Coronavirus patients are suffering from anxiety and panic attacks. Experts worry the psychological effects could linger.

• Surviving COVID-19, the disease caused by the coronavirus, doesn't just mean enduring a physical battle, but often a psychological and emotional one.
• Some patients and survivors say the experience has triggered panic attacks and debilitating anxiety for the first time.
• Psychologists say people with serious COVID-19 cases may be at risk for long-term mental health consequences like post-ICU syndrome or medical post-traumatic stress disorder.
• Visit Business Insider's homepage for more stories.

If there was one thing Deborah Tahlman didn't want to do, it was cry. The 38-year-old in Ostrander, Ohio, had COVID-19, the disease caused by the coronavirus. She also had the debilitating fatigue and difficulty breathing that can come with it. Crying, she knew, would be a physical feat.

So of course, she broke down. She cried "ugly tears." Twice. At a certain point, she told Business Insider, "I couldn't not cry."

Tahlman, a professional pinball player, believes she contracted the virus at her sport's international championship in early March. Though she couldn't get a test, clinicians at the urgent care clinic told her she was a presumptive positive.

She experienced a racing heart, fever, and utter exhaustion. Typically a person with great blood pressure and a healthy heart rate, going up the stairs became "straight dangerous," she said, and required breaks. A few times, she felt like she was having a heart attack. She constantly felt like she couldn't suck in enough oxygen.

And still, when Tahlman broke down, it wasn't so much due to the physical misery as the psychological toll.

Every time she thought she was getting better, she'd get worse again. Plus, she has celiac disease, an autoimmune condition that she worried could make her more vulnerable to complications, and had shingles last year, which could raise her risk for a heart attack or stroke.

"Pair all this with the reports of people getting better then dropping dead? Ugh," she said.

Even now, well over a month after her initial symptoms set in and days after her last fever, she expects the fear to last many months. "Whenever I have a fever anytime between now and the end of the year, I can't imagine I'll be chill about it."

Plenty of COVID-19 survivors and sufferers feel similarly, with some reporting panic attacks and debilitating anxiety due largely to fear of the unknown. Psychologists say the survivors of the virus may be at particular risk for long-term psychological effects and in severe cases, medical post-traumatic stress disorder.

Survivors and experts say the unknown is the hardest part

Living through the coronavirus pandemic is stressful enough, even if you remain healthy.

Rising death tolls, historic unemployment rates, physical isolation from loved ones, and, for many, a loss of routine and purpose, are a recipe for a mental illness epidemic alongside the coronavirus pandemic, experts have warned.

But actually enduring the disease adds even more layers of psychological strain because so much is unknown — not just about how the virus's trajectory will affect your life and society, but also how the illness will affect your body.

"Not knowing if the pull in your chest is pneumonia or residue inflammation [is scary,]" Nathalie Eisenberg, who lives in New York City and got the virus five weeks ago, told Business Insider. "Will you live? Will you die?"

Doubts about whether you're truly getting better can mess with your mind, too. Patients and doctors have reported a "second-week crash" during which people believe they're improving but then get sidelined with symptoms like shortness of breath and body aches.

"The fatigue and weakness last weeks it seems, and the COVID symptoms will come raging back the minute you accidentally over-exert," Lisa, a media executive in Connecticut who started experiencing mild symptoms in mid- March, told Business Insider.

Previously someone who ran four miles daily, she recently felt well enough to go for a walk. But 15 minutes in, she had to call her husband because she was too weak to make it home. "Is this the moment where I can't breathe, or am I OK still?" said Lisa, whose asked to use her first name only since her company didn't approve her talking to the media.

"What messed me up was ... I didn't feel that sick, but in recovery I realized how sick I was," she said. "That's what was scaring me the most."

Some patients are experiencing panic attacks and anxiety

For some patients, fear of the unknown is so debilitating it's causing symptoms of clinical anxiety for the first time.

Or is that racing heart and difficulty breathing due to COVID-19? That, too, is tough to know.

Dashauna Ballard, who started developing COVID-19 symptoms including intense sinus pressure, fever, and extreme fatigue on March 30, said the experience has "unlocked" panic attacks, which she'd never had before. One was so intense it sent her to the hospital, and she almost succumbed to another when she thought about losing her breath while sleeping.

"I asked myself, 'What would happen if I stopped breathing? Am I going to die?'" Ballard, who's staying with her parents in Selma, Alabama, where she's still recovering, told Business Insider.

Martha Barrera, who lives in Orange County, New York, has a similar experience. She got sick on March 18 and is still battling symptoms. She too never had anxiety before. Now, she has night terrors and lays awake between 3 am and 7 am, worried that she might stop breathing.

"Knowing how terrible it makes you feel and not knowing when all of this will end or what will happen to you next is the most terrifying part of this illness," she told Business Insider. "We are the guinea pigs. We are the ones that have to figure it out for everyone else. I have never felt so alone or scared."

Renée El-Gabalawy, a clinical psychologist at the University of Manitoba, where she runs the Health, Anxiety, and Trauma Lab, told Business Insider that "panic will undoubtedly be higher" during this time, even among people who aren't sick since any bodily change can be interpreted as highly threatening.

For people who do have or did have COVID-19, panic attacks are especially likely since respiratory illnesses and the episodes "seem to be intricately linked," she said. They share many symptoms like shortness of breath and shaking, and can exacerbate each other.

"If panic symptoms emerge," El-Gabalawy said, "an individual will find these extremely threatening, and this will also induce re-experiencing episodes of the active illness."

Psychologists say this virus may be uniquely positioned to leave survivors with lasting psychological effects

While people expect some lingering respiratory issues after lung-related diseases, they're often surprised by the emotional aftermath, Dr. Craig Weinert, a pulmonologist and critical-care physician at the University of Minnesota who's studied mental health outcomes of ICU patients, told Business Insider.

"I thought I just had a lung disease," he said patients often think. "Why am I crying? Why can barely walk even though I'm not short of breath? Why can't I think straight for more than five minutes?"

The answer, in cases where people spent time in the ICU, may be that the patients have post-ICU syndrome, a cluster of symptoms including generalized weakness, cognitive challenges, and poor mood.

The syndrome typically isn't debilitating enough to reach a clinical level of depression or anxiety but can drain survivors and their family members for months or years, Weinert said. It's especially frustrating because it doesn't have a clear treatment.

COVID-19 survivors may also be susceptible to medical PTSD, which is closely linked with how threatened patients feel by the disease, El-Gabalawy said.

"In a situation like this one, even in mild cases, the perceived degree of threat is going to be really high related to the knowledge that there is a significant proportion of people who die from this illness."

While any life-threatening illness can lead to post-ICU syndrome or medical PTSD, experts worry that a factor unique to this disease — isolation, whether in the hospital or a bedroom — may make survivors even more susceptible to psychological consequences.

"This is unprecedented — the inability to have family around you as you are experiencing and recovering from this severe illness," Weinert said.

How that affects patients, and their families, long-term remains to be seen.

Some COVID-19 survivors come out mentally stronger

Jane Pauw, a 60-year-old pastor in Seattle, was so sick with COVID-19 in early March that she didn't even have the energy or mental clarity to feel anxious. "Because I wasn't really 'with it' during the worst of it, I didn't really even have a chance to worry about it or to think about worst-case scenarios," she told Business Insider.

The darkness she fell into had silver linings, like quieting her mind and preparing her to be even more aware of the world around her now that she's recovered. "We often think of darkness as being horrible and sinister and scary, but there is a lot of good that happens underneath the ground in darkness before spring comes," she said.

CNN anchor Brooke Baldwin wrote about a similar experience during the depths of her illness. "The clarity this can bring is more illuminating than anything I could have uncovered in my normally busy, 'full' life," she said.

Pauw recommended people who are psychologically suffering, whether they have COVID-19 or not, try to think about the low as an opportunity to work on copings strategies, ideally with the help of good friends or a therapist.

"It's a way of saying, 'I might as well take advantage of the suffering that I'm having because if I can explore my own experience and feelings now, it will be helpful for many things down the road,'" she said. "And that's kind of a hopeful thing."