Researchers are starting to explain the anxiety many victims feel.
Right now, everything I own is in garbage bags piled up in the middle of my kitchen and bathroom and filling my shower. It's been that way for a week and a half and will continue to be so for at least another week on top of that. If you live in a major city, you might know why. If not, welcome to the hell that is bed bugs.
This isn't the first time I've had bed bugs. Nor the second. It's the third, and this time it’s taken two visits from the exterminators to (hopefully) rid our apartment of the tiny beasts. Luckily we were able to catch the bugs early, before they got a real hold on the apartment. Unluckily, that’s mostly because rather than mosquito-esque little bumps, my bites turn into hardened ping-pong ball sized welts that itch for over a week. So when we have bed bugs, I know pretty quickly. And each time, everything goes into bags. I stop sleeping. I avoid furniture on the street. I refuse to enter libraries.
I used to joke that I had bed bug PTSD. There is a certain kind of anxiety that the seemingly invisible biters incite. But in fact, it might not be a joke. Research is starting to show that bed bug infestations can leave people with anxiety, depression, and paranoia. And that’s normal. In fact, it would be weird for you not to be freaked out, says Stéphane Perron, a doctor and researcher at the University of Montreal. “If you have bed bugs, and if you don’t care, that’s not a normal reaction. You should be worried. I would consider it a normal reaction to a stressor.”
Perron has published a number of papers on the psychological ramifications of bed bugs. In one study, he and his team looked at apartments that had been reported to the Montreal Public Health Department for unsafe conditions. Some of those units were infested with bedbugs, but not all of them. Perron and his team gave the tenants of these buildings a series of questionnaires that assessed all sorts of health impacts, including psychological ones. All told, 39 of the units had bed bugs, and 52 of them didn’t. When they compared the psychological results between those two samples—a method that helps to control for factors that impact mental health like socioeconomic status—they found that tenants with bed bugs were far more likely to report anxiety and sleep disturbances than those without.
Another study by medical entomologist Jerome Goddard at Mississippi State University examined posts on bed bug related websites like Bedbugger.com. When they compared those posts against a checklist of PTSD symptoms they found that 81 percent of people writing these forum posts were describing psychological and emotional effects often associated with the disorder, things like hyper-vigilance, paranoia, obsessive thoughts, and depression. “One person scored high enough to actually be considered a PTSD patient,” Goddard says. (The comparison they did here isn't diagnostic. In other words, Goddard can't actually diagnose anybody with PTSD from the results.)
In another study, researchers sent out questionnaires to seven different cities. They got 474 back. In the survey, they asked people to describe their reaction to the bites. Beyond the physical reactions, 29 percent of people said they suffered from insomnia, 22 percent reported emotional distress, and 20 percent said they had anxiety due to the bugs.
There are a number of reasons to take these preliminary studies with a grain of salt. For one, researchers don’t know anything about the mental state of the participants before they got bed bugs. And that’s important. In one case study that Perron published, a woman with a prior history of mental health issues got bed bugs and eventually committed suicide. “The bed bug is a stressor like many other stressors,” Perron says. “For people who are vulnerable, it may result in having a pathological fear of bedbugs or even delusions of parasitosis,” when a person falsely believes they are infested with bugs. So knowing the mental state of people before they were infected is key, and missing in these early reports.
It's early days for studies like these, and Goddard is the first to admit that they aren’t perfect. But they're a start. “I think all these things sort of added together, suggest that at least bed bugs are associated with anxiety and sleep disturbance,” he says. “Now whether or not a person can truly have PTSD I don’t know.” And they do suggest that there’s something particular about bed bugs that sets them apart from other biting insects like tics, fleas, mosquitos, and chiggers.
When I tell people I have bed bugs, they say things like, “So, you’re setting fire to everything you own, right?” The EPA acknowledges the urge. “There is no need to throw out all of your things,” they assure visitors to their bed bug information page. But after weeks of garbage-bag living, the prospect of just lighting it all on fire and leaving doesn’t seem so unreasonable. And several bed bug studies note the extreme lengths to which people go to get rid of the bugs—everything from actually setting things on fire to attempting to self-treat with loads of toxic chemicals. Even my exterminators are aware of the trauma the bugs incite. At the bottom of the two-page preparation guide for treatment, they write:
NOTE: Bed bug infestations are very traumatizing and it may take time to get over what you have experienced. There have been many cases where people feel they are still being bitten, even though the bed bugs have been eradicated from the home. Before you contact our office due to bites, please ensure that you are actually being bitten and that you do not have a rash or scratches from something else.
(When I read that passage to Perron he explained that it’s actually highly unlikely to continue to feel like you’re getting bitten once the bugs are gone. “I’m surprised they put that in their pamphlet, because no, it’s quite rare,” he says. More likely, the company simply doesn’t want its customers to bug them.)
There are a lot of reasons the tiny insects incite such insanity. Bed bugs strike you where you’re most vulnerable. Sleeping becomes impossible. Every tiny movement, every air molecule that touches your skin in just the wrong way, becomes a bug. I pecked out most of this post on my iPhone during a sleepless night. Thankfully my boyfriend is a heavy sleeper, and doesn't notice when every half-hour throughout the night I leap out of bed, grab my headlamp, and root around under the covers searching for the insect I was so sure I felt.
Then there are the garbage bags. If I have one tip for you from all this, it’s to use clear garbage bags. This isn’t just about being able to see which bag holds what as you unpack. It’s about looking around your apartment every day for several weeks at a vast sea of black garbage bags—pushing past them as you try to weave through the living room into the kitchen.
I’m not alone in my fight against bed bugs. A 2013 survey called Bugs Without Borders estimates that 99.6 percent of exterminators got calls about bed bugs last year. In New York City alone there were 9,233 complaints about bed bugs in 2013. And according to the pest control company Orkin, New York City isn’t the worst city for the suckers. In fact, the Big Apple is number 17 on their list, behind Chicago, Los Angeles, Columbus, Ohio, Detroit, and 13 unlucky others. There aren’t good numbers on exactly how many bed-bugged units there are in the United States, but the public has been whipped into a frenzy about the insects for years. This year, they were spotted on the subway system in New York City and I considered giving up transportation all together.
But, of course, despite how common they are, you can't tell anybody you have bed bugs. Admit you have them, and forget having anybody over again.
I am lucky, though. My landlords responded quickly to each call about the bugs, and after a few weeks of garbage-bag living we are always back to normal. That’s not the case for many people, who might live in buildings with landlords who aren’t as responsive, or in places where the landlord has no responsibility to deal with the problem. Exterminators are expensive, and the whole process is time-consuming and costly. None of this was a barrier for me, but it is for a huge number of people. “The very poor can’t do anything about it, and the rich, it’s a pain and it costs a lot of money but sooner or later they’ll get rid of them,” Goddard says. And it’s true. I can see the light at the end of the bedbug tunnel. And once it’s over, my madness will likely subside.
Both Goddard and Perron say that more work needs to be done to truly understand the ways in which bed bugs mess with our minds. But in the meantime, doctors should be aware of the potential risks. Goddard says he’s not sure whether doctors know to watch for psychological impacts when patients come in with bites. “I suspect those doctors just say call an exterminator. I don’t think they would think, 'Oh my gosh this person has some severe emotional distress.'” Perron agrees. “I would say that the goal of this research is to say we should deal with it because it has more than skin-deep consequences. It has consequences especially for a vulnerable individual.”
As for me, I’m starting to sleep again. And tomorrow I’ll begin the long process of unpacking the seemingly endless piles of garbage bags. It will all be over soon, and I didn’t even have to set anything on fire.
This post originally appeared on The Atlantic.