Dr Wayne Kampers | Harley Street Psychiatrist | Private Harley Psychiatrist | Harley Street Psychiatry

The COVID-19 pandemic has triggered significant emotional, physical, and economic problems around the world, with an emerging mental health pandemic of adjustment disorders, anxiety, depression and suicide, and an increase in trauma and stress related conditions like post-traumatic stress disorder (PTSD) and post-pandemic stress disorder (PPSD).

The negative impacts of the pandemic have affected every aspect of life and it is estimated that 10 % of people will develop severe psychological problems as a result of the pandemic.

Adjustment disorders are maladaptive reactions to an identifiable psychosocial stressor or multiple stressors (e.g., divorce, illness or disability, socio-economic problems, conflicts at home or work) that usually emerge within a month of the stressor.

The disorder is characterised by preoccupation with the stressor or its consequences, including excessive worry, recurrent and distressing thoughts about the stressor, or constant rumination about its implications.

Failure to adapt to the stressor causes significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.

The symptoms are not better explained by another mental disorder (e.g., Mood Disorder or PTSD) and typically resolve within 6 months, unless the stressor persists for a longer duration.

COVID Stress Disorder is pandemic-related adjustment reaction that meets the impairment and distress criteria for adjusment and mental health disorders in general.

Although it may be that many cases of adjustment disorder abate once the stressor has passed (usually <6 months), this is not always the case; some cases become chronic, with progressively intensifying psychopathology usually lasting longer than 6 months.

Traumatic stress symptoms associated with the COVID Stress Disorder may consist of intrusive thoughts and images of news media or social media stories about the pandemic.

Patients could be advised to limit their exposure to disturbing media, while staying informed from reliable news services, but not spending hours per day watching disturbing (and possibly exaggerated) social media or news media accounts of traumatic pandemic-related events.

The COVID Stress Disorder (Syndrome) is associated with a range of pandemic-related phenomena including:

• Avoidance of supermarkets and shops (for fear of infection)
  
• Fear and avoidance of healthcare workers (also for fear of infection)
  
• Use of personal protective equipment (masks, gloves, and visors)
  
• Panic buying and stockpiling of supplies in preparation for self-isolation
  

When the current pandemic eventually comes to an end, many people will have lived through all kinds of traumas, stresses and losses including:

• The stress of restrictive measures (lockdowns and quarantines), social distancing and isolation
  
• The loss of friends and loved ones
  
• The loss of education and job opportunities
  
• The loss of the ability to socialise and connect with friends and family
  
• Not being able to travel abroad for funerals and to see loved ones
  
• Mounting financial hardships with loss of jobs, businesses, homes, and financial independence
  
• Loss of relationships and ending of marriages
  
• Loss of health
  

Post -Pandemic Stress Disorder (PPSD) is increasingly being recognised as a form of COVID-19-induced Post Traumatic Stress Disorder (PTSD).

Although PPSD is not yet an official medical diagnosis the symptoms are not dissimilar to those of PTSD with:

Re-experiencing symptoms

• Reliving any traumatic event related to COVID-19
  
• COVID-related nightmares
  
• Increased anxiety levels or panic about becoming infected
  
• Increasing irritability
  
• Triggers
  
• Autonomic physical symptoms
  

Avoidance behaviour

• Avoidance of seeing people because of fear
  
• Feeling emotionally detached or numb
  
• Self-medicating with alcohol to numb feelings
  
• Social withdrawal, anhedonia, loss of motivation
  

Alertness and Reactivity symptoms

• Hypervigilance, insomnia, or interrupted sleep
  

Mood related symptoms

• Mood changes related to isolation, fear, and uncertainty
  
• Ruminating
  
• COVID-related intrusive thoughts and nightmares
  
• Catastrophic thinking
  
• Depressive cognitions
  
• Hopelessness
  

Some examples of COVID-19 traumatic stressors include

• Severe illness/hospitalisation
  
• Witnessing death
  
• Death of a loved one
  
• Extreme exposure to COVID-19 details
  
• COVID-19 exposure and quarantine/social isolation
  
• Employment loss/income loss
  
• Caregiver burden
  
• Compassion fatigue in healthcare workers
  
• Inadequate PPE in healthcare workers
  
• Having to make difficult medical decisions if you are a doctor
  

The COVID-19 pandemic has seen a sharp increase in domestic violence with people spending more time at home with abusive partners and increasing conflict as a result of unemployment and other financial stressors.

The added burden of caregiving and the risk of losing job may fall more heavily on women. Those who struggle to tolerate uncertainty and distress fare worse as do people with poor health or other chronic diseases.

While medication is not routinely offered as first-line treatment for PTSD or PPSD, it may form part of your treatment plan if, for example, you are depressed, anxious, agitated, or not ready to commence talking-based treatments.

The important thing is determining the right approach for your needs and circumstances.

If you think you are suffering from PTSD or PPSD, then please get in touch to arrange an assessment.