As face masks become the norm, many wearers quietly suffer 'mask anxiety'

Dentists say they're seeing an uptick in teeth grinding since the pandemic. A Google Trends analysis showed a surge in searches related to panic attacks. Pandemic stress is said to be part of the drive behind an increase in calls to the National Eating Disorders Association over the last few months.

This article first appeared in Salon.

Indeed, it's no secret that the coronavirus pandemic is taking a toll on our mental health in ways that might not even be fully aware of yet. Now, there's also a newfound cohort of people who are struggling with "mask anxiety," a neologism meaning a fear of, or anxieties relating to, strapping a mask on your face. With pandemic restrictions in place, such anxieties can make leaving one's home almost impossible.

Both the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend cloth masks for the general public. Health experts strongly agree that the evidence is clear that masks can help prevent the spread of COVID-19. However, for some people, wearing a cloth mask can induce a panic attack, evoke feelings of suffocation, or lead to anxious and intrusive thoughts. According to Google Trends, the term "mask anxiety" has been on the rise since the first week of March this year; it peaked at the end of July.

Psychiatrist Dr. Melissa Shepard told Salon while the term "mask anxiety" isn't in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), she defines the term as any "anxious thoughts, feelings, or avoidance behaviors that come from the fear or stress of wearing a face mask."

"They [face masks] can intensify anxiety that you already have or you can sort of develop anxiety just related to the facemask," Shepard said. "There's the feeling of anxiety that kind of rises up, your heart rate increases, you feel like you're short of breath, or you start to feel dizzy and sweaty." She added that there are often negative thought patterns that are part of this experience.

The act of wearing a face mask in the United States to slow the spread of COVID-19 has become politicized. The notion of having anxiety has been used loosely over the years, too. Shepard told Salon that the people she sees who have mask anxiety are often wearing them, just uncomfortably.

"People with the true face [mask] anxiety are almost always the ones that are actually wearing face masks, still they're just extremely uncomfortable when they're doing it," Shepard said. "I've noticed generally people who are truly anxious about the facemasks are trying really hard to wear them; they're just, you know, kind of silently suffering."

Writer Nikolina Jeric is one of those people. Jeric told Salon that the mask anxiety she has today may come from when she was a kid and struggled to wear Halloween costumes that involved "anything that went around" the face.

"Now with the COVID-19 pandemic, it has become a real nightmare and for the sake of my health, I need to always test my courage each time I enter the store or public transportation," Jeric said. "When I wear a mask, it only takes a few minutes for me to start breathing faster and shallower, despite my best efforts to control it."

Jeric added that throughout the pandemic the anxiety has eased.

"It's gotten better now, but a couple of times at the grocery store I didn't think I was going to make it by the time it was my turn at the cash register," Jeric said. "The bright lights, all the people and not being able to breathe properly make it a challenge every time I need to go buy some groceries; the same goes for taking the bus. Thankfully though I can listen to music on the ride which helps calm me down a tad."

Blaise Ramsay, who lives in Texas, says she has struggled with mask anxiety, and before the pandemic she struggled with anxiety generally.

"I had a recent bout with it — I was shopping with my kids and my husband and suddenly it felt really hard for me to breathe," Ramsay said. "I got dizzy and disoriented, and had to consciously tell myself 'OK, I need to breathe, I need to breathe.'"

Ramsay said she has "literally not been able to go anywhere for prolonged periods of time," because of the anxiety that's induced when she wears a mask. At home, she spends her time gardening, which has always been an effective way for her to cope with her anxiety.

Shepard said that the societal shift to wearing masks, and it becoming a social norm, could relate to the anxiety.

"This whole pandemic has been anxiety-provoking for so many, because this has been one of the first times we've been on the edge of science and research that's constantly emerging," Shepard said, adding that the confusion over face masks in the beginning of the pandemic may not have helped things. (The CDC at first didn't recommend that the general public wear cloth face masks). Shepard said that seeing people wearing masks also makes it difficult for people to read each other's facial expressions. "That's something that's very socially evolutionary. . . . you need to be able to see someone's face to be able to fully trust them."

Likewise, the mere act of seeing people wear masks can be a trigger.

"People are wearing masks, you're wearing a mask, and it reminds you that you're in the middle of a pandemic, and that a lot of people have died from this and it's really scary," Shepard said. "It kind of kicks off all of those negative and scary cognitions that can then contribute to increasing the anxiety with the face mask."

Shepard said if you're struggling with mask anxiety, it's definitely something that you can work through with a therapist.

"Some people don't want to reach out because they feel like it's silly, but it's not not silly at all," Shepard said. "And know that face masks are safe, and that it's something that we have absolutely studied in the laboratory settings and we know that despite some of the politicization, there are no clinically significant changes in people's biology that happen because of wearing face masks."