Identifying Emotionally
Troubled Students
Maria Bartolomeo-Maida, Ph.D.
Coordinator of Counseling
Counseling Resource Center
Kingsborough Community College
Goals Of This Presentation:
1. To provide a context that offers insight as to why problems may
arise.
2. To differentiate between normal adolescent developmental issues
& more serious psychological problems among college students.
3. To provide basic education about symptom patterns & warning
signs of emotional problems.
4. To inform staff about how to assist & refer troubled students.
How Do We Define “Emotionally
Troubled” ?
• Post Virginia Tech- large focus on campus safety & the
ability to identify violent behavior.
• Perception by counseling staff- increase in severe
pathology on campus (but is this actually true?). 85% of
counseling center directors have reported seeing
students with more serious mental health problems in
recent years (Gallagher, Gill & Sysco, 2000).
• Methodology in many studies have limitations.
• Helpful to have an operational definition of what
“severe psychopathology” is.
Normal Developmental Issues Facing
College Students (Kadison & DiGeronimo, 2004)
• Identity Development (Who am I?, Where do I fit in?).
• Relationships and Sexuality (anxiety about sexual
freedom, STDs, peer pressure, body image, intimacy & gender
differences).
• Interpersonal Issues (conflict resolution, acceptance of
different cultures, etc.)
Typical Challenges Among College Students
(Kadison & DiGeronimo, 2004)
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Academic pressure to succeed
Balancing extracurricular activities
Parental expectations
Racial and cultural problems
Financial worries
Social fears (terrorism, campus safety, sexual assault)
Pressure to find work
More On Financial Worries…
• College Tuition is expensive-between 1981 and 1994 costs
increased 153 percent at public universities & over 200 percent at
private universities.
• Students from divorced families have increased financial stressstudent must gather tax forms from both parents, sometimes a
parent becomes estranged.
• Academic progress gets strained with a part time job that student
feels necessary to have.
• Loans are not always an option students want to take due to
being indebted.
• Uncertain economic times (Recession, gas prices, etc.)
(Kadison & DiGeronimo, 2004)
More On Social Fears…
• Social climate in which we live creates
uncertainty for students. This includes:
1. Increase in campus violence in recent years
2. Post 9/11, bombing of trains in Madrid
3. For women, the fear of being raped is a crime
more feared than being murdered.
Challenges Facing International Students
in Particular
• 1995 survey of students at CUNY reported that 51%
of students attending the 6 community colleges were
born outside of the U.S. (Brilliant, 2000)
• Issues of acculturation.
• International students might view counseling as a sign
of weakness, it is stigmatized in their country.
• Students might feel depression and mourning with the
realization of the struggle of immigration (typically
after the 1st yr. in new country). (Brilliant, 2000)/ language
barriers, homesickness, etc.
International Student Challenges Continued…
• Somatic complaints, family problems, the loss of loved ones,
adjustment to food and climate, finances, culture shock (In
Grayson & Stowe, 2005)
• Non-support at times from their ethnic counterparts- “acting
white” or the opposite-these students are first in family to
attend college and there is significant pressure to excel.
• Different learning styles- (i.e. in Asian countries, students are not
allowed to challenge or disagree with the instructor but very
different in the U.S.)
• Legal issues- temporary student visas, etc.
• Effects of Terrorism- i.e. students of Muslim countries (Kadison
& DiGeronimo, 2004)
Other Challenges/ Possible Causes of
Problem Behavior…
• Students are lacking role models at home.
• Students may become very sensitive to perceived
criticism (reminder of earlier trauma).
• Many students may feel embarrassed, powerless or
invalidated if smallest thing goes wrong.
• Anger in particular can be fueled by a loss or conflict in
their personal lives.
• Important to think about students’ environmental and
cultural background when trying to understand
behavior.
(Hernandez & Fister, 2001)
Differences in College Students Today
• Students are more isolated-they rely more on peers than
on family, cultural norms, etc. Isolation from web &
other technology leaves students w/poor social skills.
• Students have blurry perceptions of boundaries
between themselves & faculty and staff (seen as peers).
• Decrease in students attending college for intrinsic,
moral value. Seen only as a means for employment.
(Hernandez & Fister, 2001)
Differences Continued…
• A more diverse cross section of our society is attending
college more than any other time in history (Gilbert,
1992)
• Students are more nontraditional- age, socioeconomic
status, mental illness, etc. (Benton & Benton, 2006)
• There are more veterans returning to college than ever
before.
Common Disruptions in Classrooms
Are these typical adolescent issues or something we
should worry about??
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Leaving class frequently
Copying work/ plagiarism or lying
Refusal to participate
Continued tardiness
Disruptions from electronic devices/ from food
Sleeping in class
Off topic conversations
Any others???
(Amada, 1999)
Common Psychological Problems
Among College Students
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Depression
Sleep Disorders
Substance Abuse
Anxiety Disorders
Eating Disorders
Impulsive Behaviors (cutting)
Suicide
(Kadison & DiGeronimo, 2004)
Some Alarming Statistics
• 25% of college students are now being prescribed
medications compared to 7% 14 years ago.
• 17% of students engage in self injurious behavior on
college campuses compared to 12% national average.
• In the most recent ACHA survey, almost 20% of
students indicated that during past year, they had
become so concerned about a friend that it interfered
with their academics.
Statistics Continued…
• In research conducted over 13 year span (1988-2001) at Kansas
State University, researchers found that anxiety disorders
doubled and depression as well as suicidal ideation and intent
tripled (Benton et al., 2003).
• Of 16,000 students in 2002 by the ACHA, 54.6% reported
feeling hopeless in the past year, 37.6% reported feeling so
depressed 3 or more times in past year that they could not
function, 9.5% reported seriously considering suicide, 1.4%
made an attempt (Benton & Benton, 2006).
Statistics, p 3.
• A 10 yr study on suicides at Midwestern University Campuses
shows that students ages 25 & over were at greater risk for
committing suicide (Silverman, 1997).
• Overall, however, the student suicide rate is one half of the
national rate (Silverman, 1997).
• Studies suggest that 80% of students who commit suicide have
not visited their campus counseling center (Hanover Research
Council, 2008).
Demographic Information
• Onset period for mental disorders = 20 yrs old for
schizophrenia (males), mood disorders, and substance
abuse, 30 years old for schizophrenia (females).
• Depression is more prevalent in females. Eating
disorders are more prevalent in females though there is
an increase in males (athletes) and transgendered
students in recent years.
• 80% of mental illness in men occurs between ages 2027.
• Onset for eating disorders = bulemia during college
years, anorexia develops somewhat earlier.
Suicide In Particular
• Suicide is the 2nd leading cause of death on college
campuses.
• The odds that a student will commit suicide are 1,000
to 1 (Pavela, 2007)
• 7.5/100,000 college students commit suicide/ National
Average is 15 per 100,000 (Silverman et al., 1997)
• Males are 4x more likely to commit suicide/ Caucasians
are more likely to commit suicide.
Depression
5 or more of the following symptoms are present over a two
week period:
- depressed mood most of day
-diminished interest in almost all activities
- significant weight loss, weight gain
- insomnia or increased sleeping
- restlessness
- fatigue/ loss of energy
- reduced concentration/ indecisiveness
- feelings of worthlessness/ excessive guilt
- recurrent thoughts of suicide
Bipolar Disorder
• Students experiencing a manic episode may exhibit the
following:
- poor judgment -reckless behavior
- impulsivity
- sexual promiscuity
- grandiosity
- rapid speech
This is often followed by period of depression and
withdrawal. There is a strong genetic component.
Anxiety
• According to the NIMH, anxiety affects approximately
19 million adults and 9.1% of college students.
• Anxiety disorders include: panic disorder, OCD, PTSD,
Phobias, and GAD.
• Symptoms can range from exaggerated worries, fear of
humiliation and embarrassment, to many physical
complaints such as headache, nausea, shortness of
breath, etc.
PTSD
Symptom criteria according to the DSM-IV:
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The traumatic event is persistently reexperienced.
There is persistent avoidance of stimuli associated w/
the trauma and emotional numbing.
Persistent symptoms of increased arousal (not
present before the trauma)- i.e. hypervigilance,
difficulty falling asleep, irritability, etc.
Substance Use
• 1400 college students between 18-24 die each year from
alcohol related injuries (MVA).
• 31% of college students met criteria for alcohol abuse
in the past 12 months.
• Alcohol problems are highest among young adults ages
18-29.
(National Advisory Council of the National Institute on Alcohol Abuse and
Alcoholism, 2002)
Substance Abuse Diagnosis
• Criteria for substance abuse, according to the
DSM-IV, is at least 1 or more of the following
during 12 mth pd.= recurrent use resulting in
failure to fulfill major obligations at work,
school, etc., recurrent use in situations in which
it is physically hazardous, recurrent substance
related legal problems, continued use despite
having persistent social or interpersonal
problems.
Other Substance Problems
Are we seeing the impact of being on drugs such as
Adderrall & Ritalin?-these drugs keep you awake longer
& have the following negative side effects: lack of
appetite, paranoia, dry mouth, aggression, sleep
deprivation (Kadison & DiGeronimo, 2004).
Are we seeing alcohol withdrawal?- the following may
develop w/in several hours to a few days: insomnia,
anxiety, nausea, hallucinations, autonomic hperactivity
(DSM-IV, 2000).
Sleep Difficulties
• The most common physical complaint of
college students.
• Sleep problems often become self-fulfilling
prophecies.
• The costs of sleep deprivation: cognitive
difficulties, anxiety, depression, reduced physical
health, irritability, etc.
• 80% of depressed people have sleep disorderswhich one comes first?
(Kadison & DiGeronimo, 2004)
Asperger’s Syndrome
On the autism spectrum of development disorders.
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Symptoms may include any of the following:
Impairment in the use of nonverbal behavior (body
posture, eye to eye gaze, etc.)
Failure to develop peer relationships
Lack of social reciprocity
Inflexible adherence to specific routines, rituals
Repetitive motor mannerisms (hand flapping, etc.)
Psychosis
• 50% of individuals who are psychotic do not
think they are.
• Individuals may be exhibiting delusions or
hallucinations:
Delusion- firmly held false beliefs (most
common are being controlled by someone else,
being persecuted by someone else)
Hallucination- perceiving things that do not
actually exist (can be auditory and visual)
Schizophrenia
• Refers to a class of disorders in which severe distortion
of reality occurs.
• According to the DSM-IV, 2 or more of the following
are present during a 1 month period:
- delusions
-hallucinations
- disorganized speech (incoherence)
-disorganized behavior
-negative symptoms (flat affect, alogia, avolition)
Personality Disorders
Enduring patterns of behavior/ personality
characteristics that are inflexible and pervasive across a
broad range of personal/ social situations. DSM –IV
defines 10 distinct ones.
Paranoid PD- distrust and suspiciousness of others
Schizoid PD- detachment from social relationships,
restricted range of expression/ emotion
Borderline PD- instability of self image, interpersonal
relationships, impulsivity
Organic/ Neurological Problems
• Frontal Lobe Brain problems (tumor, injury,
stroke): impulsivity, poor judgment, reduced
reasoning ability.
• Medical issues such as Hyperthyroidism
• Mental Retardation
• Tic Disorders/ Tourettes
How do these psychological disabilities
manifest?
In class or during advisement sessions, students may:
- show signs of cognitive and processing difficulties.
- have trouble following directions and processing
information.
- seem socially awkward or unfriendly.
- uninterested or dazed/ confused
- have difficulty remembering something
- seem hostile or defensive/ easily agitated and
argumentative
Warning Signs Of Violence
• Loss of temper
• Frequent physical fighting or other current violent
behavior
• Increase in use of drugs or alcohol
• Increase in risk taking behavior
• Has access to weapons
• Has detailed plans to commit acts of violence
• Announcing threats or plans of hurting others
• Psychiatric history
More on Violence…
• For the period from 1995-2002, colleges students ages 18-24
experienced violence at average annual rates lower than those for
non-students in same age group (East Tennessee State University
Memorandum to Faculty, 2008).
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Overall, violence is difficult to predict.
The best predictor of violence is prior violence.
Violence risk increases with use of alcohol.
School violence in recent years are often shooting sprees for
which perpetrator commits suicide.
• Recent research has shown that the vast majority of people who
are violent do not suffer from mental illness (American Psychiatric
Association, 1994).
Americans with Disabilities
• Section 504 of the Rehabilitation Act of 1973 and the Americans with
Disabilities Act of 1990, prohibit universities from discriminating against
individuals with disabilities (including mental disabilities).
• Discrimination is prohibited against “otherwise qualified individuals”- one
who with or without reasonable modifications meets the essential eligibility
requirements.
• “Disability” includes a mental impairment that substantially limits a major life
activity.
• Under these acts, universities can take disciplinary action when behaviors are
disruptive but they can not take disciplinary action when the person is ill and
the behavior is not disruptive.
(Benton & Benton, 2006)
Specific Cultural Issues Not To Be Overlooked
When Determining a Behavior “Troubled”
• According to the DSM-IV, there are culture
bound syndromes that denote locality specific
patterns of troubling experience that may or
may not be linked to a particular DSM-IV
category.
• According to the DSM-IV, many of these
patterns are indigenously considered to be
“illnesses”.
Why Might Staff Be Reluctant To
Intervene?
• Literature seems to focus on faculty in particular vs.
other staff.
• Some faculty feel they could handle situations on their
own.
• Faculty might feel embarrassed that there are problems
in their classroom.
• Might feel fear of harming the psychologically fragile
student.
• Might feel fear of student retaliation
• Might remain silent for fear of receiving inadequate
administrative support.
(Amada, 1999)
How To Assist Students
• 3 R’s = Recognize, Respond, Refer (Benton & Benton,
2006)
• It is appropriate to approach students anytime you have
concerns.
• Many students may feel relieved that someone cares.
• Waiting to intervene may complicate the situation.
• Helpful to document behavior as you see it happening.
The Importance of Making a
Referral!
• Research has shown that students who reported
having significant emotional problems over the
previous year and had more functional
relationships with their advisors were more likely
to use mental health services (Hanover Research
Council, 2008)
In The Case of Suicide…
• Not helpful to tell students, “look on the bright
side” or “you’ll get over it”.
• Many students cry out for help through writing
assignments, poetry, etc.
• We should always take this seriously.
• Remain with the student and walk them to
counseling if possible.
• Contact public safety even if the student does
not comply.
Language To Use When Making a
Referral:
• “I’ve noticed that you’ve appeared sad and withdrawn
during our last few meetings…”
• “I’m aware that you have fallen asleep in class more
often during the past few weeks…”
• “I’m concerned about your tendency to come late to
every appointment we have had so far and I want to
make sure you are okay…”
• Be direct, supportive, and nonjudgmental.
• Provide empathy vs. trying to fix or gloss over problem
(i.e. “you’ll do just fine on the exam”)
Other Considerations When Making a
Referral
• Helpful to know about the counseling center &
services offered on your campus.
• Find out if students have resources at home, etc.
• Find out if they have ever used counseling
services in the past.
• If calling counseling directly, it’s best if you tell
the student that you are referring them.
• Helpful to escort student.
And More Considerations…
• Ask for clarification if necessary (i.e. “I am not
sure what you mean”)
• Invite the student to speak in a private area.
Might be helpful to see where the student is
comfortable meeting.
• If the student refuses or is reluctant to talk,
indicate that your door is open and that the
student can return at a later time.
(Hernandez & Fister, 2001)
Managing Other Specific Situations
• Angry student- try not to personalize their agitation, try
to remain calm & model calm behavior, avoid
challenging body language.
• Paranoid student- try to understand that most attempts
you make at communicating with student might be
fraught with defensiveness and feelings of personal
attack by student.
• Disorganized student- do not pretend to understand
them. Try to get them to a safe place (Counseling,
Health Services, etc.)
• Withdrawn students- we must be creative in trying to
engage them, sometimes this takes time and trust needs
to be established.