How to Know if You Have COVID PTSD, and How to Cope

It's safe to say that Americans are living in a heightened state of fear, anxiety and isolation. Tens of millions of people have been infected with COVID-19 and even more have felt the effects of living in a world where the virus is a constant concern. So it's no surprise that mental health statistics show post-traumatic stress disorder (PTSD) is also on the rise.

PTSD develops after a person experiences a traumatic event, either directly or by witnessing a loved one face a trauma, explains Emily Guarnotta, PsyD, clinical psychologist in New York state and blogger at The Mindful Mommy. The condition has become so prevalent since the onset of the coronavirus pandemic that it has garnered its own diagnosis: COVID PTSD.

One June 2020 study in ​Medicine​ found a 16.8 percent increase in the incidence rate of PTSD among nurses in China who had been exposed to the virus. A more recent January 2021 study in the ​British Medical Journal ​discovered that nearly half of anaesthetic and intensive care unit (ICU) hospital staff reported symptoms consistent with PTSD as well as severe depression, anxiety and drinking problems.

Much like the virus itself, it appears that COVID PTSD has more than one strain. According to Alyza Berman, LCSW, RRT-P, founder and clinical director of The Berman Center in Atlanta, there is COVID PTSD and COVID Pre-TSD — and you don't have to have had the virus in order to experience it.

"People with COVID Pre-TSD have the fear of what ​could​ happen if they get COVID-19 and, in turn, experience similar symptoms without actually having been diagnosed," she says.

According to Berman, these symptoms include:

• Nightmares
• Difficulty sleeping
• An avoidance of certain situations
• Having an adverse reaction to certain stimuli that previously did not affect you
• High levels of anxiety
• Social isolation
• An extreme amount of (irrational) fear

People with COVID PTSD are those who have directly experienced the virus, oftentimes in its most serious form, according to Berman. They experience the same myriad of unwanted and difficult-to-cope-with symptoms.

People who have COVID long-hauler syndrome, a condition where the symptoms of COVID-19 linger for several weeks or months after a person tests negative for the virus, may be at an increased risk for COVID PTSD over time, says Allison Chawla, LMSW, a psychotherapist, spiritual counselor and certified life coach in New York.

"Prolonged endurance and tolerance of symptoms can absolutely cause depression and over time trigger PTSD," Chawla says.

According to Sarah Harte, LICSW, director of The Dorm D.C. in Washington, D.C., other risk factors for COVID PTSD include:

• Being treated in the ICU for the virus
• Having pre-existing comorbidities, such as other mental health problems like anxiety and/or depression
• Being a frontline health care worker or the family members of a frontline worker

But COVID PTSD can happen to anyone who experiences a significant enough level of anxiety, depression, fear and isolation, notes Chawla.

Here are some red flags that signal you or a loved one might have COVID PTSD.

People who have PTSD often experience what's known as hyperarousal or hypervigilance, which means you're significantly more aware of your surroundings, Harte says.

"Hyperarousal interferes with sleep, concentration and can cause people to be easily startled," she says. "People who experience hyperarousal have difficulty managing unexpected events — which is especially difficult during this pandemic when so much is unexpected and different from our lives pre-pandemic — and often avoid circumstances that cause anxiety."

This avoidance, she goes on to explain, can lead to other undesirable effects, including isolation and disconnection from personal relationships.

This umbrella term covers several mental health symptoms, including memory loss, confusion or mental fuzziness.

"These symptoms are commonly associated with anxiety, depression or significant stress, and ongoing stress can further exacerbate the symptoms, creating a cycle that is difficult to interrupt," Harte says. "This can be especially difficult when the brain fog lasts for months on end, making it difficult to return to normal functioning — like getting back to school or work, caring for loved ones and enjoying simple pleasures."

Oftentimes with COVID PTSD, intrusive thoughts or reminders of the traumatic event, such as being in the ICU, flood back in the form of memories or nightmares, Guarnotta says.

"These reminders are distressing to the person and can cause the person to feel as if they are reliving the trauma all over again," she says. "People with COVID PTSD may find themselves constantly thinking about what they experienced or witnessed to the point that it can be difficult to focus on other things."

Exposure to reminders of trauma can overwhelm a person with anxiety and distress, Guarnotta says.

"A person with COVID PTSD may try to distract from their thoughts and feelings about what they experienced or witnessed," she says. "They may also avoid people, places or things that remind them of the trauma, such as hospitals and doctor's offices."

Some of Berman's clients have developed a large amount of irrational fear toward things or situations that they've never before had issues with or feared in their entire life.

"This fear has caused them to socially isolate, even after having the virus, and created major barriers for physical or emotional contact, even if it involves following COVID guidelines or regulations," she says. "For some, this fear may persist until the vaccine is widely distributed, and for others it may actually be cemented long term and take form in other aspects of life, such as incessantly washing hands, not using public spaces/restrooms, or limiting their social encounters as an emotional safeguard to tamp down their COVID PTSD."

There are effective ways of coping with PTSD of any kind, including that which is related to COVID. Here are some expert tips for making the condition more manageable.

Like any illness, be it physical, mental or emotional, you can't expect to heal in a short amount of time. For this reason, Harte recommends focusing on what you can to help you feel better day by day.

"Get a good night's rest by focusing on good sleep hygiene, allow yourself to wind down without electronics, engage in soothing activities and develop a routine that will signal to your body that it's time to rest," she says. "Be sure to eat regularly and focus on nourishing meals, and try to work in some body movement each day — stretching or light yoga or a walk can contribute to feeling stronger and helping your body heal."

As tempting as it is to keep the news on in the background, it's better for your mental health to turn it off.

"If there is something important to know, you will find that you are aware of it simply by listening to other people talk," says Jacob Teitelbaum, MD, a board-certified internist and expert on chronic fatigue syndrome. "It is hard to recover from PTSD if you keep putting yourself in the traumatic situation, so whether one is getting PTSD from being around an abusive person, or situation, the first step is to physically disconnect from it."

Though it can be understandably difficult putting your experience with COVID PTSD into words, especially to loved ones who might not understand or be as empathetic as you'd hope, it's important to do so, Berman says.

In fact, she says that accurately expressing to others how you're feeling and the ways in which you've been affected by COVID is one of the most effective ways to help manage your symptoms.

"Communicate to your loved ones how COVID PTSD is affecting your daily life and the ways in which they can potentially help or be more understanding in certain situations," she says. "As with anything, positive communication with others is imperative to maintaining strong relationships and keeping your own mental and physical wellbeing intact."

If your symptoms persist for more than a month or are causing problems with day-to-day functioning, Harte recommends reaching out to a mental health provider.

"Effective treatments for trauma exist, including psychotropic medications and therapies such as trauma-focused CBT, eye-movement desensitization and reprogramming (EMDR) and cognitive processing therapy," she says. "Ask your doctor for a referral to a provider, or seek out a COVID-19 survivors support group in your area."