One of the biggest concerns keeping behavioral health specialists up at night is the emotional weight of the coronavirus outbreak. As the number of Americans reporting symptoms of anxiety has tripled since the start of the pandemic, providers are witnessing a new phenomenon: adults and children suffering from post-traumatic stress disorder (PTSD).
It’s one reason why PTSD should be redefined in the wake of the pandemic.
PTSD is a syndrome resulting from exposure to a traumatic event, such as a real or life-threatening injury or sexual assault. Commonly, PTSD manifests itself through symptoms including:
- Persistent re-experiencing of a traumatic event, via nightmares or recurrent thoughts
- Negative alterations in cognition and mood, such as an inability to recall important aspects of the trauma, a persistent negative emotional state, loss of interest in important activities, and detachment from those around you
- Increased arousal or reactivity, including irritability, a highly sensitive startle reaction, self-harm or recklessness
While the pandemic itself does not formally meet the criteria for causing PTSD, many of the same issues can result from this widespread and overwhelming event. Additionally, certain crises during the pandemic can trigger anxiety and fear, such as the loss of a family member or sudden loss of employment or income.
Further, our experience during the pandemic shows that children may demonstrate different signs of PTSD than adults. For example, children ages 6–11 may show extreme withdrawal, disruptive behavior, and/or an inability to pay attention. Other common actions in children may include regressive behaviors, nightmares, sleep problems, irrational fears, irritability, refusal to attend school, outbursts of anger or fighting. The child may have somatic complaints with no medical basis. Schoolwork often suffers, and depression, anxiety, feelings of guilt, and emotional numbing are often present.
Understanding PTSD during COVID-19
It's normal for a pandemic to propagate fear in both adults and children or manifest confusion or anger. However, when these feelings don't go away or become worse, an adult or child may have PTSD.
Front-line healthcare workers in the United States are especially at risk for PTSD, with some already exhibiting early indicators of PTSD as they deal with the continuing threat of COVID-19. Among children, those with lack of Internet access or whose parents work in healthcare face increased susceptibility for this stress disorder, as do adults who have undergone a prior traumatic event or childhood abuse. Loss of employment or a sudden drop in income can often put adults and, in some instances, their children at risk.
Yet widespread myths remain regarding who can get PTSD and what circumstances can prevent children and adults—including healthcare workers—from getting the support and care they need. It is often assumed that individuals should be able to move on from the COVID-related trauma they have experienced. The truth is that the strong emotions felt by someone suffering from PTSD can prompt changes in the brain that result in it not being possible for some individuals to move on, much as they want to do so.
How can healthcare providers most effectively identify mental health concerns in their peers and their patients? Here are four things to consider:
Know what to look for in specific patient cohorts. For example, some healthcare professionals have a hard time asking for help. They are trained to put their needs aside and therefore might internalize their anxieties, fears, sadness and grief to continue to function and care for their patients. Unfortunately, this can manifest itself in adverse ways, such as increased use of alcohol and substances to deal with these emotions. Among children 6 and under, those who have difficulty sleeping and concentrating or find themselves feeling jumpy or easily irritated and angered may be exhibiting signs of PTSD.
Understand that people don’t always show signs of PTSD immediately after a traumatic event. PTSD symptoms may not appear until months or years after a traumatic event has occurred. They can also come and go over many years. During COVID-19, it can be hard to anticipate when symptoms such as anxiety, irritability or a persistent negative emotional state may flare up. Often, they are cued by triggers. In the current environment, triggers could include news reports, social media or discussion with friends or family.
Help patients understand what is in their control. It’s natural for patients to feel anxious or worried about what is happening during a pandemic. Sending children back to school, for example, or choosing to teach children from home can both cause extreme stress for parents, while requirements to wear a mask all day on school grounds could prove overwhelming for small children or those just entering middle school. Provide tips that help patients offset their stress with positive, calming activities. Teach them breathing techniques that help their muscles relax, and suggest actions that keep their mind occupied, such as yoga or other forms of exercise.
Realize that there is no “normal” amount of time for PTSD recovery. It’s also important to note that some people may need help sooner than others. If PTSD is impacting an individual’s sleep, mood, focus or ability to function for a prolonged period of time, it is important to direct the individual toward professional help—in person or virtually. With the use of telehealth devices increasing at a record pace during the pandemic, patients’ options for mental healthcare have significantly increased, giving behavioral health providers the opportunity to meet patients “where they are” via the technologies with which they are most comfortable.
Navigating the return to normal
The road to COVID recovery is long, and it can be highly confusing for both adults and children. New threats seemingly emerge on a regular basis, and updates in information continually change our response. As children embark on the start of a new school year during the pandemic—and as adults evaluate the impact of COVID-19 on their professional and personal lives—ensuring that healthcare professionals recognize the potential for PTSD and respond to it effectively will be key to supporting healthy outcomes.
Varun Choudhary, MD, MA, DFAPA, is a board-certified forensic psychiatrist and national behavioral health chief medical officer for Magellan Health.