates group texted me. I finally put my phone on do not disturb and went to sleep.
I've been extremely anxious the last two weeks and it's hard to sleep. I have group projects in two online classes and I can't get anyone to agree to a time when we can all chat online and discuss our parts. The project is due in three days and we haven't gotten anything done.
Technology can be very distracting and prevent us from being in the moment. I think mindfulness meditation techniques have become more popular in response to the constant distraction of technology. Mindfulness, one of the best treatments for anxiety, is the concept of being in the moment and paying attention to what is going on inside and around you in a nonjudgmental way.
Students tell me social media in general increases their stress level. They feel insecure when they see pictures of a student having fun at a party, going on a great trip, or getting a prized internship. They experience FOMO (fear of missing out) and walk around with a feeling that they are just not good enough. In chapter 6, I will review how the pursuit of perfection increases anxiety and other mental health issues.
Excerpted from "The Campus Cure"
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Table of Contents
Part I. Problems
Chapter 1. Anxiety: The College Years are Now the Age of Anxiety
Chapter 2. Depression: When College Is Not the Happiest Time in Life
Chapter 3. Substance Use Disorders: Should You Just Say No When It Comes to Drugs and Alcohol?
Chapter 4. Academic Failure to Thrive: Attention Deficit Disorder and Other Ailments
Part II. Pressures
Chapter 5. Loneliness: The Importance of Social Belonging in College Success
Chapter 6. Perfectionism: The Dangers of Duck Syndrome
Chapter 7. Culture, Sexuality, and Gender Challenges: A Time to Heal
Chapter 8. Financial Stress: Debt Bubbles, Depression and Healthcare Blues
Part III. Crises
Chapter 9. Suicidal Behaviors: A Parent’s Worst Fear
Chapter 10. Sexual Assault and Intimate Partner Violence: Being There in Their Darkest Hour
Chapter 11. Psychosis: Heartbreak and Hope
Chapter 12. Eating Disorders: Drunkorexia and Other Dangerous Trends