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Brain Fog After COVID-19 Possibly Linked to PTSD

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Key Takeaways

  • A new report shows that “brain fog” and other neurological symptoms in people who have had COVID-19 might be linked to post-traumatic stress disorder (PTSD).
  • PTSD is common in people who survive acute life-threatening medical events including heart attack, stroke, and cancer.
  • Social anxiety, financial and job loss, and stigma contribute to increased COVID-19-related PTSD symptoms. Brain fog might also be related to stress, lack of sleep, and hormonal changes.

A new report has found that “brain fog” and other neurological symptoms people experience after recovering from COVID-19 might be associated with post-traumatic stress disorder (PTSD).

“The history of past human coronavirus outbreaks resulting in similar health emergencies suggests there will be a substantial prevalence of post-traumatic stress disorder (PTSD) among COVID-19 survivors,” the researchers noted in the study, which was published in August in The Clinical Neuropsychologist.

The researchers looked at previous studies on other coronaviruses, including those that cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The authors state that the goal of their report was to enlighten neuropsychologists who may need help identifying COVID-19-related PTSD.

What Is "Brain Fog?"

Brain fog is “a general term used to describe a lack of focus and concentration,” Nicole Avena, PhD, an assistant professor of neuroscience at Mount Sinai School of Medicine and visiting professor of health psychology at Princeton University, tells Verywell.

“It is not a medical term," Avena says. "Whether or not this is permanent in COVID-19 patients is unknown because it has not been thoroughly assessed via research studies.”

While brain fog can be associated with an underlying neurological condition, thorough testing is required to rule out other possible causes, including stress, lack of sleep, and hormonal changes.

Illness-Related Trauma

“Trauma comes in many forms with our reaction to experiences being highly subjective,” Lisa Webb, PsyD, a licensed clinical psychologist based in Tennessee, tells Verywell. “That is, you can experience something and have no resulting trauma from the event, whereas someone else might experience the same situation and have disabling symptoms as a result of experiencing the event. This can be applied to individuals diagnosed with COVID-19.”

Webb points to a 2014 study published in the journal Social and Personality Psychology Compass in which researchers noted that “Posttraumatic stress disorder (PTSD) occurs in 12% to 25% of survivors of acute life-threatening medical events such as heart attack, stroke, and cancer, and is associated with recurrence of cardiac events and mortality in heart attack survivors.”

In addition to the fear such illnesses cause, Webb says that the stigma attached to having COVID-19 might also affect an individual long after they have recovered.

“The person [is] asked at appointments, when at restaurants, and at events if they have ‘ever been positively diagnosed with COVID-19,'" Webb says. “These interactions then traumatize the person further, as the stigma is a reminder of the harrowing event they may have had to endure with COVID-19 treatment.”

Webb also notes that the financial burden of paying for treatment, job loss, and navigating relationships with people who fear contracting the illness contribute to COVID-19-related PTSD.

What This Means For You

If you or someone you know is experiencing signs or symptoms of PTSD and has recently had COVID-19, know that it's not all in your head. To ensure an accurate diagnosis and helpful treatment, talk to your provider about your symptoms.

Signs and Symptoms

Webb says that PTSD caused by COVID-19 would be considered illness-induced or medically-induced PTSD. The symptoms of this form of PTSD are similar to those experienced by people who have trauma from military experience or sexual assault.

“These can include flashbacks, intrusive memories, agitation, sleep difficulties, and mood changes,” Webb says. “Although similar, illness-induced PTSD has four key aspects that differentiate it from discrete events that precipitate traditional PTSD disorders.”

Webb explains four characteristics of illness-induced PTSD that make it different from the more well-known form of the condition.

Chronic Illness Doesn't Have a Fixed End Point

Most combat or terror-related PTSD symptoms stem from external factors that are typically time-limited events, such as a single assault or a finite period in combat. In contrast, individuals with illness-induced PTSD are living without a definite endpoint to their illness.

The enduring somatic threat (EST) of the illness continues to a part of one’s daily reality. The illness also cannot be avoided—especially when treatments and follow-up medical appointments and procedures are necessary.

These follow-up activities are particularly noteworthy in cases of COVID-19, as the length of immunity and the long term physiological impacts of the virus are still unknown.

Illness Is Internal, Not External

Trauma is often considered an “outside” threat, but illness occurs inside a person. In other forms of PTSD, a person can often remove themselves from a triggering situation. In illness-precipitated PTSD, a person cannot escape from their body.

PTSD symptoms can also be exacerbated by illness symptoms, which can cause an overlap between a person's physical and mental health.

Being on High Alert

Always being on high alert—called hypervigilance—is a classic characteristic of PTSD. Traditional PTSD therapy uses interventions that help a person recognize that this level of vigilance is not necessary. However, with chronic illness, that's not necessarily the case.

Hypervigilance is often required to stay in tune with symptoms or be on the lookout for worsening or new symptoms.

While being on high alert to monitor physical health is necessary, this checking also keeps the body in a heightened state of vigilance. Over time, chronic vigilance can actually worsen symptoms of chronic illness and exacerbate PTSD symptoms such as insomnia, fatigue, or isolation.

Constant Intrusive Worry About the Future

Typically, intrusive PTSD memories and triggers are about events that happened in the past. When chronic illness symptoms are ongoing, a person may experience a mix of intrusive thoughts that are both from the past and future-oriented, such as the uncertainty of one’s health trajectory.

The 2014 study found that 81% of the intrusive thoughts that were associated with illness-induced PTSD were related to a person's fears about the progression of their illness and the possibility of death.

Getting Help

Treatment for illness-induced PTSD typically involves working with a clinician who is experienced in cognitive processing therapy (CPT) that “focuses on challenging and modifying unhelpful beliefs regarding their illness and the uncertainty of their health trajectory,” Webb says, citing a resource published by the American Psychological Association (APA).

Research shows that some people with illness-induced PTSD benefit from treatment that incorporates mindfulness with acceptance and commitment therapy (ACT).

For any treatment to be effective, the most critical element is that people know that what feeling and experiencing is real. “Chronic illness is not imaginary,” Webb says, and it's important that people who are experiencing symptoms of PTSD after having COVID-19 persist in getting answers—even if they are being told it's "all in their head."

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Article Sources
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  1. Kaseda ET, Levine AJ. Post-traumatic stress disorder: A differential diagnostic consideration for COVID-19 survivorsThe Clinical Neuropsychologist. 2020;34(7-8):1498-1514. doi:10.1080/13854046.2020.1811894

  2. Edmondson D. An enduring somatic threat model of posttraumatic stress disorder due to acute life-threatening medical eventsSoc Personal Psychol Compass. 2014;8(3):118-134. doi:10.1111/spc3.12089

  3. American Psychological Association (APA). Cognitive processing therapy (CPT). Updated July 31, 2017.

  4. Association for Contextual Behavioral Science. Acceptance and commitment therapy (ACT).