Though a relationship between sexual assault and suicidal thinking is established, fewer studies explore complex coping mechanisms for these college student treatment issues. We hypothesized that the relationship between sexual assault and suicide ideation was mediated by binge eating concerns and that treatment for recent sexual assault would also result in greater change in eating concerns and suicidal thoughts. An eating concerns subscale and an item assessing suicidal thoughts from the Collegiate Center for Mental Health (CCMH) 2018-2019 data set were completed during treatment (n = 53,016). Results supported the hypotheses, revealing eating concerns as a significant partial mediator. Moreover, recent sexual assault survivors, particularly men, experienced greater changes during treatment than clients with other presenting concerns. Findings suggest problematic coping strategies that may increase the likelihood of suicidal thinking following sexual assault. Practitioners should monitor students' eating concerns and emphasize emotional regulation strategies to reduce suicidality. Limitations of correlational methodology and small effect sizes are also discussed.