The stress of the COVID-19 pandemic is likely to trigger symptoms for people with a diagnosed mental illness. This article from Everyday Health has ideas on ways to cope for those with OCD, Anxiety, PTSD, Depression, Bipolar Disorder, Substance Use Disorder, Eating Disorder, ADHD, and Schizophrenia or Delusional Disorder.
The COVID-19 pandemic has forced the American people to confront an array of stressors — job loss, isolation, and economic uncertainty — all at once. This abrupt change will undoubtedly have a significant impact on the mental health of the average person but will likely be particularly hard on those with preexisting mental health conditions. In fact, a recent survey-based study accepted for publication by The American Journal of Psychiatry on April 14 found that during China’s lockdown, over 20 percent of respondents with a prior mental health condition felt their symptoms got worse. What does that tell me, as a therapist? We — therapists, families, and friends — should be prepared for some people to need extra help. Here are ways the COVID-19 pandemic could impact the most common mental illnesses, and some tips for coping with them.
Obsessive-Compulsive Disorder: What’s Normal Right Now?
Everyone is worried about germs at the moment. The fear of getting sick with COVID-19 is a lot for the average person to cope with, but it’s even trickier for someone who is predisposed to obsessive (intrusive and unwanted) thoughts or compulsions (irresistible urges). Obsessions over germs and the compulsion to clean are already among the most common features of obsessive-compulsive disorder (OCD), so it’s no surprise that many people with OCD wonder whether their current urge to sanitize is normal or the result of their diagnosis. (1) If attempts to clean less cause significant anxiety, if you are having physical problems like cracked skin due to washing too much, or if you are consistently getting into arguments with your loved ones over cleanliness, the behavior is likely a result of your OCD and not a healthy adaptation to the times.
How to Cope
The best way to deal with OCD is to allow yourself to feel uncomfortable while not giving in to your urges. (Easier said than done, I know.) Obviously, some increase in handwashing and cleaning is necessary during this time, so it is a little complicated to know which behaviors to give up and which to keep. Talk to a trusted friend, family member, or healthcare provider if you need help figuring out which behaviors are unhealthy. If you feel comfortable, ask a partner or roommate to help keep you accountable in not giving in to your urges. If you are not able to see your mental health provider often due to the pandemic, explore other tools: Some of my clients have found it helpful to use the support features available through the app NOCD in between sessions.
Anxiety Disorders: Coping With More Uncertainty
There are many types of anxiety. The most common form is generalized anxiety disorder (GAD), which is excessive and persistent worrying over various aspects of life, commonly including health, relationships, and finances (all of which can be negatively impacted by this pandemic). Besides adding to existing worries, this pandemic is additionally hard for someone with GAD because of how much uncertainty is involved. When will it end? Will it come back? Will I get sick? Will I lose my job? In my experience, people who have GAD cope with this uncertainty by ruminating over worst-case scenarios and constantly planning for them. This is stressful and exhausting, often leading to physical health symptoms, like stomachaches or headaches, trouble sleeping, and feeling on edge.
How to Cope
For starters, empower yourself. Think of a time you had a setback and handled it as a reminder that, although you may not be able to anticipate everything that happens in life, you will probably be able to handle stressors as they come up. Next, shift your focus of worry to what you can control instead what you cannot. For example, if you are worried about your finances, shift your focus from “Will I lose my job?” (which you cannot control) to “Let me make a budget and spend my money wisely” (which you can control).
If you are still struggling with worries over what you cannot control, schedule 5 to 10 minutes each day to be “worry time.” As thoughts pop up during the day, remind yourself to wait until worry time to focus on them. Then during worry time, write all of your worries on paper. Many people I have done this exercise with end up realizing that they worry about the same few things all of the time, and by reserving time to really focus on them, some people have even gotten bored of their same old worries.
All of these exercises are easier when you are mindful of when a worry thought pops up. This allows you to deal with the worry train when it approaches instead of being carried away by it. If you are new to mindfulness, I suggest trying a free meditation app such as MyLife or a guided meditation podcast such as Tara Brach’s.
Post-Traumatic Stress Disorder: Threats Feel More Prevalent
Post-traumatic stress disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a terrifying event. Symptoms include trouble sleeping, unwanted thoughts of the event, severe anxiety, and flashbacks. People with PTSD are thought to have a heightened stress response (often referred to as “fight, flight, or freeze”). Daily life can be exhausting to someone with PTSD because they constantly feel as though they are being threatened though there is no true threat. This is especially problematic during the pandemic, as threat seems to be everywhere, even the grocery store. In addition to this, depending on what trauma caused the PTSD, other features of this pandemic — such as the reports of deaths, the isolation, or possible survival guilt (guilt that you are healthy while others are severely ill) — can also exaggerate PTSD symptoms.
How to Cope
If you are feeling triggered by recent events, reach out to a trusted loved one or your mental health provider if you have one. Pay attention to what is triggering your symptoms. If the news is, for example, limit how much you watch and read to once a day for a few minutes, which is enough for need-to-know updates. Make sure you engage in self-care including exercise, eat three nutritious meals daily, and make time for hobbies you can do from home or while social distancing.
The stress and worry of this pandemic alone can lead to a depressive episode, categorized by low mood, little interest in activities, feelings of guilt, feelings of low self-worth, fatigue, diminished concentration, disturbed sleep, disturbed appetite, or recurrent thoughts of death. This is true for someone who has not experienced depression before and is even more likely in someone with a history of major depressive disorder (MDD), which is characterized by five or more depressive symptoms for two weeks or more. In my experience with clients prone to depression, mood follows behavior. In fact, a common treatment for major depressive disorder is behavioral activation, which treats depression by having a person do rewarding things, like reaching out to friends, exercising, spending time in nature, or completing a work project. The fact that people are more isolated and less able to engage in these activities could lead to depression.
How to Cope
You can use the same techniques listed in the anxiety section to try to manage the stress. Additionally, stick to a healthy routine, especially activities that approximate those you find satisfying. That may require some creativity. For example, if you used to work out in a gym and cannot go there now, still carve out time to work out. If you miss gym classes, try an online fitness class. If you are a social person, host a brunch or appetizers over Zoom.
Bipolar Disorder: Need for Routine Is Paramount
People with bipolar disorder experience depressive episodes (as described above) and manic episodes, which are categorized by extreme happiness or irritability, a lack of need for sleep, increased energy, and increased activities. This pandemic can worsen bipolar depression in the same ways it can worsen unipolar depression (also known as MDD, as described above). Significant stress can similarly lead to manic symptoms. Additionally, if people with bipolar disorder change their routines significantly due to the pandemic, and particularly if they are sleeping less, they are at risk of a manic episode.
How to Cope
Routine! Routine! Routine! Try your best to stick to a routine, especially going to bed and waking up at about the same time. Avoid behaviors that can interfere with sleep before bed, like reading news updates on your phone. Avoid using substances, like alcohol, to help with sleep or manage stress, as those can lead to mania in people with bipolar disorder.
Substance Abuse Disorders: Many People Are Using Substances as a Coping Tool
Liquor stores have been deemed essential throughout this pandemic, and while many businesses are suffering, it is estimated that liquor sales are up 55 percent compared with this period last year. (2) It is clear that, alcohol use disorder or not, people are using more alcohol — and likely other substances such as marijuana — to combat the stress and boredom that can come with this pandemic and staying at home.
People who misuse substances, defined by an inability to control use and having substance-related health or social problems, may be using more substances than usual, and people who are sober may be struggling to maintain sobriety. Whether you have been diagnosed with an alcohol use disorder or not, it is important to be mindful of how much you are drinking because alcohol can cause sleep problems, lead to depression, worsen anxiety, and over the long term, have health consequences, such as increasing the risk of a number of cancers.
How to Cope
If you are worried your substance use may be problematic, or if your friends or family keep telling you that it may be, you should try to stop use for a while. If you become irritable or anxious without the substance and struggle not to use, you may need support from a healthcare provider. If you are trying to abstain from alcohol and experience withdrawal symptoms, reach out to your healthcare provider, as alcohol withdrawal can be fatal. If you are currently sober and struggling, keep in mind what helped you achieve sobriety. Whatever coping skills you used previously, try to continue. Reach out to a loved one for support. In a time of isolation, it may also be helpful to reach out to a community, like Alcoholics Anonymous or The Tribe (a free online wellness community with a number of peer-to-peer support groups, including one for addiction).
Eating Disorders: A Feeling of Lack of Control May Be Triggering Them
There are different forms of disordered eating, such as anorexia, bulimia, and binge eating. In my experience treating people with eating disorders, having a sense of control is a common theme. Many people are struggling now with the lack of control we have over what is happening, how it is being handled, and how long the situation will last. Someone with an eating disorder may experience a worsening of symptoms in an attempt to gain back some control. Additionally, a person prone to binge eating may be turning to food to cope with stress.
How to Cope
Practicing acceptance of yourself and of the things that are out of your control may help prevent a worsening of symptoms. This does not mean that you are deciding not to change anything about yourself or your situation; it just means you are allowing the present moment to be as it is without judgment. If you are experiencing a worsening of disordered eating, reach out to your counselor or psychiatrist.
Attention Deficit Hyperactivity Disorder: Lack of Schedule May Aggravate It
People diagnosed with attention deficit hyperactivity disorder (ADHD) may have trouble with attention, focus, planning, sitting still, and impulse control. For some, this new way of attending work or school from home may be helpful, allowing them to do things in their own time and take breaks. For others, the lack of structure may worsen attention issues and lead to procrastination and trouble being productive.
How to Cope
If you are struggling to stay focused, create a schedule and to-do list each night for the following day. Include time for meals, work, and downtime. Scheduling downtime will allow you to indulge a bit throughout the day without wasting too much time talking on the phone or scrolling through social media. Also, be specific. For example, instead of writing "Do work,” actually write the items you want to accomplish. Many people find it helpful to schedule a challenging or boring task before something fun or relaxing, like a meal or a planned phone call with a friend. This provides a little incentive to get through the task.
Keep in mind that the medications commonly used to treat ADHD — stimulants such as methylphenidate (Adderall or Ritalin) — can worsen anxiety. So if you have ADHD and are feeling more worried or anxious than usual because of COVID-19, you should talk to your provider about these new or worsened feelings.
Schizophrenia and Delusional Disorder
Schizophrenia and delusional disorders both have the presence of delusions (beliefs that are firmly maintained though they go against facts or norms) as a common feature. These disorders are not as common as the other disorders listed here, but they, too, can be easily exacerbated during the pandemic. Some people may become convinced they have contracted COVID-19 even if there is no evidence supporting this. Additionally, just searching the news or social media, you can see a number of conspiracy theories that have arisen since the start of the COVID-19 pandemic. Further, the effects the pandemic is having on the availability of common household products and medical supplies (such as masks) can lead to mistrust of one another and authorities. All of these can be challenging for someone who is already prone to suspicion.
How to Cope
Usually, someone with delusions does not realize it. If you are concerned about someone you love, try to be understanding. Firmly telling them that they are wrong will not work and will likely lead to them feeling more threatened. If you worry that the delusional thoughts are interfering with their behavior, help them reach out to a provider for help. If there is an imminent safety concern, call 911.
A Word About Access to Mental Healthcare
Not only can the COVID-19 pandemic worsen symptoms of various mental illnesses, it can also make it more difficult for people to get the care they need. For example, many patients do not want to go to clinics or offices to get care out of fear of getting sick. If you are worried about this, ask your mental health provider about virtual visits (called telehealth). Ideally, this takes place with video and audio. But if your mental health provider does not have this set up or if it feels too tricky for you, ask about the possibility of simple phone calls.
Discuss any worsening of symptoms with your provider. Now that many hospitals are crowded with people who may have COVID-19, it is important to work with your provider to anticipate a potential crisis with the hope of managing it outside of the hospital. Of course, if you feel unsafe, it may be necessary to go to a hospital. If you can, call your provider, who may be able to help you select a less crowded hospital or a hospital that has an area for mental health crises that is separate from physically ill patients.
Besides worrying about access to care, some people are worried about access to their medications as well. Given that some ingredients used in medications are manufactured in other countries, it is possible that the supply of medications could become disrupted as countries deal with the pandemic. Although no commonly used psychiatric medications, such as selective serotonin reuptake inhibitors, have yet to be in short supply, if you are stressed about the availability of your medication, ask your doctor about a 90-day supply of medication instead of a 30-day supply.
Medically Reviewed by Justin Laube, MD
Last Updated: May 18, 2020 at Everyday Health
Read the original article with additional links and references at Everyday Health
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