Here’s a peek into my nights lately: It’s past midnight, and I’m in bed having yet another panic attack, gasping for air, wondering if this is it. Is tonight the night that my worst nightmare comes true? Does my shortness of breath mean something is physically wrong with me—like having the new coronavirus—or am I yet again dealing with anxiety? Will the ambulance get here in time? Would there be space at the hospital for me if I needed to go? What if they’re out of ventilators? It feels like my throat is closing up; my lungs aren’t working. I’m going to die, and my funeral is going to have to be a Zoom meeting.
These kinds of thoughts aren’t anything new for me. I’ve had anxiety since I was 12 and have experienced more nights like this than I can count.
When I first heard that the new coronavirus was spreading in China, I took notice but wasn’t too worried about my own personal safety. But as days went by and I couldn’t go on Twitter without seeing headlines about death, and as the outbreak officially became a pandemic, my health anxiety came flying out of the gates. It got even worse when every article I read about the new coronavirus mentioned a symptom I know all too well: shortness of breath. This is the main way my anxiety manifests physically. One day, I texted my sister, “How the hell am I supposed to know if my shortness of breath is from anxiety or the coronavirus?” If you’re wondering the same thing, welcome to the extremely not-fun club.
Millie K., 23, has also experienced increased anxiety lately. Like me, she constantly deals with shortness of breath, usually around bedtime. Being inundated with news that involves talk of respiratory distress has heightened her awareness of her breathing even more.
“I focus so hard on it, and I feel like my breaths aren’t enough and that I need more oxygen, so I end up yawning nonstop to try to get some air, but it doesn’t help,” Millie tells SELF. “With coronavirus happening, and [some] symptoms being respiratory and including shortness of breath, it’s quite scary. If shortness of breath is a side effect of anxiety, how would you know if it’s the virus causing it, or anxiety, or both?”
What causes shortness of breath
While shortness of breath can be a symptom of both anxiety and the new coronavirus, the science behind how it happens is different for each.
With anxiety it comes down to your fight-or-flight response, which is essentially a primitive biological reaction to danger, Michael McKee, Ph.D., assistant clinical professor of psychology in the department of psychiatry at Columbia University, tells SELF. When your body thinks you might be in peril (which, as basically anyone with anxiety knows, can happen even if you’re actually not), your sympathetic nervous system kickstarts a physiological response, theoretically so you can better protect yourself. As McKee explains, this can cause a cascade of effects like a racing heart and quicker breathing. (Here are other physical symptoms of anxiety.) This reaction is thought to have helped our ancestors be able to run away from or attack a threat, and it’s what makes some of us who deal with anxiety feel winded even now.
The scientific term for anxiety-related shortness of breath is psychogenic dyspnea, Richard Castriotta, M.D., pulmonary critical care specialist at Keck Medicine of USC, tells SELF. Sometimes it can happen because of hyperventilation, which means you’re breathing too quickly. This is also known as “overbreathing.”
“The reason you [feel like you] can’t get enough air in is that you’re already breathing at your max, and therefore there isn’t room to increase the breathing,” Dr. Castriotta says. “That’s why you have that sensation.” How ironic that breathing too much can make it feel like we aren’t getting enough air.
A type of vocal cords dysfunction can also make you feel like your throat is closing up when you’re anxious. “The vocal cords don’t open up the way they should when you’re trying to breathe, and they stay closed or partially closed,” Dr. Castriotta says, which can make it harder to breathe normally. (And, of course, knowing that you sometimes have a difficult time breathing can just make you more anxious, causing a vicious cycle.)
On the other hand, shortness of breath due to the new coronavirus is caused by the pathogen SARS-CoV-2. By definition, SARS-CoV-2 affects the respiratory system—SARS stands for Severe Acute Respiratory Syndrome. According to The American Lung Association, once SARS-CoV-2 makes its way into the respiratory tract, it appears to attack cells that line airways in the lungs. The resulting fluid and debris can lead to symptoms like difficulty breathing.
With this symptom overlap, can you blame me for freaking out?
How to tell the difference between breathing problems from anxiety and the new coronavirus
To be really upfront, this is a tricky topic overall. It’s one thing to explain (very good) expert-based advice for differentiating between the two, but the nature of anxiety can make it really hard to put into practice. First, we’ll walk through expert insight on how to try to tell the difference, then we’ll get into the nuances of why this advice can be hard to follow—plus what you might still be able to do for relief.
Even though shortness of breath from anxiety can certainly make you panic that you have the new coronavirus, there are a couple of concrete ways to try to tell what’s causing your shortness of breath, Dr. Castriotta says.
First, think about if you have a history of shortness of breath as an anxiety symptom. If you’ve experienced multiple spells of anxiety manifesting with the exact symptoms you’re currently dealing with, including shortness of breath, it might be easier to convince yourself that’s what is going on. If that’s the situation at hand, here are some tips for dealing with overwhelming new coronavirus anxiety. If your anxiety normally presents in other ways and this shortness of breath is new for you, that’s worth noting and bringing up with your doctor or therapist via a phone call or a virtual visit. (Even if it’s a new symptom for you, it doesn’t necessarily mean you have the new coronavirus! Anxiety is a wily beast and won’t necessarily feel the same every time.)
Next, you can try to assess your other symptoms or lack thereof. According to the World Health Organization (WHO), people with the new coronavirus who are symptomatic are most likely to have a fever, fatigue, and a dry cough. It’s possible to experience other symptoms as well, even beyond shortness of breath, like a stuffy or runny nose, sore throat, aches and pains, or G.I. issues like diarrhea. Having only shortness of breath doesn’t automatically mean you have the new coronavirus, and having multiple symptoms on this list also doesn’t automatically mean you have the new coronavirus. These other symptoms could be from some other health condition like the common cold, the flu, or a stomach bug. Combined with anxiety-induced shortness of breath, this could make you certain you have the new coronavirus when you don’t.
With that said, it is possible to have shortness of breath from both anxiety and the new coronavirus. That’s why, no matter what, it’s a good idea to flag your symptoms to your primary care doctor, if you have one, or to call a resource like your state’s public health department or a local COVID-19 hotline. Hopefully, whoever you talk to can give you advice on how to best take care of yourself if it does seem that you may have a case of the new coronavirus.
Your capacity to reach out for help will depend on a lot of factors. For example, if you’re actively having a panic attack, it’s not exactly easy to just pick up the phone and have a conversation about your symptoms. But talking to a medical professional when you’re able can help give you some insight into what exactly you might be dealing with.
The reality of living with anxiety in the age of the new coronavirus
For people who have health anxiety, knowledge isn’t necessarily power. Even though I rationally know anxiety is probably causing my symptoms, I still obsess over them.
“[People with health anxiety] often scan themselves and go back to the symptom that they had been tracking,” says McKee. “There’s research finding that this intensifies the actual sensation. Examining it makes it feel worse.”
Yet it feels impossible to not examine it. Even though the World Health Organization has been extremely clear that you can’t know if you have the new coronavirus by doing a “home test” of your breathing—and that attempting this can be dangerous—I still find myself trying it out, just to see if I can. If I’m feeling really nervous, I breathe into the peak flow meter I ordered at the start of all of this to make sure I get a “normal” reading. (A peak flow meter is often used to test how well people with asthma can expel air from their lungs.)
What makes all of this even harder is that some of the methods for telling the difference between shortness of breath from anxiety and the new coronavirus can reinforce these fears. Seeking reassurance, whether from a doctor, a friend or a family member, or a medical device, is a common health anxiety behavior, McKee says. Sure, these kinds of things can feel helpful in the moment, allowing a short reprieve from fears of illness. But, according to McKee, someone with health anxiety can quickly become dependent on this type of “checking” behavior to try to reassure themselves they’re not sick. “There’s no positive benefit other than brief relief from anxiety. It’s only temporary. You know that in five minutes, you’re going to check it again,” he says.
He’s right. I do take my oxygen measurement and temperature over and over again, as if there’s going to be a major change from the last time. I’m not the only one. Denise H., 43, who has had health anxiety for years, has also been constantly checking her temperature, blood pressure, oxygen levels, and breaths per minute, she says.
“I wake up every day wishing this was all a nightmare,” Denise tells SELF. She has asthma and a heart condition, making the virus even scarier to her because they could put her at greater risk for COVID-19 complications. “I spend hours wondering if I’m dying or if it’s panic. I get lightheaded, nauseated, and start trying to do breathing exercises. I feel like I lose my ability to breathe automatically,” Denise says.
Then there’s the fact that, according to McKee, some people with health anxiety completely avoid the doctor for fear of learning what horrible thing might actually be wrong with them. If that’s true for you, while the advice to call a doctor to discuss your symptoms is valid, it can be really hard to actually do.
So what should you do instead?
How to handle shortness of breath from anxiety
When trying to get yourself out of an anxious spiral, McKee recommends using relaxation techniques like deep diaphragmatic breathing and engaging in distractions that’ll occupy your mind such as crossword puzzles, mental exercises like counting backward from 100, or even a video game or exercise. Here are some great tips for making a panic attack more bearable, which can help with non-panic anxiety too.
McKee also urges people with health anxiety to stop reading or watching news related to the new coronavirus, or, at the very least, to significantly limit news consumption. And make sure you’re only looking at news from accurate sources.
If you’re wondering how I’m personally keeping it together, it’s thanks to online therapy, the power of distraction, and forcing myself to do a few self-care acts every day. Physically moving, whether it’s doing an at-home barre workout or going for a quick skateboard ride up and down the street, has been really beneficial for me. My logic is, “If I can do this exercise without collapsing, my lungs are probably fine.”
Under the supervision of a professional, Denise has started taking Zoloft, an antidepressant that’s also used to treat anxiety disorders. She’s hopeful that it will reduce her symptoms. Medication can be a really useful option for dealing with anxiety issues like severe and persistent shortness of breath. As for Millie, she’s been quarantining with her boyfriend, who’s been supportive of her during this time, and says her favorite distraction technique that helps a bit is spelling words out letter by letter on her fingers.
Connecting with people in the same shoes as me, like Denise and Millie, has been extremely comforting throughout this journey. It helps to know there are people out there having the exact thoughts that I am. If there’s anything I’ve learned from this anxiety-filled pandemic experience, it’s that I’m not alone. And if you’re feeling this way too, neither are you.
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