The Behavioural and Psychological Symptoms of COVID-19 (BPSC-19)

Firstly, as we all face the current healthcare crisis, I acknowledge the challenging nature of these times and hope you are all safe and well.

I suggest we phone our family and friends, and if that’s difficult, then consider writing a letter or sending a card. I love receiving letters and cards… I’m staying off social media more lately, but it does highlight lots of interesting articles, and this blog has been inspired by one.

A couple of days ago, a post on Facebook by Imogen Wall has had me thinking, which for those who have followed me here for any length of time, you will know can be a bit dangerous! After reading her post and advice a few times, I’ve realised her post spells out why there will (should?) be a new medical term.

Behavioural & Psychological Symptoms of COVID-19 (BPSC-19)

People are self reporting or are being seen to be experiencing behavioural and psychological symptoms of COVID-19 (or are they normal human responses), including:

  • anxiety
  • mood disturbance, e.g. depression
  • stress due to enforced isolation and distancing
  • reactions due to the amygdala (fight or flight)
  • anger (fight response)
  • aggression (fight response)
  • irritability (mood disturbance)
  • trying to escape (flight response, wandering)
  • Hoarding (excessive shopping)
  • absconding (flight response, wandering)
  • confusion
  • being irrational (e.g. fighting for toilet paper or spitting on fruit in the supermarket)
  • difficulty making decisions (should I visit my son before they close the borders)
  • excessive worrying
  • inability to concentrate, or do simple tasks such as spell
  • poor sleep (sleep disturbance)
  • awaking the middle of the night (sleep disturbance)
  • sundowning (sleep disturbance)

So, we must ask ourselves, are these reactions normal human responses, or are they the “neuropsychiatric symptoms of COVID-19″?

And if so, will they end up in the DSM-V, and be experienced by at least 90% of the population? I’d suggest this is already evident, and have seen and read a lot of stories where there is mild to severe ‘hysteria’ and open displays of deep distress.

For the record, I am not meaning to disrespect or demean in any way those people who are stressed, but rather, to put their reactions to COVID-19 into a more realistic perspective. This is because people without dementia are not used to enforced isolation, or social and physical distancing, whilst people with dementia experience it from the day we dare to share our diagnosis.

Isolation, stigma, discrimination and distancing (social and physical) are the daily realities of most people living with dementia.

We can only hope that society is not intending to chemically and physically restrain the whole world, simply because of the normal human reactions they are having to the enforced isolation and physical distancing that has been imposed on them. And for anyone interested in helping to #BanBPSD, by Reframing Dementia, please join the special interest group.

One must hope this new term BPSC-19 will not provide a medical rationale to over-medicate and restrain people…

Kate Swaffer © March 2020

Anyway, here is most of Imogen’s post on Facebook that has inspired my thinking and the creation of the new term. I recommend reading it, as it does contain a lot of excellent advice for anyone experiencing any of the symptoms of BPSC-19.

Pandemic Anxiety 101

Imogen Wall © 22 March 2020

“So… my goodness. A couple of days ago, I threw out an off-the-cuff post on aid worker tips for surviving lockdown and quarantine….

Ladies and Gents, this is Pandemic Anxiety 101.

IN CRISES, WE START DOING WEIRD STUFF: Over the last week I have struggled to sleep, stayed up late into the night reading endless news articles, bought pasta I don’t even like very much, got angry with my mum for not staying home. My spelling is a disaster and I’m definitely drinking more. I’ve been a bit teary, and all I really want to eat is cake, cake and more cake. From what I got back from my post yesterday, I’m not alone. 

If you’re having a wobble, you may also have noticed all sorts of weird stuff going on. Are you arguing more, talking faster, struggling to sleep, restless, desperate for information? Or are you teary and overwhelmed, perhaps feeling a bit sick? Struggling to make decisions? Just want to stay in bed? Tummy upsets? Having palpitations, butterflies, headaches? Ranting, picking fights or getting into arguments? Laughing unexpectedly or saying random, inappropriate things? Developing Very Strong Opinions on epidemiology overnight? Or have you just completely gone to ground?

If you are feeling any of these things: good news! You are not going mad. And you are 100% not alone. You are, in fact completely normal: a fully emotionally functional human being. Congratulations! Why? I’ll explain: take a seat and put the kettle on. 

WE ARE LIVING IN TURBO-ANXIOUS TIMES. Well, no kidding. We’re in the middle of an unprecedented crisis that has showed up unexpectedly (they do that) and which presents a mortal threat to ourselves, our loved ones and our way of life. It’s terrifying and it’s getting worse and it makes us feel totally out of control. And this is on top of anything else we have going on.

HERE’S THE SCIENCE BIT. When we are exposed to threats and need to deal with them, our brain springs into action. Specifically a tiny, innocent-looking thing buried behind your ear called the amygdala (fun fact: it’s the size and shape of an almond). It’s the bit in charge when we are frightened and right now, it’s in full tin-hat klaxon mode. Unfortunately, it’s also very ancient bit of kit. It came into being when threats basically consisted of being eaten by large scary animals like bears. You know that thing about when you have a hammer, everything looks like a nail? Well, to the amygdala, everything looks like a bear. It’s also pretty basic, so it really only has two settings. They are no bear 🙂 and BEAR!!!. 

SETTING: BEAR!!!. Because all threats look like a bear to the amygdala, it preps you accordingly. There are really only two reactions to a bear about to eat you: fight it, or run away really fast. So this is what the body gets you ready to do. It’s called the Fight or Flight response (there’s also freeze, meaning you just get paralysed). It does this by flooding your body with chemicals like cortisol, and adrenaline. Your heart rate goes up, you feel super alert, your breathing goes shallow, your muscles are ready for action. These chemicals are also largely responsible for the huge range of other cognitive/physical/emotional reactions in my intro. In group fear situation like a pandemic, this tends to happen whether you think you’re scared or not – anxiety is even more infectious than COVID. Your body reacts even if your conscious mind doesn’t.

BEAR V VIRUS: Obviously this is all great if you really are running away from a bear. But we’re now in a situation where we’re being asked to do the EXACT OPPOSITE of running away. We are being told to sit tight. Literally stay still. Process large amounts of information, make complicated and life changing decisions, and stay calm. All while a bit of your brain is running around yelling BEAR!!! BEAR!!! BEAR!!! This isn’t easy. The result is an awful lot of stress and anxiety. And if you’re anything like me, you end up feeling really overwhelmed and having all sorts of reactions.

SIGNS AND SYMPTOMS: Anxiety isn’t just mental – it’s also physical, cognitive and behavioural. You will notice all kinds of things: stomach upsets, headaches, insomnia, changes to eating, changes to the way you talk. It’s also cognitive: it’s very difficult to think straight when you’ve got the BEAR!!! BEAR!!! BEAR!!! thing going on – so we also become very bad at making decisions, absorbing information and generally thinking rationally. Which is EXACTLY what we need to do. 

SO WHAT TO DO: well, the good news is it is possible to calm down. We can turn the amygdala from BEAR!!! to NO BEAR, and not just by distracting it with cake and tea. Here are some solid, scientifically proven things you can do.

BREATHE. It’s so basic, but breathing exercises are basically magic. They work in minutes and you can do them anywhere. They work because of all the physical reactions the amygdala triggers, rapid breathing is the only one over which we have conscious control. Control your breathing and you are basically telling your body: it’s OK. There is no bear. Your body will then start to dial down the adrenaline and cortisol and all the other reactions will slow to a halt. How to control your breathing? It’s easy – and if you want help just put “two minute breathe bubble” in into Youtube. The golden rules are these:

• In through the nose, out through the mouth. SLOWLY
• Make the outbreath longer than the inbreath – imagine there’s a candle in front of you and it mustn’t go out
• Breathe from the tummy not chest – really make your tummy go out when breathing in. 
• Do it for two minutes – time yourself – and see how you feel

Seriously, try it – this technique is used by everyone from top athletes to the US military to help stay in control while under stress. There are all sorts of versions – from yogic breathing to box breathing to 4-7-8. Google them, mess around, figure out what works for you.

CALL A FRIEND: Don’t suffer alone. Call a mate – someone who’ll listen while you have a bit of a rant, or a cry, or a general wobble. Someone you can trust not to judge you and who’ll just sympathise. And if you get one of those calls, just be nice to them. You only need to be kind. You can’t fix what’s going on so just give them a bit of space to rant and tell them they’re normal and doing great. And if you’re OK, call your friends and check in on them. Especially if they’ve gone silent. 

LAUGH: it doesn’t matter what is funny – laughter is a huge releaser of endorphins. Silly memes, silly jokes, stand-up, rolling around with your kids – videos on youtube. The sillier the better. Also v good for bonding with friends, which will also help you feel less alone. 

DO SOMETHING WITH YOUR HANDS. Yes you can meditate if this is your bag, it’s amazing. But if it’s not, and personally I’m rubbish, then trying to start when you’re already anxious is really hard. So do something instead with your hands, that you have to focus on to get right. Cook. Tidy. Knit. Draw. Bake. Garden. Mend things. This is what nice middle class therapists like me call Mindfulness.

TREAT YOUR BODY: We hold stress in our bodies at least as much as our minds. Take a bath or a shower. Put on things that feel good on your skin. Use nice smelling body creams. Stretch. Skip. Do yoga. Dance. Eat healthy but delicious things – fresh if you can get it. All of these will help calm you down. 

SUNSHINE. It’s SPRINGTIME amid this horror – enjoy it. If you can’t go outside, open the windows and feel it on your face and breath it in. If it’s safe for you to go outside (maybe you live in the country) do it, while of course observing social distance. Go for a walk. Being outdoors, connecting to nature, is hugely calming.  

STEP AWAY FROM SOCIAL MEDIA/THE NEWS: All it will do will scare you more and make things worse. Turn off the telly and for gods sake avoid the psychopathic digital wild west that is Twitter. Stick to sensible sources like the BBC and the NHS, and limit yourself to short need-to-know bits a day. You’ll feel better immediately. Talk to friends instead – this is physical, not social distancing

STEP AWAY FROM TERRIBLE COPING MECHANISMS: They will all translate as BEAR!! to your poor brain. Especially don’t get drunk, especially if you’re alone (BEAR!!!), take drugs (BEAR!!!), stay up all night reading (BEAR!!!), get sucked into conspiracy theories (BEAR!!!), pay attention to ANYTHING Donald Trump says (BEAR!!!).  See? Stress levels going up already. Breathe. 

BE KIND: to yourself and others. Now is not the time to go on a diet. Nor is this the time to start on Proust or makeover your life. You’ll probably struggle to concentrate, fail and make yourself feel worse (hat tip Laura Gordon for this bit). Don’t make this more stressful than it already is. Think comfort books, comfort telly, comfort everything. Personally I re-read children’s books. Everyone is wobbly, everyone is going to have a meltdown at some point. Understand that if someone is angry or aggressive, then they are also just scared. And eat more cake. Cake makes everything better.

So, there we go. Hopefully a bit less BEAR!!. Now, that kettle should have boiled by now. Go make a nice cup of tea, sit by a window and drink it in this lovely morning sunshine. We are British after all. And save me some cake <3.”


23 thoughts on “The Behavioural and Psychological Symptoms of COVID-19 (BPSC-19)

  1. Pingback: It’s logical… |

  2. Kate I have read this post countless times now and shared it with my entire organisation. It is so well written, thought provoking and then frustrating to think the reality of it!
    I am keeping it at the forefront of my mind with everything I do when I’m at work.
    Thank you thank you thank you!


  3. Pingback: Revisiting BPSC-19 |

  4. I heartily agree that the list of reactions that you created are, as you said, “normal human responses” rather than neuropsychiatric symptoms of COVID-19. This is true because so many of us, who do not have a diagnosis of COVID-19 are having many, if not all of, these reactions. So in that sense, they are not “neuropsychiatric symptoms” of COVID-19, but reactions to the psychological and social circumstances that occur as a result of the virus and the attempts to deal with its prevalence. I would say that the reactions that you have listed are more appropriately termed “Basic Personal Signs of Distress” (a different version of BPSD) in relation to COVID-19 as experienced by everyone to one degree or another regardless of diagnosis. Thus, this form of BPSD, Signs of Distress, are rather logical and reasonable reactions to a potentially life threatening threatening situation.

    Likewise, in relation to people living with dementia, there is a host of “Basic Personal Signs of Distress” that are quite logical and reflect an appropriate ability to reflect upon the meaning of the effects of the disease that results in a diagnosis of dementia. For example, if a person could no longer sign his or her name, tie shoelaces, dress him or herself effortlessly, use eating utensils, engage in effortless conversation, recall the names of loved ones upon seeing them, recall recent events quickly and easily, and the like, it would be quite appropriate, all things considered, that said person might well feel depressed, anxious, angry, retreat from social gatherings, feel agitated, and so on. These reactions are not “symptoms of dementia” in the same way that spots on the skin are symptoms of measles or fever is a symptom of malaria. Rather, these reactions are psychological/emotional signs of distress that require the ability to reflect upon and to assign appropriate meaning to the dysfunctions that the person is experiencing.

    Thus, it is very important to recognize the difference between appropriate distress and symptoms of disease. To conflate the two is incorrect and illogical and can result in treatment that is inappropriate to say the least.

    Liked by 1 person

    • Thank you for your considered response to my concept Dear Steven, I’m not sure if you agree, or if this is what you meant in any way, but to me, it strengthens the need to Ban BPSD altogether, as it has ensured clinicians have managed all personal signs of distress (or normal human responses as I prefer to call them), as neuropsychatric symptoms of dementia.

      Liked by 1 person

    • Thanks Robin… good luck with getting your family (and colleagues?) to read it too. Stay safe and well; I hope things in Canada at this difficult time are not too stressful.


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