Anxiety and panic attacks

Explains anxiety and panic attacks, including possible causes and how you can access treatment and support. Includes tips for helping yourself, and guidance for friends and family.

What are anxiety disorders?

Anxiety can be experienced in lots of different ways. If your experiences meet certain criteria your doctor might diagnose you with a specific anxiety disorder.

Some commonly diagnosed anxiety disorders are:

  • Generalised anxiety disorder (GAD) – this means having regular or uncontrollable worries about many different things in your everyday life. Because there are lots of possible symptoms of anxiety this can be quite a broad diagnosis, meaning that the problems you experience with GAD might be quite different from another person’s experiences.
  • Social anxiety disorder – this diagnosis means you experience extreme fear or anxiety triggered by social situations (such as parties, workplaces, or everyday situations where you have to talk to another person). It is also known as social phobia. See our page on types of phobia for more information.
  • Panic disorder – this means having regular or frequent panic attacks without a clear cause or trigger. Experiencing panic disorder can mean that you feel constantly afraid of having another panic attack, to the point that this fear itself can trigger your panic attacks. See our page on panic attacks for more information.
  • Phobias – a phobia is an extreme fear or anxiety triggered by a particular situation (such as going outside) or a particular object (such as spiders). See our pages on phobias for more information.
  • Post-traumatic stress disorder (PTSD) – this is a diagnosis you may be given if you develop anxiety problems after going through something you found traumatic. PTSD can involve experiencing flashbacks or nightmares which can feel like you’re re-living all the fear and anxiety you experienced at the time of the traumatic events. See our pages on PTSD and complex PTSD for more information.
  • Obsessive-compulsive disorder (OCD) – you may be given this diagnosis if your anxiety problems involve having repetitive thoughts, behaviours or urges. See our pages on OCD for more information.
  • Health anxiety – this means you experience obsessions and compulsions relating to illness, including researching symptoms or checking to see if you have them. It is related to OCD. You can find out more about health anxiety on the Anxiety UK website.
  • Body dysmorphic disorder (BDD) – this means you experience obsessions and compulsions relating to your physical appearance. See our pages on BDD for more information.
  • Perinatal anxiety or perinatal OCD – some people develop anxiety problems during pregnancy or in the first year after giving birth. See our pages on perinatal anxiety and perinatal OCD for more information.

You might not have, or want, a diagnosis of a particular anxiety disorder – but it might still be useful to learn more about these different diagnoses to help you think about your own experiences of anxiety, and consider options for support.

Anxiety and other mental health problems

It’s very common to experience anxiety alongside other mental health problems, such as depression or suicidal feelings. If you have symptoms of both anxiety and depression but don’t fit one more clearly than the other, you might be given a diagnosis of ‘mixed anxiety and depressive disorder’.


Living with GAD & panic attacks after losing my Dad

“I really believe that talking is one of the best therapies you can have.”Read Zoe’s story

How to manage stress

Explains what stress is, what might cause it and how it can affect you. Includes information about ways you can help yourself and how to get support.

What is stress?

We all know what it’s like to feel stressed, but it’s not easy to pin down exactly what stress means. When we say things like “this is stressful” or “I’m stressed”, we might be talking about:

  • Situations or events that put pressure on us – for example, times where we have lots to do and think about, or don’t have much control over what happens.
  • Our reaction to being placed under pressure – the feelings we get when we have demands placed on us that we find difficult to cope with.

“It’s overwhelming. Sometimes you can’t see beyond the thick fog of stress.”

There’s no medical definition of stress, and health care professionals often disagree over whether stress is the cause of problems or the result of them. This can make it difficult for you to work out what causes your feelings of stress, or how to deal with them. But whatever your personal definition of stress is, it’s likely that you can learn to manage your stress better by:

  • managing external pressures, so stressful situations don’t seem to happen to you quite so often
  • developing your emotional resilience, so you’re better at coping with tough situations when they do happen and don’t feel quite so stressed

Is stress a mental health problem?

Being under pressure is a normal part of life. It can help you take action, feel more energised and get results. But if you often become overwhelmed by stress, these feelings could start to be a problem for you.

Stress isn’t a psychiatric diagnosis, but it’s closely linked to your mental health in two important ways:

  • Stress can cause mental health problems, and make existing problems worse. For example, if you often struggle to manage feelings of stress, you might develop a mental health problem like anxiety or depression.
  • Mental health problems can cause stress. You might find coping with the day-to-day symptoms of your mental health problem, as well as potentially needing to manage medication, heath care appointments or treatments, can become extra sources of stress.

This can start to feel like a vicious circle, and it might be hard to see where stress ends and your mental health problem begins.

“[When I’m stressed] I feel like I’m on the verge of a breakdown.”

Why does stress affect me physically?

You might find that your first clues about being stressed are physical signs, such as tiredness, headaches or an upset stomach.

There could be many reasons for this, as when we feel stressed we often find it hard to sleep or eat well, and poor diet and lack of sleep can both affect our physical health. This in turn can make us feel more stressed emotionally.

Also, when we feel anxious, our bodies release hormones called cortisol and adrenaline. (This is the body’s automatic way of preparing to respond to a threat, sometimes called the ‘fight, flight or freeze’ response). If you’re often stressed then you’re probably producing high levels of these hormones, which can make you feel physically unwell and could affect your health in the longer term.

Borderline Personality Disorder

Alicia’s story: how I reframed my perspective after my mental health diagnosis

Having a diagnosis of a mental health condition doesn’t determine the rest of your life.

Feeling hopeless

After a desperate plea to the doctor late last year, I was referred to a consultant psychiatrist and received a formal diagnosis. Sitting on the edge of my chair in the clinical assessment room, I told her how anxiety was plaguing nearly every moment of my day and how I felt too low to function most of the time. How I felt like I was dragging my body and mind around all day, doing everything I had to do, but feeling no connection or emotion to it. How I felt angry, hopeless, self-destructive and even suicidal. Things had gotten really bad this time and I had no idea how I would get out of it.

The consultant looked concerned. She stopped me and said, ‘We need to rule something out,’ then handed me a list of questions and a pen.

The diagnosis 

Less than an hour later, I found myself leaving the hospital grounds in a state of shock. The consultant seemed to think I had something called Borderline Personality Disorder (BPD), also sometimes called Emotionally Unstable Disorder. I had vaguely heard of it before. Crazy, out of control, mentally unwell, unstable, dangerous… were all the stigmatising words that raced through my mind, negative connotations I felt deeply afraid of.

Shock and fear

Up until now, I thought I’d been struggling with anxiety and depression, so it came as a shock to be given a new diagnosis I’d never even considered before. I was still in a state of disbelief when I returned home to my partner and broke the news. He didn’t want to believe it either.

What sort of person had I become? Was I way more messed up than I thought I was? How could I have not been diagnosed with this before now? Was this something I could recover from or was my life, as I knew it, over? These were more of the stigmatising thoughts that initially came to mind.

I felt confused, angry, close to tears, anxious, frightened and ashamed, all at once.

But I also felt something else pawing for my attention.

A gentle relief 

Finally, my struggles had been identified. Validated. Heard. Understood. Yes, I’d been given a label, and maybe that comes with both pros and cons but, truthfully, I took great comfort in knowing that other people felt this way. I have an amazing partner, the most brilliant best friend and a wonderful support network, but I often struggle to articulate how I am feeling to them. It often leaves me feeling like nobody really understands me, and never will.

The consultant had a thorough understanding of my inner world, and made sense of the whys and the how’s of what had happened to me, what was happening to me right now, and how the right treatment could, over time, help me to manage and overcome my difficulties. I felt relieved that a fulfilling and meaningful life still seemed possible, with the right professional help and support.

A ray of hope

I’d had several different types of talking therapy including counselling, CBT and long-term psychodynamic therapy. Some of these had been helpful but I still felt something was missing. I’d been in and out of the NHS system for over three years. I’d tried meditation, medication, exercise, putting my career on hold, online courses and countless self-help strategies. I had begun to give up hope of ever feeling normal again.

Although hard to digest for the first few weeks, the diagnosis gave me hope that one day things would get better. My huge highs and lows started to make sense, as did my interpersonal difficulties, self-sabotaging anxiety and highly critical inner voice tearing me down daily. The diagnosis seemed to fit. The funny thing is, I sometimes felt deep down that there was something more serious and complex happening inside of me all along.

Knowledge is power

After the diagnosis, I began searching for as much information as I could about BPD from reliable sources on the internet and soon discovered that, like any mental health condition, I was on a spectrum in terms of my symptoms and behaviours. I found out that there were many types of personality disorders and how these were split into a number of overlapping categories. I discovered the term Quiet BPD. There was a whole wealth of new information to absorb and, although scary to read at times, it felt good to feel a little back in control of my life.

I read about the different types of specialised therapy options for people with BPD, studying in-depth scholarly articles on the evidence and effectiveness of each approach. I also researched the recovery and remission rates, which helped set my own expectations of what was actually achievable and realistic.

It doesn’t need to define me

Overwhelmed by a constant whirlwind of negativity, I was completely out of touch with who I was and what I was actually like before things got so bad. I had been trying so hard to get rid of how I felt and desperately hold onto any good feelings. Feeling better had become a full-time job, and it was exhausting.

I often felt so anxious, low or self-destructive that it was easy to lose touch with the other parts of myself that make me, me. The parts of me that make me a loving partner, a loyal friend and a thoughtful daughter. The parts of me that love to meet new people, have fun, write, go to live gigs, be creative and help others. The part of me that is a little ditsy, making my partner and friends laugh (they actually write lists of hilarious things I come up with). Although I still have a way to go, slowly but surely, those parts of me are returning. All it took was to realise they were still there all along and make small positive actions to reconnect with myself.

Being given a diagnosis can help you, not hold you back. Accept it as yours, don’t let it define you and always remember it is only one part of you.

Mental Health in a Time of Pandemic

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The ongoing Covid-19 outbreak is in many ways unprecedented, in both the scale of this challenge, the scale of public health response, and the historical context in which all this is unfolding. Covid-19 is the first global pandemic of the social media age, the first of the “alternative facts” era, and is occurring at a moment when politics and society seem to be in a state of accelerated flux.

Yet for all that is new about Covid-19, the disease still behaves like any number of prior epidemics. It is, for example, similar to the 2003 severe acute respiratory syndrome (SARS) outbreak, an event which created a number of lessons for our present moment. SARS was, in many ways, the best-case scenario for responding to a global infectious threat. The spread of SARS was contained fairly quickly by public health efforts, chiefly through the widespread use of quarantine. But even this relative success still had consequences for health. In 2004, I worked with colleagues on a study of SARS control and the psychological effects of quarantine in Toronto, Canada. We found among quarantined persons a high prevalence of psychological distress, including symptoms of depression and posttraumatic stress disorder (PTSD). A key takeaway: Even if we can halt the physical spread of a disease through the expeditious use of quarantine and social distancing, we will still have to contend with its mental health effects in the long-term.

This is a message that is frequently forgotten. The mental health effects of Covid-19 can shape health for many years, long past the events that precipitated them. We have been focusing, correctly, on saving lives and mitigating the short-term consequences of Covid-19, but the long-term consequences may be equally, if not more, important. While it can be difficult to take the long view when the events of the moment are so compelling, it is necessary, if we are to ensure the steps we take now are in the best interest of public health once this pandemic passes and our task moves from one of response to one of recovery.

To envision how this long-term future may unfold, it helps to look to the past, and not just to past epidemics. Protests, riots, mass uprisings, and natural disasters can also teach us much about how large-scale, disruptive events can shape mental health. What do we know about the consequences of such events?

In a study published earlier this year, I worked with colleagues to investigate the mental health effects of protests, riots, and revolutions. Our work looked at the immediate effects of these events, as well as their long-term consequences. We found that the prevalence of depression and PTSD among populations after collective actions like protests and riots is comparable to levels experienced after natural disasters and terrorist attacks. This was the case for populations directly and indirectly affected by such events, suggesting a “spillover effect,” as anxiety over a disruptive event ripples through communities. We see similar effects after natural disasters, where mental health consequences can include depression, PTSD, and substance use disorders.

Then there are the economic effects of such events. In the case of Covid-19, we have already seen traces of these effects in the falling stock market, but the fortunes of Wall Street do not reflect what may be the true cost of this pandemic. With so many eyes focused on the stock market, it is possible to miss that the economic brunt of Covid-19 will likely be borne by low-wage, hourly workers, who can ill-afford the time away from work that containing the disease may necessitate. This will have consequences for health. Income is closely linked to health—physical and mental. There is, for example, a 10 to 15 year difference in life expectancy between Americans at the very bottom of the economic ladder and those at the very top, and income inequality has been linked with depression risk. Covid-19 could deepen this inequality over the long-term, even as, in the short-term, it undermines the peace of mind necessary for robust mental health, and compounds the challenges of people already prone to mental health struggles.

Millions worrying about the impact lockdown is having on mental health

New research[i] shows that nearly three-quarters (6.4 million) people aged 70 and over in Great Britain are worried about the effect that Coronavirus is having on their life right now[ii], with over two-fifths (2.9 million) of them saying their mental health has been affected by Coronavirus[iii]

During lockdown, half of these older people (3.3. million) reported that their access to essential items like groceries and medication had been affected[iv]. While the Government’s instructions to stay at home are vital for protection against the virus, they also mean that millions of older people are locked down alone, at an incredibly anxious time. 

Mental health problems don’t end as you get older. Older people experience depression, loneliness and anxiety like other age groups. However, many older people do not seek help and instead, adopt a ‘stiff upper lip’ approach to dealing with these feelings, and the longer the lockdown continues, the more these feelings risk being amplified. 

The research shows that many older people feel anxious at this time, but not just for themselves. Over four in five (7.7m) people aged 70 and over are worried about the effect that Coronavirus will have on their family and friends[v], particularly their mental health and wellbeing, with over two-fifths (3.6m) of them believing it[vi] will affect it. 

Caroline Abrahams, Age UK’s Charity Director said: “Lockdown brought sudden changes to all of our lives and that has naturally affected our feelings and mood leaving many of us experiencing feeling low, worried or having problems sleeping. 

“Understandably, social distancing can be boring or frustrating for many older people even though it is an essential measure for keeping us safe. We all miss being outside with other people and seeing our friends and family. Many are missing life events, seeing and hugging grandchildren, meeting new additions to families, going to weddings and gatherings. Even very basic things like getting online to order essential food and products can present a challenge. All of these things can have an impact our mental health which is why we should all take some simple steps to safeguard our own and other’s emotional wellbeing.”

At times like these, it can be easy to fall into unhealthy patterns of behaviour which in turn can make you feel worse. For Mental Health Awareness Week Age UK is highlighting some simple steps that can help older people to stay mentally and physically active during this time:

Stay current There’s a huge amount of information available on the online, including misleading or inaccurate news that isn’t always easy to spot at the moment. General coverage of this Coronavirus can also often focus on the risks for older people.

The constant stream of information we’re getting about coronavirus can feel overwhelming so set time aside to catch up with the latest information perhaps once or twice a day and avoid constantly rereading information. Stick to official sources of information.

Keep to a routine
Maintaining a routine as best you can may help you feel better and more in control. If you can’t do what you normally do, try and create a new routine that prioritises looking after yourself. Keep windows open to let in fresh air, get some natural sunlight if possible, or get outside into the garden if you have one.

Don’t bottle it up – reach outIf you feel particularly anxious and overwhelmed make sure you talk to someone you trust like a friend or family member. Don’t ignore those feelings.

Stay connected
Now more than ever it is essential we stay connected and adapt how we connect with people to find new ways to stay in touch.  A regular chat with a friend can make a huge difference to how we feel. Sharing stories and even having a bit of a moan when we need it can work wonders! Stay in touch over the phone or by post. Those who are more confident using technology may choose tokeep in contact with friends or family, using email or social media or try video call services like Skype or FaceTime. For a guide visit www.ageuk.org.uk/information-advice/work-learning/technology-internet/video-calling/

Keep moving
Being active – even just a little bit – is proven to help give you a boost. A quick walk down the street,  bearing in mind the Government’s advice on social distancing of keeping a two metre space from other people, gardening, or moving around the house are all good pick-me-ups. However, being more active isn’t about working up a sweat or running marathons it’s simply about moving more each day, in whatever way works, within our own capabilities. Follow Government advice if you’re taking a walk and take precautions.

For those with less mobility or who may be sitting down a lot during the day, get up at least once an hour. If that’s not possible, moving arms and legs for a few minutes will help. Set small goals and achievable targets then build on those goals. There are some exercises on the Age UK website that offer simple ways to keep active during the pandemic: www.ageuk.org.uk/information-advice/coronavirus/staying-safe-and-well-at-home/home-exercises/

Do something you enjoy every day
Settle in with a favourite book or audio book, do some cooking, listen to the radio or tune in to an afternoon radio play. Try your hand at writing or do a puzzle in the newspaper or online. Make sure that you have everything you need to take up or continue hobbies, such as arts and crafts or wool if you are a keen knitter.  

Maybe there is a neighbourly Book Club dial-in. It might turn out that some of these options  are a good way to nip loneliness in the bud in the long-term as well.

Eat healthily
If you are staying at home because you are 70 and over or have a serious health condition, try shopping on the internet or maybe a neighbour could help collect shopping for you.

If you can, aim to get plenty of fresh fruit and vegetables, and remember that frozen and tinned fruit and vegetables count towards your five-a-day. Try to drink 6-8 glasses of fluid every day.

Don’t use alcohol, or other drugs to deal with emotions.
Keep an eye on the Government’s and NHS advice on staying at home and visiting friends and family: 

https://www.gov.uk/government/publications/covid-19-stay-at-home-guidancehttps://www.nhs.uk/conditions/coronavirus-covid-19/

For a free guide called Your Mind Matters which focuses on improving mental wellbeing or information on depression and anxiety in later life visit:

https://www.ageuk.org.uk/information-advice/health-wellbeing/conditions-illnesses/depression-anxiety/

The Silver Line (0800 4 70 80 90) is a free, national, confidential helpline which is open every day and night, offering information, friendship and advice to older people. More details on The Silver Line website: www.thesilverline.org.uk

For information on talking therapies visit:
https://www.nhs.uk/conditions/stress-anxiety-depression/benefits-of-talking-therapy/

LAXATIVE ABUSE

Laxative Abuse

Laxatives are available in several forms, functioning in a manner depending on the needs of each user. For example, bulk-forming laxatives work like fiber, and increase “the bulk of the stool.” Osmotic laxatives increase water that go out of the bowels to soften the stool; stimulant laxatives increase the speed of movement in the bowels. Some of these are available in powder form and can be mixed into liquids.

Lastly, stool softeners reduce the texture of stools by decreasing the surface tension. Some forms of laxatives can take a day or 2 to work; therefore, if someone is seeking instant relief, they may have to try another form, or some may double their dosage. Though laxative abuse is relatively small in past years, it can become a problem, with short and long-term side effects.

Laxative Side Effects

Despite its intended use, people have used laxatives to achieve their ideal body weight. Since laxatives encourage regular bowel movements, they can decrease bloating and assist in weight loss. Side effects are mild, but uncomfortable, including:

  • Flatulence
  • Bloating
  • Dehydration
  • Feeling sick
  • Dark urine

Taking laxatives according to the recommended doses is usually harmless. However, when taken over time, laxatives have potential for abuse as well as harmful side effects.

Laxative Myths

Laxative abuse occurs when someone wants to use laxatives to lose weight. Studies revealed laxatives do not assist in weight loss. Laxatives do help with shedding water weight, hence their popularity in weight detox regimens.

No studies have confirmed the connection between laxative use and weight loss. However, other studies confirm weight loss that does occur is temporary. Water weight, or bloating differs from losing fat in the body. Because of how laxatives work by “keeping water in the gut around the stool,” the loss of water weight causes a temporary reduction of the appearance of belly fat or bloating.

A study noted “56.3% of people with eating disorders used laxatives.”

Laxative Abuse And Eating Disorders

Laxative misuse is often associated with people who suffer from the eating disorders anorexia nervosa or bulimia nervosa. Additionally, it is most commonly associated with teenagers and some obese populations. Sadly, statistics concerning laxative use were revealing of the myths surrounding their use.

A study noted “56.3% of people with eating disorders used laxatives.” Additionally, “71.6% of people suffering with purging anorexia abused laxatives.” Furthermore, these findings reveal laxative use is not just for vanity, but can be addictive to support feelings of shame, depression, body dysmorphia, the need to fix in, or anxiety.

These statistics noted women between 14 to 19 endured eating disorders. Often times, there is a connection between traumas like Post-Traumatic Stress Disorder and eating disorders like bulimia; hence the laxative dependence. While the laxative itself may not be as addictive as other substances, the desire to feel empty via abusing a chemical can be a motivating factor.

Effects of Laxative Abuse

When someone uses laxatives on a continued basis, he or she reduces vital minerals in the body like magnesium, sodium, potassium, and phosphates, which allow muscles to work correctly. As a result, our most important organs may not function in the best form for our bodies. Long-term laxative use can wreak havoc on the bowels, the digestion, and cause dehydration.

Since laxative use is intended to reduce bloating and lose weight, many of the effects of laxative abuse will be physical, although they will vary. Some of the signs of laxative abuse include but are not limited to:

  • Vomiting
  • Blurred vision
  • Fainting
  • Dehydration
  • Skin rashes
  • Depression
  • Gas
  • Bloating
  • Heart attack
  • Muscle spasms
  • Urinary Tract Infections (UTI)
  • Diarrhea
  • Intestinal paralysis
  • Increased risk of colon cancer

Not only do these symptoms cause physical injury and physical dysfunction, the added pressure to be thin, and concerned family members can complicate matters even more. Lastly, if someone is not feeling physically well, he or she won’t be their healthiest self, and may withdraw from feelings of depression. Once depression occurs, he or she may self-medicate in unhealthy ways.

Long-Term Effects of Laxative Abuse

In addition to health problems, depression, a lack of self-confidence and digestion problems, there are more long-term health risks associated with laxative abuse. Many of these are irreversible and severely damaging. Some of these include:

  • Kidney failure
  • Gastrointestinal damage
  • Liver damage
  • Bowel nerve damage

Bowel nerve damage can cause the intestinal tract to function poorly, hence someone continually using laxatives to assist in bowel movements.

Get Help Today

Stopping a laxative use disorder can be difficult to do at home or alone. If you are struggling to stop abusing laxatives, and have experienced a traumatic experience, you may need a hands-on approach to treatment. Contact a treatment provider and discover how having support and one-on-one counseling can target deep-seated trauma. Lastly, nutritional plans are available to help restore a healthy weight for patients. Don’t delay; you owe it to yourself to find the best treatment available.

What Causes Anxiety

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Anxiety may be caused by a mental condition, a physical condition, the effects of drugs, or a combination of these. The doctor’s initial task is to see if your anxiety is a symptom of another medical condition.

Common causes of anxiety include these mental conditions:

These common external factors can cause anxiety:

  • Stress at work
  • Stress from school
  • Stress in a personal relationship such as marriage
  • Financial stress
  • Stress from global occurrences or political issues
  • Stress from unpredictable or uncertain world events, like a pandemic”
  • Stress from an emotional trauma such as the death of a loved one
  • Stress from a serious medical illness
  • Side effect of medication
  • Use of an illicit drug, such as cocaine
  • Symptom of a medical illness (such as heart attackheat strokehypoglycemia)
  • Lack of oxygen in circumstances as diverse as high altitude sickness, emphysema, or pulmonary embolism (a blood clot in the vessels of the lung)

The doctor has the often-difficult task of determining which symptoms come from which causes. For example, in a study of people with chest pain — a sign of heart disease — 43% were found to have a panic disorder, not a heart-related condition.

Clinical Depression

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Depression ranges in seriousness from mild, temporary episodes of sadness to severe, persistent depression. Clinical depression is the more-severe form of depression, also known as major depression or major depressive disorder. It isn’t the same as depression caused by a loss, such as the death of a loved one, or a medical condition, such as a thyroid disorder.

To diagnose clinical depression, many doctors use the symptom criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Signs and symptoms of clinical depression may include:

  • Feelings of sadness, tearfulness, emptiness or hopelessness
  • Angry outbursts, irritability or frustration, even over small matters
  • Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
  • Sleep disturbances, including insomnia or sleeping too much
  • Tiredness and lack of energy, so even small tasks take extra effort
  • Reduced appetite and weight loss or increased cravings for food and weight gain
  • Anxiety, agitation or restlessness
  • Slowed thinking, speaking or body movements
  • Feelings of worthlessness or guilt, fixating on past failures or self-blame
  • Trouble thinking, concentrating, making decisions and remembering things
  • Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
  • Unexplained physical problems, such as back pain or headaches

Symptoms are usually severe enough to cause noticeable problems in relationships with others or in day-to-day activities, such as work, school or social activities.

Clinical depression can affect people of any age, including children. However, clinical depression symptoms, even if severe, usually improve with psychological counseling, antidepressant medications or a combination of the two.

Mask anxiety, face coverings and mental health

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Explains why masks can cause difficult feelings, and gives practical tips on how to cope. Includes information on exemptions for mental health reasons.

What is the law about masks?

The UK and Welsh Governments are making it compulsory for people to wear masks or face coverings in certain places, like on public transport. But the exact places and dates are slightly different in England and Wales. 

Why masks can cause difficult feelings

We all want to help stop the spread of coronavirus. And we know it isn’t easy. It means making big changes in our lives, like following social distancing guidelines, and now wearing masks.

But masks are not straightforward for everyone. Some of us may find covering our face very hard, or even impossible to cope with. And for those of us with existing mental health problems, masks may pose extra challenges.

For example:

  • Covering your mouth and nose might affect the air you breathe, which might make you feel anxious or panicky. This can then cause other symptoms as well, like feeling dizzy or sick, which you might associate with the mask.
  • You might feel trapped or claustrophobic.
  • Covering your face changes the way you look, which may cause negative feelings around your identity or body image.
  • Having certain materials touching your skin might feel very hard to cope with (sensory overload).
  • If you wear glasses, they might get steamed up so you can’t see clearly. This might add to feelings of being claustrophobic
  • Masks are a visual reminder of the virus, so seeing masks might make you feel on edge or unable to relax. It might seem like danger is everywhere.
  • Seeing people covering their faces might make you feel uneasy or scared of others. They might seem threatening, sinister, or dehumanised.
  • On the other hand, you might feel very anxious or upset around people who are not wearing masks in public. (Although many people are exempt from wearing them, and you won’t always know their reasons.)
  • If you are exempt from wearing a mask, you still might feel very anxious about being judged, shamed or stigmatised in public. Or about the possibility of being asked to pay a fine. This may feel especially hard to cope with if the reason you can’t wear a mask is also to do with your mental health.

Do I have to wear a mask?

If you feel able to wear a mask or face covering, then you must.

But there are some exceptions. The Government says you do not have to wear a mask if you have a ‘reasonable excuse’ not to. 

The exact guidance on how this applies to mental health conditions is written differently for England and Wales. And it’s being updated quite often. But in practice the meaning is similar.

In both nations, reasonable excuses to do with mental health include:

  • If you’re not able to put on, wear or remove a face covering, because of a physical or mental illness or impairment, or disability.
  • If it’s essential to eat, drink or take medication.

In England, the guidance also specifies that a reasonable excuse would be:

  • If putting on, wearing or removing a face covering will cause you severe distress.

(There are other exemptions besides these. You can find the full list of exceptions in England on the UK Government website, and the full list of exceptions in Wales on the Welsh Government website.)

What counts as ‘mental impairment’ or ‘severe distress’?

There is no clear-cut definition of ‘mental impairment’ or ‘severe distress’ in the mask regulations. These terms may cover a lot of different experiences.

For example, you might feel severely distressed or impaired if wearing a mask triggers acute symptoms of a mental health condition, like:

But even if you don’t have an existing mental health diagnosis, you might still feel overwhelmingly anxious, distressed or unwell when wearing a mask.

It can be difficult to judge if you feel unwell ‘enough’ to be excused from wearing a mask. But remember: you are the expert on your own experience.

  • If you’re not sure, look for a way to make covering your face feel more bearable. Try some of our tips for coping with masks and face coverings, and see if they help. You might be able to lessen your symptoms, so you feel less unwell.
  • If you’ve tried everything and nothing helps, you might decide you do have a reasonable excuse for not wearing a mask. That’s ok.
  • It might change. For example, you might have better or worse days, times or places. So you might feel exempt sometimes, but not all the time. That’s ok too. Use your face covering as much as you are able.

How do I prove I have a reasonable excuse?

You don’t need to. There’s no legal document or proof that you need to carry on you.

If you’re challenged about not wearing a mask:

  • You could tell the person: “I’m exempt for health reasons”, or “I have a good reason that you can’t see. Please be kind”.
  • Or you could write down your reason to show people, on a piece of paper or on your phone.
  • Various organisations have created optional exemption cards and badges that you can display. You do not need to buy or apply for one, and you do not need to carry or show one. But you may find having something like this to hand makes you feel more comfortable. It’s your choice. (You can find exemption cards to print or download on the UK Government website).

The Welsh Government is advising you to carry evidence of your condition if possible in Wales, but you do not have to.

Unfortunately, you might find that not everyone understands, or is supportive. This can be really hard to cope with. But you’re not alone. It might help to think about extra self-care ideas, to help look after yourself.

Tips for coping with masks and face coverings

You might not ever feel totally comfortable with masks. But there are lots of things you could try to help make the experience easier for you.

Anxiety, panic and breathing issues

If wearing a mask makes you feel panicky or like it’s harder to breathe:

  • Get some fresh air outside before and after you wear your mask.
  • Do something to relax you before and after you wear a mask. For example, you might do a short breathing exercise. (We have some tips on relaxation exercises).
  • Choose a face covering that hangs down your neck, rather than fitting around your jaw. This type of covering is called a ‘neck gaiter’. It might feel more breezy.
  • Keep your body as cool as possible. For example, by wearing loose-fitting clothes or sitting by an open window on the bus.
  • Add a comforting scent to your face covering. This might be a few drops of lavender oil, your own perfume or aftershave, or a smell that reminds you of someone else.
  • Reduce the time you spend having to wear your mask. For example, by planning your shopping in advance to help you keep browsing time down in shops.

Physical discomfort

If wearing a particular material creates sensory overload:

  • Experiment with different fabric types. You could try making a face covering from an old t-shirt that doesn’t bother you to touch. You can search for mask-making tutorials online. The Government also has some information on how to make your own mask.
  • Experiment with different ways to secure your mask. Some fit round the ears, some tie behind your head. You could try attaching buttons to a hat or hairband, so the mask does’t irritate your skin.
  • Choose another type of face covering that doesn’t touch your face in the same way, like a neck gaiter.

If wearing a mask steams up your glasses and makes it hard to see:

  • Wash your glasses with soapy water, and polish them with a tissue. A thin layer of soapy film may make it harder for the lenses to steam up.
  • Sit your glasses on top of the fabric by raising the top of your mask up onto your nose.
  • Line your mask with a tissue so it absorbs some of the moisture.

Body and identity issues

If covering a part of your face makes you feel uncomfortable in your identity or body image:

  • Think of your mask as a fashion accessory. Search for a mask or face covering with a design or pattern that expresses who you are. You could use a scarf or bandana. Or try to find a selection of colours that you can match in with your outfits.
  • Choose a transparent mask or see-through face covering, so it doesn’t obscure your face.

Anxiety around other people wearing masks

If seeing other people in masks make you feel uneasy or afraid:

  • Shift your focus away from someone’s face when communicating with them. Try switching the way your body is facing so that you’re side-by-side with the person you’re talking to, and both looking in the same direction.
  • Try to pay extra attention to your non-human surroundings. This might be trees, traffic, shop window displays, or the sounds and smells you notice. It may not be possible to avoid looking at people entirely. But by balancing it with other things that feel more usual, you might feel more calm.
  • Take a distraction out with you. For example, listen to music or podcasts through headphones, or call to someone you enjoy chatting to.
  • If someone you have to see often (like a friend or housemate) wears a mask that you find very scary, you could try gently letting them know how you feel. They might be able to change it or cover it up in your presence, to help you.

Being supportive to others

There are many ways we can be supportive to people who might be struggling with masks.

  • Don’t judge people who are not wearing masks. Don’t assume that someone not wearing a mask is ‘just being selfish’. Many people are exempt from wearing masks, and it might not be immediately obvious why.
  • Acknowledge people. You could say a friendly ‘hello’ or ‘good morning’ as you pass them, or wave your hand.
  • Communicate in other ways. Try using your voice, eyes, hands and body language to compensate for what you aren’t able to show through smiles or other facial expressions.
  • If you see someone regularly who is uncomfortable with masks on other people, ask them what would help. For example, you might be able to get a transparent mask to wear with them.
  • If you work in a place where masks are compulsory, make sure you fully understand the exemption rules. If someone tells you they are exempt, accept their word for it.