--Identify there's an issue.  This awareness may be initially experienced as a physical sensation (nausea, dread) or a mental one ("something's not right here").

--Clarify, "What's the issue here?"  This may be intertwined with some writing "issues" so you may have to do a little separating out.

--Sometimes we have a personal connection to the touchy issue at hand and that may increase the intensity of our response.  Ask yourself, "What's my personal connection to this?  Is this impacting my response?"  If this is the case, do what you need to take care of yourself and take a step back.  These help me: breathing, reminding myself this is a separate person, I don't have to rescue them, fix them, take care of them, counsel them, step into their shoes for more than a minute, etc.  Talk to a colleague.

--Define: What is my role here?  What am I willing to recognize in my feedback to this student's essay?  What are my limits and limitations?

--Don’t worry about causing students harm by acknowledging a touchy situation they have written about.  If you approach a student with honesty, a calm and warm demeanor and express your concerns without judgment, you cannot do anyone any harm.  If you take the time to take the steps I've just written above, this will increase the likelihood you will approach it in a helpful way.  Your role here is to recognize content that troubles you, point it out to the student in a caring, truthful way, offer resources and possibly follow-up.

Some examples of responses:
Referring someone for counseling:  "If you are the speaker in this essay it sounds like there's a lot going on and it's quite overwhelming.  I'm thinking you may need and deserve more support than you're receiving right now.  There are some great people at the counseling center who can help you sort out what's happening for you.  Have you considered going over there?  I'd be certainly willing to help out with that; I have their phone number.  They've helped a lot of students and their services are free and confidential."

(You can also choose to frame your entire response in terms of "the speaker."  It can feel a little odd but also gives the student a "safety barrier" and allows them to make the choice of acknowledging out loud the issue if and when they want to.)

"You mention "be specific here" in your paper.  I take this very seriously.  I'm wondering what's happening for you?"  Allow them to respond and clarify.  If you continue to be concerned let them know so.  If they continue to resist help and you aren't comfortable that they are safe, call Women's Services x2387 or the Counseling Center at x2461.  You can receive help specific to your situation.  There are some privacy issues here but if there's concern that a student will hurt themselves or someone else, a counselor will contact the student, etc.