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Psychosomatic Coughing: Do I Have Coronavirus, or Is It All in My Head?

Anxiety can definitely inspire some dry coughing. A fever on the other hand...

Last Friday, I landed at LaGuardia in New York after six days in Chicago, prior to a comparable amount of time in L.A. During this time, I stayed in one Airbnb, two friends’ guest rooms, performed at four comedy shows, rode in countless cabs, ate out everyday, hugged friends, colleagues and family alike and (humblebrag) had sex. Looking back now, none of these are good things. I’m not sure if I’ve had COVID-19 already, but I do have a two-week supply of anxiety about it. 

The symptoms of coronavirus paranoia are less serious than coronavirus itself, but they’re similarly real and also include a cough and shortness of breath, both of which are brought on by a psychological stress response to the current state of the world. The numbers of people being diagnosed are climbing daily, yet test shortages have left most of those under 60 without compromised immune systems to self-diagnose, assume the worst and self-isolate just in case. President Trump claims that more tests will be available in the coming days, but that remains to be seen. If there was ever a time to be understandably anxious, we’re living in it. 

“Symptoms such as difficulty breathing, shortness of breath and feeling hot or sweating could be indicative of stress, anxiety, COVID-19 or something else entirely,” psychotherapist Shirley Porter explains. “Since COVID-19 has reached pandemic status, individuals who were already experiencing health-related anxiety, might begin to become hyper-focused on symptoms that could indicate this type of infection.”

Many people who have anxiety, a mental disorder that affects upwards of 18 percent of the adult population, are all-too-familiar with what Porter is describing. Feeling disconnected from your body is a common symptom, and anxious people like me often struggle to separate their physical symptoms from psychological ones. And so, anytime I feel off, it raises the same question: Am I sick, or just imagining things?

In particular, psychogenic coughs, also known as somatic coughs, are any coughs with no physical explanation and have psychological roots instead. The exact rates of somatic coughs are unknown, but they’re thought to be more common in children than adults. Scientists are also unsure exactly what causes them — pointing to multiple reasons instead (a la hyperventilation related to panic attacks). Occasionally described as “habit coughs,” they can occur after legitimate viral infections and linger afterwards out of habit. Similar to coronavirus coughs, somatic coughs are typically dry but are described as having a “honking” or “barking” sound. Another big difference is that a somatic cough isn’t usually present at night before bed, or when you’re alone in general. 

This distinction was comforting in my case. I felt mostly fine when working from home by myself and then jogged a leisurely mile without incident. But the minute I was in a crowded grocery store, an uncontrollable urge to cough took hold, probably because I was now in front of an audience. “Coughing because we think we might cough can happen,” licensed counselor Greg Moffatt says, adding that coughs can work like yawns. That is, when other people cough in front of us, we tend to cough more, too. “Yawning, coughing and other behaviors can be contagious in that we can yawn because others are yawning.”

“A cough certainly can have links to anxiety,” agrees Shuhan He, an emergency room physician at Massachusetts General Hospital at Harvard Medical School. But he adds, anxiety and psychosomatic symptoms aren’t powerful enough to give anyone a fever. “In the coronavirus, what people tend to have is quite severe symptoms like fever, chills, muscle aches and dry cough. If these symptoms occur, you may have it.”

In a perfect world, of course, the recommendation would be to go to the doctor for peace of mind, but unfortunately, that’s not where we’re at. So for now, I’ll just worry about taking my temperature every five minutes.

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