Sending a child off to college is supposed to be an exciting milestone. For many families, however, the first semester away from home can reveal challenges that were difficult to see from a distance.

A university student may be academically overwhelmed, socially isolated, struggling with a breakup or family conflict, worried about money, questioning their identity or future, having difficulty adjusting to independent living—or experiencing a much more serious mental health problem.

For parents and loved ones, one of the most difficult questions can be: Is this normal college stress, or is something seriously wrong?

The answer is not always obvious. College students can be remarkably good at hiding emotional distress, particularly when they are determined to convince their parents that everything is fine.

This is especially important when a student is living on campus, perhaps hundreds or thousands of miles from home, and is responsible for making decisions that parents previously helped manage.

The Unique Stress of Going Away to College

College represents a major developmental transition. A young adult may be living independently for the first time while simultaneously being expected to manage academics, finances, relationships, health, transportation, meals, laundry, sleep, and an increasingly complicated social environment.

The student may have to:

Wake up and get to class without parental supervision.

Manage a demanding academic schedule.

Decide when and how much to study.

Handle money and budgeting.

Buy and prepare food.

Maintain an adequate sleep schedule.

Navigate roommates and communal living.

Establish new friendships.

Deal with romantic relationships and breakups.

Manage sexual and social pressures.

Resist or participate in drinking and drug use.

Handle loneliness and homesickness.

Adjust to a different culture or geographic environment.

Decide what to do when something goes wrong.

Think about majors, careers, internships, graduate school, and employment.

Deal with disappointing grades or academic failure.

Learn to ask for help without a parent immediately intervening.

For a student who has always relied heavily on family support, this sudden independence can be exhilarating—but it can also be destabilizing.

A student who previously appeared confident and successful may suddenly struggle with organization, motivation, emotional regulation, sleep, eating, or decision-making.

And because college students often spend much of their time away from their families, problems can escalate for weeks or months before parents realize what is happening.

When Is College Stress More Than College Stress?

Stress itself is not necessarily a psychiatric disorder. Anxiety before an exam, sadness following a breakup, homesickness during the first semester, or disappointment after receiving a poor grade can be normal human experiences.

The concern increases when symptoms become persistent, severe, increasingly disruptive, or dangerous.

Parents should pay particular attention to changes from their child’s normal behavior.

Potential warning signs include:

Significant withdrawal from family and friends.

Missing classes or repeatedly failing to attend academic obligations.

Dramatic deterioration in grades.

Sleeping almost constantly or barely sleeping.

Significant appetite or weight changes.

Poor hygiene or deterioration in self-care.

Loss of interest in activities previously enjoyed.

Persistent sadness, hopelessness, irritability, or emotional numbness.

Excessive worry or panic.

Racing thoughts or inability to calm down.

Increasingly erratic or impulsive behavior.

Uncharacteristic anger or aggression.

Paranoia or extreme suspiciousness.

Hearing or seeing things other people do not.

Talking about feeling worthless, trapped, or like a burden.

Talking about death or suicide.

Self-harm or unexplained injuries.

Repeated intoxication.

Secretive behavior surrounding drugs or alcohol.

Spending excessive amounts of money.

Sudden changes in social groups.

Significant changes in personality.

Being awake for unusually long periods while appearing unusually energetic.

Confusion, disorientation, or behavior that seems disconnected from reality.

One symptom by itself does not establish a diagnosis. A qualified mental-health professional needs to evaluate the student’s history, symptoms, functioning, substance use, medical conditions, medications, family history, and other factors.

Symptoms and Possible Mental Health Diagnoses

The following cross-reference can help families understand what a professional might consider. It is not a diagnostic tool.

What a Parent May Notice	Possible Clinical Explanation
Persistent sadness, hopelessness, loss of interest, fatigue, guilt, sleep/appetite changes	Major depressive disorder
Excessive worry, restlessness, irritability, muscle tension, difficulty concentrating	Generalized anxiety disorder
Sudden episodes of intense fear, racing heart, shortness of breath, dizziness, fear of losing control	Panic disorder/panic attacks
Fear of social judgment, avoidance of social situations, intense self-consciousness	Social anxiety disorder
Distress following a major life change that appears disproportionate or interferes substantially with functioning	Adjustment disorder
Intrusive memories, nightmares, avoidance, hypervigilance after trauma	Post-traumatic stress disorder (PTSD)
Periods of unusually elevated or irritable mood, decreased need for sleep, rapid speech, impulsivity, grandiosity, or risky behavior	Bipolar-spectrum disorder, including manic or hypomanic episodes
Hallucinations, delusions, severe paranoia, disorganized thinking or behavior	Psychotic disorder or mood disorder with psychotic features; substance-induced psychosis must also be considered
Inattention, disorganization, procrastination, impulsivity and difficulty completing tasks that began earlier in life	Attention-deficit/hyperactivity disorder (ADHD)
Severe restriction of food, bingeing, purging, or intense preoccupation with weight/body image	Eating disorder
Repeated drug use despite academic, interpersonal, financial, physical, or psychological consequences	Substance use disorder
Mood, anxiety, paranoia, hallucinations, insomnia, or behavioral changes occurring during or after substance use	Substance-induced mental disorder must be considered

The last category is particularly important.

Don’t Assume Every Psychiatric Symptom Is a Primary Mental Illness

A student who becomes paranoid after using a high-potency THC product, for example, may not necessarily have a primary psychotic disorder. A student who becomes severely depressed while misusing substances may have depression, a substance-induced condition, or both.

Similarly, prolonged sleep deprivation, certain medications, medical conditions, intoxication, and withdrawal can produce symptoms that resemble psychiatric disorders.

That is one reason a comprehensive assessment matters.

The Possibility of a Dual Diagnosis

The term dual diagnosis is commonly used when a person has both a mental-health disorder and a substance-use disorder. Today, clinicians often use the term co-occurring disorders.

This situation deserves particular attention among university students.

A student may begin using a substance to cope with anxiety, depression, loneliness, trauma, insomnia, or academic pressure. The substance may temporarily make the student feel better. Over time, however, repeated use can create dependence, worsen psychiatric symptoms, interfere with treatment, and make the underlying problem more difficult to identify.

SAMHSA emphasizes the importance of integrated approaches that address co-occurring mental-health and substance-use conditions rather than treating them as completely unrelated problems.

Cannabis and Weed

Cannabis should not automatically be dismissed as harmless simply because marijuana is legal for medical or recreational use in some states.

Cannabis can produce anxiety, paranoia, disorientation and, in some people, psychotic symptoms. The CDC reports associations between cannabis use and psychosis, schizophrenia, depression, social anxiety, and suicidal thoughts or behaviors.

Heavy or frequent use can also interfere with attention, memory, learning and decision-making. Approximately three in ten people who use cannabis are estimated to develop cannabis use disorder, with greater risk associated with earlier initiation and more frequent use.

Parents should therefore ask questions such as:

How frequently is your student using cannabis?

How much are they using?

Are they using increasingly potent products?

Can they stop when they want to?

Are they using it before class?

Are they missing classes because of it?

Has their motivation changed?

Are they becoming more paranoid?

Has their sleep changed?

Are they experiencing panic attacks?

Have they experienced hallucinations or unusual beliefs?

Delta-8 and Delta-9 THC

Students may believe that Delta-8 THC is fundamentally different from marijuana and therefore safe. That assumption can be dangerous.

The FDA states that Delta-8 THC products have not been evaluated or approved for safe use and has received reports of adverse events involving hallucinations, anxiety, confusion, vomiting, tremor, dizziness and loss of consciousness. Delta-8 is psychoactive and intoxicating, similar to Delta-9 THC.

High-potency THC products may be particularly concerning when a student already has anxiety, depression, paranoia, mood instability, or a personal or family vulnerability to psychosis.

Kratom

Kratom is another substance that can be overlooked because it is sometimes marketed as a plant-based or natural product.

The FDA warns consumers not to use kratom because of serious potential adverse effects including liver toxicity, seizures and substance use disorder. The FDA also describes tolerance, cravings, continued use despite consequences, physical dependence and withdrawal among some people who develop kratom-related substance use disorder.

Students may use kratom in an attempt to manage anxiety, depression, pain, energy, withdrawal, or other problems. That does not make self-treatment safe.

If a student is taking kratom regularly, a professional should know about it.

Nitrous Oxide, “Whippets” and Galaxy Gas

Nitrous oxide deserves special attention because some college-age young adults may perceive it as a relatively harmless party drug.

It is not.

Nitrous oxide can produce euphoria, dizziness, impaired judgment and loss of consciousness. Repeated use can result in vitamin B12 deficiency and neurological injury, while high concentrations can interfere with oxygen delivery. Poison Control specifically warns about the dangers associated with recreational use of Galaxy Gas and other nitrous oxide products.

Nitrous oxide is also commonly sold in canisters sometimes called “whippets.” Recreational inhalation should not be confused with medically supervised use.

If a student is using nitrous oxide repeatedly, particularly if they are experiencing numbness, weakness, confusion, balance problems, fainting, unusual behavior, or psychiatric symptoms, medical evaluation is warranted.

What Does a Dual Diagnosis Look Like?

Consider a hypothetical student who leaves home for college and initially does well.

Several months later, the student:

Stops attending class.

Begins sleeping during the day.

Becomes increasingly isolated.

Starts using cannabis every day.

Begins experiencing panic attacks.

Starts using Delta-8 products to “calm down.”

Becomes increasingly paranoid.

Eventually tells friends that people are watching them.

A family might initially assume the student has developed an anxiety disorder.

Another family might assume the cannabis is the entire problem.

A professional needs to consider both possibilities.

The student could have an underlying anxiety or mood disorder complicated by cannabis use. The student could have a substance-induced condition. The student could have a primary psychiatric disorder that is being worsened by substance use. Or several conditions could be occurring simultaneously.

The correct answer requires assessment rather than speculation.

Solutions

There is no single solution for every struggling university student. The appropriate level of care depends on the severity of symptoms, safety concerns, substance use, willingness to participate in treatment, previous treatment history, and the student’s ability to function.

Individual Counseling

Individual psychotherapy is often an appropriate starting point for students experiencing anxiety, depression, adjustment problems, relationship difficulties, trauma, academic stress, grief, or other emotional concerns.

University counseling centers can be an excellent first point of contact, particularly because they understand the unique pressures of college life.

Group Counseling

Group counseling can be particularly valuable for students who feel isolated.

A well-run therapeutic group can help a student recognize that other people are experiencing similar problems while also providing opportunities to practice communication, emotional regulation, interpersonal skills and healthy coping.

Many university counseling centers offer groups, workshops, support groups or skills-based programs.

Psychiatric Care

Psychiatric evaluation becomes particularly important when symptoms are severe, persistent, recurrent, involve significant impairment, or may require medication.

Psychiatric care can be appropriate for conditions such as major depression, bipolar disorder, severe anxiety, ADHD, psychotic disorders and other psychiatric conditions.

Medication decisions should be made by qualified medical professionals after a careful assessment.

Substance use should always be disclosed to the psychiatric provider because drugs and medications can interact in clinically important ways, and intoxication or withdrawal can complicate diagnosis.

Inpatient or Residential Treatment

Sometimes outpatient therapy is not enough.

Inpatient psychiatric hospitalization may be appropriate when a student presents an immediate danger to themselves or others, is experiencing severe psychosis or mania, cannot care for basic needs, or otherwise requires intensive stabilization.

Residential behavioral-health treatment can provide a more structured environment for students who need intensive therapy and monitoring but do not necessarily require acute psychiatric hospitalization.

A higher level of care may be especially appropriate when mental illness and substance use are occurring together.

Professional Behavioral Health Intervention

Sometimes the central problem is not that treatment does not exist. It is that the student will not participate in treatment.

Parents may find themselves watching their child deteriorate while the student insists nothing is wrong.

A professional behavioral-health intervention can help families develop a structured, clinically informed approach to communicating concern, setting boundaries, presenting treatment options and addressing resistance.

Behavioral Help Solutions LLC
behavioralhelp.com
(305) 467-8666

What Parents Can Do When Their Student Says, “I’m Fine”

One of the most frustrating experiences for a parent is hearing, “I’m fine,” while everything about the student’s behavior suggests otherwise.

Arguing with the student about whether they are mentally ill rarely solves the problem.

Instead, focus on observable facts.

Rather than saying:

“You have a mental-health problem.”

Try:

“I’ve noticed that you’ve stopped going to class, you’re barely sleeping, you’re isolating yourself, and you don’t seem like yourself. I’m concerned about you, and I want to help.”

Ask open-ended questions.

“How are you really doing?”

“How much are you sleeping?”

“Are you going to class?”

“Have you been drinking or using drugs?”

“Have you been using marijuana or THC products?”

“Have you used Delta-8 or Delta-9 products?”

“Are you using kratom?”

“Have you been inhaling nitrous oxide or using whippets?”

“Do you feel safe?”

“Have you had thoughts about hurting yourself?”

“Would you be willing to talk with a professional?”

Parents should not be afraid to ask directly about suicide. Asking about suicidal thoughts does not create suicidal thoughts. If a student indicates an immediate danger to themselves or someone else, the priority changes from persuasion to safety and emergency evaluation.

In the United States, the 988 Suicide & Crisis Lifeline can be reached by calling or texting 988. For an immediate life-threatening emergency, call 911 or go to the nearest emergency department.

The Bottom Line: Families Are Not Alone

A child struggling at college can leave an entire family feeling frightened, confused and powerless.

Parents may wonder whether they should wait. They may worry about overreacting. They may be concerned about violating their child’s independence. They may feel guilty about sending their child away. They may be angry about substance use. They may disagree with other family members about what should happen next.

These reactions are understandable.

But a university student’s struggle with mental health does not mean that the student’s future is ruined.

There are manageable options.

Sometimes the answer is individual counseling. Sometimes it is group therapy. Sometimes psychiatric care is necessary. Sometimes substance-use treatment must be addressed at the same time as depression, anxiety, bipolar disorder, trauma or another psychiatric condition. Sometimes the situation requires residential treatment or hospitalization. And sometimes a family needs professional help intervening when the student is unable or unwilling to recognize the seriousness of the problem.

The most important thing is not to become paralyzed by uncertainty.

Families with a university student struggling with mental-health issues are not alone. There are professionals, university resources, treatment programs and behavioral-health services that can help. The path forward may require strategically caring—and sometimes decisive—action. But problems that appear overwhelming today can often be addressed one step at a time.

Most importantly, a struggling college student is still a young person with a future.

With the right assessment, appropriate treatment, family support and willingness to act, recovery and a return to a meaningful, productive life are possible.