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Bed bugs' biggest health threats are psychological.

People who are isolated, have mental illness, or living in poverty are more likely to suffer lingering mental health effects from bed bugs.

  • Bed bug infestations are on the rise. While their bites aren't dangerous, their presence can cause serious mental health issues.

  • Victims of bed bugs report mental health symptoms like paranoia, obsessive behavior, nightmares, and anxiety, all of which are consistent with post-traumatic stress.

  • People who have a mental illness, live in poverty, are older, or are isolated are most likely to suffer longer-term mental health consequences from bed bugs. They're also less able to access both extermination and mental health services, exacerbating both problems.

  • For most otherwise healthy people, bed bug-related anxiety is necessary to solve the problem, and resolves soon after the bugs are gone.

  • Separating bed bug myth from fact can help people both manage the bugs and the related paranoia.

Rebecca Ross had been living in her new Minneapolis apartment for only a week when she started noticing the bugs. Having grown up in the rural Midwest, the 25-year-old wasn't afraid of insects. But these were unfamiliar.

First, there were only a few. Then, she started noticing them in clumps. Dozens of the bugs were crowded in corners, between cracks in furniture, and most of all near the bed.

She sent a picture to maintenance, who replied with a damning diagnosis: Ross's new place was infested with bed bugs. The insects, which resemble of apple seeds and feed on human blood, "infest virtually anywhere humans congregate" and are on the rise, according to the National Pest Management Association.

Still, Ross's landlord said he needed confirmation before he could send an exterminator, so Ross began collecting the critters in clear plastic bags.

A month later, the bugs had laid and hatched eggs inside the bags, filling them with swarms of tiny, hungry baby bed bugs called nymphs. And still no exterminator came.

Since her move-in day more than four months ago, Ross has gotten rid of all her big furniture, including her bed. She's stored her clothes and other items in garbage bags, and invested in an expensive heat-treatment system to kill the bed bugs.

Ross is looking for a new apartment, but the psychological scars remain.

She's constantly roused by her two cats' slightest movement or touch, and rarely sleeps more than three hours a night. She's missed work, and the depression and anxiety she already lived with have gotten worse. Friends have refused to visit and she's begun startling at odd marks on the floor or furniture, seeing bugs where there aren't any.

"I know for awhile I'm going to be on edge," she stated.

Ross's experience isn't unique. While bed bugs are a practical nightmare and a physical discomfort — their bites can leave behind itchy red welts — their real damage is more than skin deep.

Multiple researchers have documented the connection between bed bugs, emotional trauma, and lingering mental health issues. In some cases, side effects like severe anxiety, sleeplessness, difficulty concentrating, obsessiveness, and hypervigilance are severe enough mimic posttraumatic stress disorder.

"People are really emotionally affected by these things," Jerome Goddard, a medical entomologist at Mississippi State University, who's studied bed bugs' physical and psychological effects. "It just drives people crazy."

Most people who have bed bugs experience mental health consequences

A majority of people who experience bed bugs suffer psychological harm as a result, according to Goddard's research, which looked at the critters' psychological effects based on 135 victims' online accounts. His work found that 81% of bed bug victims reported negative mental health side effects, including paranoia, trouble sleeping, nightmares, and an extreme level of vigilance to prevent the bugs from returning.

Other symptoms include obsessive or intrusive thoughts and heightened anxiety. "There can even be flashbacks, where a person sees a speck of something [that looks like a bug] and that triggers them to re-experience the event," said Alexis Hansen, a trauma-oriented psychotherapist.

These symptoms are all characteristics of PTSD, according to the Mayo Clinic. One person in Goddard's study scored high enough on a checklist that he or she could have been diagnosed with the condition using the American Psychiatric Association's diagnostic criteria.

Goddard said his research doesn't account for people's mental and emotional state before the bed bugs, so it's possible some of the symptoms were pre-existing. And, because the study was based on internet posts, it is only representative of people who chose to share their experiences online, potentially leaving out a larger population with less severe symptoms.

Still, other research has suggested bed bugs could cause mental health symptoms in psychologically healthy individuals, and they certainly can exacerbate symptoms for people with previous illness.

Bed bugs have the power to make people feel helpless and trapped

Hansen said the psychological toll of bed bugs is related to two factors — first, the bugs invade the intimate space of your home and bed and second, they typically attack when you're sleeping and at your most vulnerable. "It's your safe space and something invading that is really terrifying," she said.

Goddard came to a similar conclusion in his research. "If you're outside and get bit by mosquitoes, you can go inside," he said. "But if bedbugs are in your house, where are you gonna go? You can't just get away from the world and go to bed, because that's where they are."

This creates a perception of being helpless and unable to escape, he explained, prompting people to take protection measures that seem irrational to those who haven't experienced an infestation. Goddard has heard from people who have changed clothes five or more times a day, put all the legs of furniture in cans of kerosene, and soaked themselves in bleach, all in an effort to not let the bed bugs bite.

Gavin Stern, a former bed bug victim, gets it. He experienced a bed bug infestation while he was a grad student in Stony Brook, New York, in 2011. He still thinks about it eight years later.

"It was a nightmare," Stern said. "You basically have to uproot everything. It's a major calamity out of nowhere. You don't feel safe in your own house."

The six-month ordeal permanently changed the way he views the world, Stern said. He now looks closely at every bug, particularly since he's a homeowner now and has to worry about the potential financial damage of an infestation, which can cost upwards of 5,000 to exterminate. Thoughts of bed bugs are now a routine concern alongside everyday worries like whether he turned off the stove or locked the door, Stern said.

"There's not many events from that long ago I still think about," he said. "There is life pre-bedbugs and post-bedbugs."

Bed bugs' mental health harms are a 'social justice issue'

Dr. Stéphane Perron, a public health physician and professor of the University of Montreal, has also studied the psychology of bed bug-related trauma. He said that some anxiety about the pests is natural.

"It's normal to be stressed by bed bugs in your house; it's adaptive to do something about it," he said. "If you had bed bugs and did not react, you'd probably have a mental health issue."

As Hansen put it, "during the infestation, it makes sense to feel anxious and obsessive about it, and it's almost the energy you need to deal with it." In psychologically healthy people, the anxiety typically passes soon after the problem is resolved, she said.

But for people who already live with mental illness, are isolated, older, or live in poverty, the risk of lingering or severe trauma from bed bugs is higher.

One case study in Perron's research describes an elderly woman who committed suicide after repeat infestations of bed bugs in her apartment. She had previously struggled with mental illness and could not afford to move out of the infested building.

Other research has also linked bed bugs and suicidality in multiple cases, particularly in people with a history of mental illness.

A strong stigma associated with bed bugs can also isolate vulnerable people from their support networks, Hansen added. "There's a lot of shame attached to people having bed bugs," she said. This can make it difficult for people to talk about their experiences, even with mental health professionals, who can be guilty of perpetuating the stigma themselves.

During Hansen's work as an in-home therapist for at-risk youth, for instance, some clinicians were wary of meeting with clients who had bed bugs. "There's an ethical issue there because we have to deliver the service, and how do you do it when the staff is afraid to enter the home?" she said.

The worst cases occur when people are living in unfit housing, Perron added, where landlords are unresponsive and residents lack the resources to solve the problem themselves. A few months of neglect can cause a full-blown infestation, and a severe infestation can make it hard to fully eliminate the bugs.

And, Perron's found, the longer you deal with bed bugs, the greater the mental health consequences. It's a "social justice issue," Goddard said.

Understanding how to get rid of bed bugs can help alleviate fears

Part of the psychological burden of bed bugs is that their terrifying traits are exaggerated in mythological proportions — people believe they can fly, hide anywhere, and are impossible to kill.

None of this is true, Goddard said, and the key to psychological resilience in the face of bed bugs is a hefty dose of reality.

"You can kill them. They actually die pretty easy," Goddard said. "They're not magic."

They're also easy to spot, once you know the signs. Although they are small, particularly the eggs and nymphs, bed bugs are in no way a subtle species.

Other myths are that they multiply quickly, travel on your body or in your hair, and will relentlessly pursue you and your neighbors in search of a meal. In fact, bed bugs can't sense humans outside of about a 3-foot radius, Goddard said. He added that although it's true they can sneak into clothes and luggage to hitch a ride, they're definitely not going to chase you down the street or come running down the hall into other rooms of your house.

Bed bug infestations, especially when caught early, can be very manageable. It can take months before an infestation really gets out of control, according to Goddard. But, he added, people should never try to tackle it alone or waste money on DIY products — always contact an exterminator.

And, if your mental and emotional symptoms linger after the bugs are long gone, consider another kind of professional help: that of a therapist.

"Don't just live in a world of fear and suspicion and paranoia. Don't withdraw from society," Goddard said. "Talk to someone."

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