The Mental and Emotional Tolls of Bed Bugs

Bed bugs are all over the news these days. Last fall, there were a flurry of media articles about Paris, France, being “overrun” by the little buggers, and worries that the 2024 Summer Olympics scheduled there will be affected by infestations. Bed bugs seemed to disappear from western Europe and North America in the 1940s, most likely due to effective pesticides such as DDT. However, since about 1990, they have been popping up in fancy hotels, spas, department stores, subway trains, movie theaters and, of course, people’s homes.

FIRST, SOME BACKGROUND. The common bed bug, Cimex lectularius, has been a parasite of humans for thousands of years. Historically, these tiny bloodsuckers were common in human dwellings worldwide, giving the old saying “sleep tight, don’t let the bed bugs bite” real meaning. But after a decades-long absence, they have returned as a major urban pest. Adult bed bugs are less than one-quarter inch long (about 5 millimeters), oval-shaped and flattened, resembling unfed ticks or small cockroaches. Tucked backward underneath their head is a long proboscis — a tubular mouthpart they can extend to take a blood meal. A bed bug needs only about 5-10 minutes to drink six times its weight in blood during a single meal. Adults are reddish-brown, while the babies are very small and yellowish-white in color. Bed bugs hide in cracks and crevices, generally within a few feet of a bed, coming out only to feed on an unsuspecting host. Then they run back to their hiding places to mate and lay eggs. Houses, apartments and hotels can become infested with thousands of the little bloodthirsty pests, primarily in the mattress and box springs, where they leave telltale black fecal spots. In severe infestations, they may occur all over the dwelling and produce a thick layer of bed bug feces, shed skins and eggs in their hiding places.

Although bed bugs have been suspected in the transmission of more than 40 disease organisms, there’s not much proof they can transmit human pathogens, with the possible exception of the microorganism that causes Chagas disease. In our lab, we have artificially infected bed bugs with pathogens yet failed to show that the microorganisms could survive inside the bugs and make their way to the salivary glands for (later) transmission to a host. So, for now at least, there is very little evidence that bed bugs are involved in human disease transmission.

The most common medical impacts are related to nuisance biting and the associated itching and inflammation. Bite reactions are generally itchy red spots, which usually go away in a week or so. However, some people may develop more complex skin reactions, including blisters, or even allergic reactions. Rarely, extreme cases can lead to enough blood loss to cause anemia.

OTHER EFFECTS. If bed bugs don’t transmit human diseases, and if their medical effects are primarily itchy bite reactions, then what other types of negative health effects are there? We’ve become increasingly aware of the emotional and psychological effects bed bug infestations can have on people. Run-ins with these parasites can trigger nervousness, anxiety and insomnia. One study of people exposed to bed bugs found about half reported sleep difficulties and social isolation associated with the infestation. In another survey of people living in bed bug-infested dwellings, Dr. Michael Potter, now-retired entomology professor, University of Kentucky, and colleagues found that 22 percent of respondents reported emotional distress from the infestation and 29 percent reported insomnia. Bed bugs commonly create a side effect of constant worrying and feelings of shame. In “Bed Bugs Are Back: Are We Ready,” a 2009 research report by Habitat Services and WoodGreen Community Services, one distressed person expressed it this way: “To be honest, until you go through [an infestation], you have no idea just how horrifying it really is. It is just natural for you to become paranoid; you lose sleep, you end up dreaming and thinking about bed bugs — they just consume every fiber of your being.”

To assess psychological and emotional effects of bed bugs, a colleague and I analyzed 135 internet posts concerning bed bug infestations. The majority (81 percent) of the posts reported three or more behaviors commonly associated with post-traumatic stress disorder — reactions like re-experiencing the event through intrusive memories and nightmares, startled responses and hypervigilance. Six posts detailed intense and repeated cleaning of homes or offices. Five posts reported persistent avoidance of people, activities and places that might lead to transmission of insects or arouse recollections of the original encounter. And this was perhaps the most frightening response: Five of the posts detailed suicidal thoughts or attempts. There are other anecdotal reports in the medical literature of suicides or drug overdoses.

CUSTOMER EDUCATION. As for protection and prevention of bed bugs, keep in mind they can hitch a ride into your client’s home on used furniture, clothing or other items purchased at thrift shops, secondhand stores or garage sales. Be sure to inform customers they should disinfect — more precisely “dis-insect” — these items. When traveling, it is important for them to know that not every hotel room has bed bugs, but some do. Simple precautions can help protect their belongings from infestation. Tell them to leave all unnecessary items in their vehicle, such as extra clothing, gear and equipment. When first entering their hotel room, they should place luggage in the bathroom until they have had a chance to inspect the place. They should pull back sheets and check the mattress and box springs for live bed bugs or their black fecal spots. If any bed bugs or other signs of infestation are found, they can go to the front desk and request another room.

Because bed bugs usually don’t travel far on their own, other nonadjacent rooms may be perfectly clean of the parasites. Keeping bed bugs out of houses and apartments can be difficult, especially for people who travel a lot (because they can bring them home). After traveling, it is best to unpack luggage outside or in the garage and wash all clothing from the luggage in hot water and dry on high heat. A dryer is a great tool in the fight against bed bugs.

TREATMENT. Control of bed bug infestations needs to be done correctly. Infestations found in apartments should immediately be reported to a landlord/management. Caution customers against trying to use over-the-counter pesticides or “aerosol bombs,” even if the label says, “kills bed bugs.” They simply won’t work. They might kill a lot of bed bugs, but not fully get rid of them.

My recommendation to them is to contact you, a competent pest management professional, who will inspect and treat the space with pesticides, use a complex heat treatment — or both methods — to eliminate the bugs.

Most importantly, tell them to try not to panic. They should keep in mind that bed bugs are only insects. They’re not magic. Believe me, they can be killed and eliminated from a dwelling.

The author is an entomologist with Mississippi State University Extension Service.