For Students: How to Help a ClassmateCounseling Center

It's often difficult to know how to help a friend or another student you are concerned about. Please know that the Counseling Center is here to help you work through how to support the person you care about. Below are some guidelines to help you think things through. For further support you can call our office at 507-933-7027.

Supporting a Friend or Family Member with Anxiety

It is normal to feel anxious at times especially during times of stress. For example, most people experience feelings of anxiety before an important event such as a big exam, business presentation or first date. However, when anxiety is ongoing and interferes with one’s daily life and relationships it may be an anxiety disorder. Knowing the signs and symptoms can help you recognize if a friend or family member is experiencing anxiety. Here are some signs and symptoms of anxiety:

Cognitive / Emotional
- Feeling like your mind is racing
- Constant worrying about small or large concerns
- Inability to “let things go” or repeatedly thinking about something
- Feeling overwhelmed, stuck, or frozen
- Difficulty concentrating or your mind "going blank"
- Feeling keyed up or on edge
Physical
- Muscle tension or muscle aches
- Fatigue or exhaustion
- Trembling, shaking, or feeling twitchy
- Being easily startled
- Sweating, nausea or diarrhea
- Shortness of breath or rapid heartbeat
- Being restless or unable to sit still,
- Trouble falling asleep or staying asleep
Social
- Irritability or impatience (with self and/or others)
- An intense fear of being around others
- Rehashing interactions or conversations

What you can do if you recognize anxiety in a friend or loved one:

Talk with him or her in a private place. Clearly express what you have noticed and that you are concerned about him/her.
Use active listening skills to give him/her time to express themselves.
Explain that many students experience anxiety and that treatment can be very helpful.
Encourage him or her to make an appointment with a counselor at the counseling center, and offer to help him/her make the first appointment.
Share that you are willing to help and ask how you can best support him/her.
Do not worry alone; there are many people on campus to help you help your friend.
Periodically check in with your friend/loved one, asking them how they are doing, and take time to truly listen.
Increase your understanding and awareness by learning more about anxiety disorders.

Information on Anxiety

How common is anxiety?

Anxiety disorders, as a group, are the most common mental illness in America. More than 19 million American adults are affected by anxiety each year. College students experience high levels of stress, therefore anxiety is often a challenge for college students.

What are the different kinds of Anxiety Disorders?

Panic Disorder - Repeated episodes of intense fear that strike often and without warning. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal distress, feelings of unreality, and fear of dying.
Obsessive-Compulsive Disorder - Repeated, unwanted thoughts or compulsive behaviors that seem impossible to stop or control.
Post-Traumatic Stress Disorder - Persistent symptoms that occur after experiencing or witnessing a traumatic event such as rape or other criminal assault, war, child abuse, natural or human-caused disasters, or crashes. Nightmares, flashbacks, numbing of emotions, depression, and feeling angry, irritable or distracted and being easily startled are common. Family members of victims can also develop this disorder.
Phobias - Two major types of phobias are social phobia and specific phobia. People with social phobia have an overwhelming and disabling fear of scrutiny, embarrassment, or humiliation in social situations, which leads to avoidance of many potentially pleasurable and meaningful activities. People with specific phobia experience extreme, disabling and irrational fear of something that poses little or no actual danger; the fear leads to avoidance of objects or situations and can cause people to limit their lives unnecessarily.
Generalized Anxiety Disorder - Constant, exaggerated worrisome thoughts and tension about everyday routine life events and activities, lasting at least six months. Almost always anticipating the worst even though there is little reason to expect it; accompanied by physical symptoms, such as fatigue, trembling, muscle tension, headache or nausea.

What are effective treatments for Anxiety Disorders?

People with anxiety disorders and often combine psychotherapy (counseling) and medication. Two clinically-proven effective forms of psychotherapy used to treat anxiety disorders are behavioral therapy and cognitive-behavioral therapy. Behavioral therapy focuses on changing specific actions and uses several techniques to stop unwanted behaviors. In addition to the behavioral therapy techniques, cognitive-behavioral therapy teaches patients to understand and change their thinking patterns so they can react differently to the situations that cause them anxiety.

A number of medications that were originally approved for treating depression have been found to be effective for anxiety disorders as well. Some of the newest of these antidepressants are called selective serotonin re-uptake inhibitors (SSRIs). Other anti-anxiety medications include groups of drugs called benzodiazepines and beta-blockers . If one medication is not effective, others can be tried. New medications are currently under development to treat anxiety symptoms.

Do Anxiety Disorders Co-Exist with Other Physical or Mental Disorders?

It is common for an anxiety disorder to accompany depression, eating disorders, substance abuse, or another anxiety disorder. Anxiety disorders can also co-exist with illnesses such as cancer or heart disease. In such instances, the accompanying disorders will also need to be treated. Before beginning any treatment, however, it is important to have a thorough medical examination to rule out other possible causes of symptoms.

The information on anxiety was taken from The National Institute of Mental Health Website http://www.pueblo.gsa.gov/cic_text/health/factsabout-anxietydisorders/faxanxiety.htm on 4/1/2011.

Supporting a Friend or Family Member with Depression

It is common for people who are experiencing depression, not to recognize it in themselves. Therefore as a friend or family member, you may notice signs and symptoms first. While symptoms can vary from person to person, it is helpful to know what the signs and symptoms of depression are.

They express feeling:
- Sad, down, blue, or empty
- Tired, overwhelmed, or exhausted
- Hopeless, worthless, or helpless
- Pessimistic or guilty
Their behavior changed:
- Sleeping more or less
- Decreased appetite and weight loss or increased appetite and weight gain
- Have less energy or seem tired all the time
- Are more socially withdrawn or not interested in activities (going out, events…)
- Not studying as much or missing/skipping classes
- Abusing alcohol or other drugs
- Appear restless, agitated, or irritable (taking things more personally)
They are having:
- Headaches, stomach aches, or backaches
- Pains in their joints or muscles
- Trouble concentrating, focusing, or making decision
- Thoughts about death, dying, or suicide

If you believe that someone in your life has depression, you may feel helpless and you may wonder what to do. You are not responsible for “making them better” or “taking away their problems.” What you can do is learn how to offer support and understanding as well as help them get connected to resources and support to treat their depression. Here is what you can do:

Talk with them privately. Express directly what changes you have noticed and that you are concerned. Then listen and allow the person to express them self.
Normalize their experience. Share that depression is not a flaw or a weakness and that many students here experience depression and are being treated for it. Reassure them that it usually gets better with support and help.
Encourage them to see a professional. Remind them that counseling services are free and confidential at Gustavus. If you feel comfortable, you can offer to support them in making an appointment (by telephone or walking into the office).
Ask how you can be most supportive and express your willingness to help.
Remember your own needs. Helping someone with depression can be challenging, make sure you take time for yourself, surround yourself by supportive people, and do not be afraid to ask for help in dealing with the situation.
Educate yourself on depression. Below is some information to get you started.

What is depression?

Depression is more than the blues or the blahs; it is more than the normal, everyday ups and downs. When that "down" mood, along with other symptoms, lasts for more than a couple of weeks, the condition may be clinical depression. Clinical depression is a serious health problem that affects the total person. In addition to feelings, it can change behavior, physical health and appearance, academic performance, social activity and the ability to handle everyday decisions and pressures.

What causes depression?

We do not yet know all the causes of depression, but there seems to be biological and emotional factors that may increase the likelihood that an individual will develop a depressive disorder. Research over the past decade strongly suggests a genetic link to depressive disorders; depression can run in families. Bad life experiences and certain personality patterns such as difficulty handling stress, low self-esteem, or extreme pessimism about the future can increase the chances of becoming depressed.

How common is it?

Clinical depression is a lot more common than most people think. It affects 19 million Americans every year. One-fourth of all women and one-eighth of all men will suffer at least one episode or occurrence of depression during their lifetimes. Depression affects people of all ages but is less common for teenagers than for adults. Approximately 3 to 5 percent of the teen population experiences clinical depression every year. That means among 25 friends, 1 could be clinically depressed.

Is it serious?

Depression can be very serious. It has been linked to poor school performance, truancy, alcohol and drug abuse, running away, and feelings of worthlessness and hopelessness. In the last 25 years, the rate of suicide among teenagers and young adults has increased dramatically. Suicide often is linked to depression.

Are all depressive disorders alike?

There are various forms or types of depression. Some people experience only one episode of depression in their whole life, but many have several recurrences. Some depressive episodes begin suddenly for no apparent reason, while others can be associated with a life situation or stress. Sometimes people who are depressed cannot perform even the simplest daily activities – like getting out of bed or getting dressed. Others go through the motions, but it is clear they are not acting or thinking as usual. Some people suffer from bipolar disorder in which their moods cycle between two extremes – from the depths of despair to frenzied talking or activity or grandiose ideas about their own competence.

Can it be treated?

Yes, depression is treatable. Between 80 and 90 percent of people with depression – even the most serious forms – can be helped. There are a variety of antidepressant medications and forms psychotherapy found to be helpful. People with moderate to severe depression most often benefit from antidepressants. Most people do best with combined treatment: medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life's problems, including depression. This most important step toward overcoming depression - and sometimes the most difficult - is asking for help.

Why don't people get the help they need?

Often people don’t know they are depressed, so they don’t ask for – or get – the right help. People often fail to recognize the symptoms of depression in themselves or in people they care about.

The above information on depression was adapted and taken from The National Institute of Mental Health Website http://www.pueblo.gsa.gov/cic_text/health/friend-depressed/friend.pdf on 3/31/2011.

Supporting a Friend or Family Member with an Eating Disorder

Since we live in a culture which is obsessed with thinness and dieting, it can be difficult to recognize when a person's thinking or behavior has become dangerous. You may know someone with an eating disorder. It could be your roommate, sibling, parent, or friend. The person may try to hide it, but the focus of her everyday life revolves—obsessively—around food and weight. Some people try to starve themselves. Others binge and then try to undo their binging through some form of purging.

People develop eating disorders as a way of dealing with the conflicts, pressures, and stresses of their lives. Their eating disorders may be used as a way to express control when the rest of life seems out of control. Eating disorders are very serious. They have an impact on both physical and mental health. Left untreated, they can be fatal.

When an individual is experiencing an eating disorder, it is often friends and family who notice it as a problem well before the individual does. Here are the signs and symptoms to watch for:

Intense fear of gaining weight
Obsession with fat (such as frequent comments about their weight, size, or shape)
A distorted body image
Paying constant attention to food and/or dieting (counting calories, continuously talking about food)
See food as good or bad, strongly avoiding any “bad” food
Excessive exercise (feeling like they have to exercise daily)
Withdrawal from friends and family (especially events with food)
Binge eating (eating significantly more than a “normal amount” in a sitting)
Purging (vomiting after meals or intense exercise to make up for eating)
Taking laxatives and/or diet pills for weight control
Rapid weight loss
Irritability (especially defensive when asked about eating habits)

Many people believe that individuals have to be very thin in stature to have an eating disorder. That is absolutely not true. Symptoms and severity vary greatly from person to person. Eating disorders can affect anyone at any time. If you recognize disordered eating, dieting, or exercising in someone you care about here is what you can do:

Choose a private time and location and approach your friend gently but persistently.
Explain that you're worried and express specifically what you are concerned about (such as certain behaviors or habits).
Listen sympathetically. Expect them to deny the problem and become resentful of your intervention. Be persistent despite their hostility.
Express concern about the person as a whole. Focus on your concern for their health and happiness rather than specific behaviors.
Encourage them to go to the counseling center. Remind them that all services are free and confidential and that it is never too early to get support. If they do not want to seek support on campus, encourage them to meet with a licensed mental health care provider.
Offer to help find professional help or go along for the first visit if your friend is willing to get help.
Empathize with their fear and shame, but let them know you care about them too much to ignore their destructive behaviors.
Be supportive. It's the most important thing you can do. Show your friend you believe in them, it will make a difference in recovery.
Set realistic goals. Don't expect your friend to recover overnight - it's a gradual process. You can't make them stop the behavior, but you can listen, try to understand, and offer support.
Be yourself. Be honest in sharing your feelings.
Remember that eating disorders can be very powerful and that it is not your job to “fix it.” The individual has to be ready and willing to change.
Remind your friend that people are important because of who they are, not how they look or what they do; emphasize the positive, strengths, and talents of who they are.
As it can be stressful to have someone you care about struggling with an eating disorder, get your own support and care.

It also helps to know what to avoid when concerned about someone who may have an eating disorder.

Don't comment on your friend's (or anyone's) body size, weight loss, weight gain, etc.
Don't contribute to conversations that focus on food, body size, calories, etc.
Don't give advice. Being told what to do or not do can often provoke the opposite response, and your friend may become defensive.
Don’t gossip about him or her.
Don’t get involved in a power struggle around eating or other symptoms.
Don't change your eating habits when you're around your friend. Your "normal" eating is an example to your friend of a more healthy relationship with food.
Don't blame yourself if your friend is not yet willing to acknowledge the problem or change behaviors. It can take a person a long time to accept the situation.
Don’t try to solve the problem for them or take it on alone. Eating disorders can be overwhelming, time consuming, and difficult to manage; use campus resources and professionals to help address the problem.
Don’t be afraid to talk to the person to gently but persistently express your concern and encourage him/her to get help and support.

Remember that the counseling center is always here to help if you have any questions or concerns about eating disorders. You can give us a call or make an appointment any time!

In reaching out, it always helps to know more about what the individual is experiencing. Therefore the three primary types of eating disorders are described below. But please remember that signs and symptoms can overlap and vary from person to person. It is never too soon to reach out and encourage the individual to get help.

Anorexia

Anorexia (clinically known as Anorexia Nervosa) is when people intentionally starve themselves or restrict their intake because of an intense fear of gaining weight. This disorder often involves weight loss, and while people with anorexia may look emaciate, they are convinced they are overweight or fat. Food and weight become obsessions. For some, the compulsiveness shows up in strange eating rituals or the refusal to eat in front of others. They may adhere to strict exercise routines to keep off weight. Anorexia often stems from underlying emotional cues, and can cause individuals to limit or restrict other parts of their lives beyond food- such as relationships, social activities, or pleasure. Anorexia can cause severe medical problems and even lead to death. Loss of monthly menstrual periods is typical in women with the disorder, and impotence often occurs for men. It can become life-threatening; therefore at times people must be hospitalized to prevent starvation.

Warning Signs of Anorexia

The person is thin and keeps getting thinner, losing 15% or more of their ideal body weight
Continues to diet or restrict foods even though they are not overweight
Has a distorted body image—feels fat even when they are thin
Is preoccupied with food, calories, nutrition, or cooking
Denies that they are hungry
Exercises obsessively
Weighs them self frequently
Complains about feeling bloated or nauseated even when they eat normal, or less than normal, amounts of food
Loses their hair or begins to experience thinning hair
Feels cold even though the temperature is normal or only slightly cool
Stops menstruating or becomes impotent

Bulimia

Bulimia (clinically known as Bulimia Nervosa) is the repeated cycle of out-of-control eating followed by some form of purging or dieting. People with Bulimia consume large amounts of food and then rid their bodies of the excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. Some use a combination of all these forms of purging. Because many individuals with bulimia "binge and purge" in secret and maintain a normal or above normal body weight, they can often successfully hide their problem from others for years. Many individuals remain at normal body weight or above because of their frequent binges, which can range from once or twice a week to several times a day. Dieting heavily between episodes of binging and purging is also common. Individuals with bulimia often feel out of control in other areas of their lives besides food. It is common for individuals with Anorexia to also develop bulimia. The condition occurs most often in women but is also found in men.

Bulimia can have severe medical consequences including dental and esophageal problems, kidney damage, chemical imbalance, and an overall loss of energy and vitality. It can even prove fatal. Many individuals with bulimia, ashamed of their strange habits, do not seek help until they reach their thirties or forties. By this time, their eating behaviors are deeply ingrained and more difficult to change. Therefore when it comes to getting treatment, the earlier the better!

Warning Signs of Bulimia

The person engages in binge eating and cannot voluntarily stop
Uses the bathroom frequently after meals
Reacts to emotional stress by overeating
Has menstrual irregularities
Has swollen glands
Experiences frequent fluctuations in weight
Cannot voluntarily stop eating
Is obsessively concerned about weight
Attempts to adhere to diets, but generally fails
Feels guilty or ashamed about eating
Feels out of control
Has depressive moods

Binge Eating Disorder

An illness that resembles bulimia nervosa is binge eating disorder. Like bulimia, the disorder is characterized by episodes of uncontrolled eating or binging. However, binge eating disorder differs from bulimia because its sufferers do not purge their bodies of excess food, and is more commonly referred to as compulsive overeating. Individuals with binge eating disorder feel they lose control when eating, consuming large amounts of food with a pressured or “frenzied” feeling and not stopping until they are uncomfortably full. Episodes of binge-eating are often followed by periods of guilt and depression. Usually, individuals with binge eating disorder have more difficulty losing weight and keeping it off, and therefore are obese and have a history of weight fluctuations. Binge eating can lead to severe medical problems including high cholesterol, diabetes, heart disease, and depression. Binge eating disorder is found in about 2% of the general population - more often in women than in men. Recent research shows that binge eating disorder occurs in about 30% of people participating in medically supervised weight control problems.

Warning Signs of Binge Eating Disorder

The person eats large amounts of food when not physically hungry
Eats much more rapidly than normal
Eats until the point of feeling uncomfortably full
Often eats alone because of shame or embarrassment
Has feelings of depression, disgust, or guilt after eating
Has a history of marked weight fluctuations

The information in this article was taken and adapted from The Renfrew Center Foundation website pages http://www.renfrewcenter.com/for-family-friends/index.asp and http://www.renfrewcenter.com/for-family-friends/signs-symptoms.asp on 4/4/11.