COVID-19 Is Affecting More Than Just People With Anxiety and Depression

As COVID-19 continues to spread worldwide, we’ve seen fear and uncertainty spread at the same time. From grocery shortages to record-breaking unemployment numbers and increased isolation due to social distancing, it’s no wonder we’ve seen sharp increases in anxiety and depression. A recent report from Express Scripts, a pharmacy benefit manager, found the number of prescriptions filled per week for antidepressant, anti-anxiety and anti-insomnia medications increased 21% between February 16 and March 15.

While it’s so important to talk about the mental health ramifications of this pandemic, we can’t forget it’s not just people with anxiety and depression who are being affected — folks with other mental illnesses (which are often incredibly stigmatized) are experiencing an increase in symptoms as well.

Here are the ways the COVID-19 pandemic is affecting schizophrenia, borderline personality disorder and binge eating disorder.

Schizophrenia

Schizophrenia is a chronic mental illness marked by disruptions in reality perception, often manifesting in delusions (false beliefs that aren’t based in reality), as well as auditory and visual hallucinations (seeing or hearing things that aren’t there). In some cases, someone with schizophrenia may lack emotional expressiveness, known as flat affect.

Like people with other mental illnesses, many folks with schizophrenia are experiencing heightened symptoms during the COVID-19 pandemic. 

“I have had some symptoms pop up like delusions,” Michelle Hammer, Mighty contributor and founder of Schizophrenic.NYC, said. “Having so much time inside is letting me have more time to think to myself. I keep thinking of the past and coming up with new delusions. It’s hard to know what is real sometimes.”

Brenda Johnson*, a nursing assistant who works in a psychiatric ward in Minnesota said the COVID-19 pandemic has been difficult for patients with acute schizophrenia. In non-pandemic times, Johnson said her patients struggle with breaks from reality that can range from thinking people are trying to communicate with them through the TV or radio to believing they are the savior of the world (known as a “messiah complex”). She explained that typically, her patients’ symptoms do not relate to current events, but since COVID-19, that has changed.

 “It’s the worst-case scenario, but it’s also something that is really happening,” she said. “Delusions all of a sudden take on a very realistic tone. They begin to feel like they’re the reason COVID-19 is happening, or if they do this one thing, they can stop COVID-19.”  

In addition to medication and therapy, an integral part of symptom management for many people with schizophrenia can include “reality checking” with a treatment team to help separate what’s real from what’s not. Right now, patients with COVID-19-related delusions and hallucinations see people walk around in face masks, non-stop media coverage of the virus and worldwide levels of paranoia rise — making it that much harder to separate reality from delusion.

“Imagine the paranoia and the frustration and the anger and the sadness that a ‘normal’ person is experiencing now, and make that times 100 for your patient who has schizophrenia,” Johnson said.

Peter Bullimore, a voice hearer himself and founding member of the National Paranoia Network in the U.K., said people struggling with symptoms like paranoia, hearing voices and psychosis may be revisiting past trauma during the COVID-19 pandemic. 

“A lot of feedback we are receiving is coming from people who have been able to take control of their voices and paranoia and move on from psychiatric care, but now they feel they are starting to lose control again,” he said, adding:

This is due to the fact that the current situation is reminding them of when they were sectioned in hospital against their will. They were on a ward where they had no control and if they left, they were arrested by the police and brought back. The lockdown is similar, as you cannot leave your home without good cause… This raises past difficult memories that their voices then comment on, which is then, for many people, becoming a conspiracy that something they cannot see is controlling them (the virus). 

If you have schizophrenia and are struggling right now, you’re not alone. Bullimore and his team created an email (support@nationalparanoianetwork.org) so folks who are hearing voices or experiencing paranoia during COVID-19 have a place to turn for support. 

Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental illness characterized by unstable interpersonal relationships and intense difficulty regulating emotions. BPD is the mental illness with the highest suicide rate and affects about 1.7 percent of the general population.

“Borderline personality disorder is a disorder of extremes. [During COVID-19] we’ve seen these extremes play out,” staff psychiatrist at McLean Hospital, Blaise Aguirre, M.D., told The Mighty. 

BPD is usually diagnosed when an individual meets five of the nine following criteria, which are listed below. During the pandemic, many folks with borderline personality disorder have experienced an uptick in these symptoms:

1. Making frantic efforts to avoid real or imagined abandonment.
2. Having a pattern of unstable relationships often characterized by idealizing or devaluing a person (also known as black and white thinking or “splitting”).
3. Struggling with unstable self-image or identity.
4. Engaging in risky or impulsive behavior.
5. Having frequent suicidal thoughts or engaging in self-harm.
6. Experiencing periods of emotional intensity, or frequent/rapid mood swings.
7. Having chronic feelings of emptiness.
8. Living with intense or uncontrollable anger.
9. Dissociating or having an “out of body,” disconnected from yourself-type feeling.

KellyAnn Navarre, a Mighty contributor who lives with BPD herself, explained social distancing due to COVID-19 has increased her fears of abandonment, something she had significant struggles with prior to the pandemic.

“On a typical day, it might feel like my loved ones and sense of familiarity are about to be taken away from me by a UFO. I have abandonment-themed nightmares of people disappearing or rejecting me,” she wrote in an article for The Mighty. “COVID-19 stress is proving to be an added challenge and trigger for me… Each time I see the words ‘separation,’ ‘isolation’ and ‘social distance,’ I am reminded of abandonment and loss. Each day it gets harder.” 

In non-pandemic times, folks with BPD often have stormy interpersonal relationships. Now, due to COVID-19, many are facing increased stress in their interactions with others. People with BPD who are quarantined with partners or family members may feel overwhelmed and act out in painful ways to try to regulate their emotions but actually end up damaging their relationships.

When you’re facing painful BPD symptoms, Dr. Aguirre recommends a dialectical behavior therapy (DBT) skill called opposite action. In DBT, opposite action is a deliberate choice to act contrary to what an emotional urge tells you to do. For example, if you have a small argument with a loved one and have the urge to lash out in a big way, an opposite action might be taking a walk outside and collecting your thoughts. When you feel a bit more level-headed, you can approach your loved one to talk. 

But not all people with BPD are living with others right now. Some are living alone, which brings its own set of challenges.

“For people who are living alone, it’s been very, very difficult,” Aguirre said. “They’re feeling increasingly isolated and increasingly empty, increasingly alone. Those are the people I worry about most.”

If you live with BPD and are feeling alone right now, you’re not alone. The Mighty has a large community of BPD warriors who would love to connect with you. Share a Thought or Question with the hashtag #BorderlinePersonalityDisorder on our site. Whatever you’re facing today, you don’t have to go through it alone.  

Binge Eating Disorder

Binge eating disorder (BED) is a condition characterized by recurrent episodes of eating large quantities of food, often to the point of physical discomfort. According to the National Eating Disorders Association (NEDA), bingeing episodes are frequently followed by feelings of shame, as well as unhealthy behaviors to “counter” the effects of binge-like restricting or purging. Though we typically think of anorexia when it comes to eating disorders, binge eating disorder is actually the most common eating disorder in the United States.

During the COVID-19 pandemic, people in binge eating disorder recovery may experience a resurgence of symptoms as they try to cope with a loss of control, financial concerns and fear of the unknown. 

“The constant feeling of fear and lack of structure pushes my clients with BED to use food to numb their feelings,” eating disorders and body image specialist Adi Diamant, LMFT, told The Mighty. 

Prevention guidelines like social distancing (also called physical distancing), may further isolate people struggling with BED by distancing them from the support systems they have in place in non-pandemic times.

“When I was struggling, my eating disorder and depression thrived off isolation, Chelsea M. Kronengold, communications manager for NEDA with lived experience with binge eating disorder, told The Mighty. “The more time I spent disconnected from my friends and family, the harder it was to get myself back on track,” 

While engaging in disordered eating behaviors or isolating from your loved ones might feel anxiety-relieving in the moment, these actions can do more harm than good in the long-run. Having coping skills to turn to in times of emotional crisis is vital when you’re struggling with any mental illness. For help with coping, we encourage you to check out this list of tips from the nonprofit Eating Disorder Hope.

“Letting go of shame and guilt is so important and needed! You didn’t choose to have an eating disorder, but you can choose to recover — which takes so much courage and strength,” Diamant said. “It’s OK to have hard times and hard days. If you engage in an eating disorder behavior, it’s OK. If it happens, it happens… But please do not beat yourself up. You deserve to heal.”

Thankfully, even as non-essential businesses are shutting down, treatment providers are offering teletherapy, and nonprofits are offering COVID-19-specific support. Kronengold shared that in addition to the confidential and toll-free helpline, NEDA put together a list of free or low-cost COVID-19 resources. Check it out here.

*Name has been changed to protect the identity of this health care worker.

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