Just five or 10 years ago, you probably thought that bed bug bites were an imaginary menace—a line in children’s rhyme (“Don’t let the bed bugs bite!”).

By now, of course, you know that these tiny brown bugs have made a comeback and are crawling across the U.S., turning up not only in the bedroom, but in dorm rooms, hotels, retail stores (even our undies aren’t safe!) and movie theaters.

Despite the hyped up media coverage, it’s true that bed bugs feed nearly exclusively on human blood so they go where the people are. But do they actually pose a major health threat?

Most health agencies, including the Centers for Disease Control and Prevention, say not really. Even though the little bloodsuckers may carry around more than two dozen disease-causing microbes, there is no evidence that they spread those diseases. One recent study suggests they may transfer antibiotic-resistant staph bacteria between people, but this hasn’t been confirmed and many bed bug experts remain skeptical.

In extreme cases of infestation where a person is bitten hundreds or thousands of times a day, bed bugs may cause anemia, but known cases are very rare. Other minor health concerns include allergic reactions and infections from related scratching.

But that doesn’t mean bed bugs don’t cause damage. A new line of research suggests that the critters may cause severe consequences when it comes to mental health. YouBeauty finds out what they are and what you can do to prevent a bed bug meltdown.

The Mental Toll:
Bed bugs are creepy by nature. They typically attack in the dead of the night, sneaking out of their hiding spots to suck the blood of an unsuspecting victim and then scurrying right back, unseen. They’re also directly associated with the bed—a vulnerable place where we want to feel safe and secure. So it’s no surprise that people with bed bug infestations say they suffer from a long list of mental anguishes.

In a large 2010 survey by Michael Potter, Ph.D., an entomologist from the University of Kentucky, people with bed bug infestations reported insomnia, emotional distress, anxiety, stress, paranoia and depression, to name just a partial list. Potter presented his perspective on these psychological impacts at the 2011 BedBug University North American Summit—a conference for scientists, pest control companies and industry leaders—earlier this fall.

A survey due to publish this January, led by medical entomologist Jerome Goddard, Ph.D., from Mississippi State University, adds nightmares, flashbacks and hyper-vigilance, and an excessive awareness of anything that triggers anxiety to the list. That hyper-vigilance might include obsessively searching for bugs at home or avoiding social situations out of fear of picking up bed bugs.

It’s normal to have some anxiety over bed bugs, according to Caleb Adler, M.D., an associate professor of psychiatry and neuroscience at the University of Cincinnati, who also presented at the BedBug Summit. Dr. Adler, who practices in the second most infested city in the nation, has had several patients anxious over bed bugs and says that bed bug sufferers frequently experience modest levels of stress over how to get rid of the critters and how much it will cost. Some also suffer from mild hallucinations that phantom bugs are crawling on them.

READ MORE: Your Guide to Anxiety

Still others feel embarrassment or shame, notes Dr. Adler, which could ultimately affect their personal relationships. At least one informal survey suggests bed bugs may impact your dating life.But bed bug infestations could have a far more devastating effect, particularly in those who already suffer from mental illness. In a series of case studies presented earlier this year at the American Psychiatric Association’s annual meeting, New York psychiatrist Evan Rieder, M.D., showed that bed bugs can exacerbate underlying problems such as anxiety, depression, bipolar disorder and substance use disorders.

Two of Rieder’s patients developed suicidal thoughts and one attempted suicide, fearing that her life would never return to normalcy after a bed bug infestation.

Unfamiliar Threat:
Part of the strong mental reaction to bed bugs, says Dr. Adler, may be due to the fact that they’re relatively unknown by our generation. Our ancestors lived with them for millennia up until around World War II and the advent of DDT, a now-banned pesticide that virtually wiped out bed bugs in the United States. (Before you start clamoring for the ban to be lifted, most bed bugs have evolved resistance to DDT and many other pesticides, rendering them ineffective.) Our unfamiliarity with bed bugs makes them appear more threatening.

Also, the last time we had bed bugs, psychiatry wasn’t what it is today. “World War II in many ways changed the nature of American psychiatry,” explains Dr. Adler. “Outpatient psychiatry was in a very different stage—much less treatment, much less awareness and many fewer practitioners—so it’s not the kind of thing that would have been commented on or would have appeared in the literature at the time.”

It’s possible the recent interest in bed bugs and mental health may be a result of modern psychology and bed bugs crossing paths for the first time. So far, though, all of the published research is based on anecdotes, case studies or self-reports, which are all helpful in identifying a potential link but don’t confirm a definite relationship.

The first objective large scale study on bed bugs and mental health will be presented later this year by a team led by Stephane Perron, M.D., a preventative medicine and public health specialist in Montreal. Perron’s preliminary results suggest a significant increase in both anxiety and insomnia amongst people living in apartments infested with bed bugs, some of whom had no preexisting mental illness.

Keep Calm and Carry On:
The bad news: Thanks in part to pesticide resistance, bed bugs aren’t going anywhere. So what’s the best way to prevent or lessen mental stress over these bugs?First, know thy enemy. Learn to properly identify a bed bug, where to look for them and how to control them. This knowledge, notes Dr. Adler, may help give you a sense of control. A few good places to start are the University of Kentucky’s bed bug website, BedBug Central and the bed bug fact sheet from Ohio State University.

Next, be mindful of your belongings. At his BedBug Summit lecture, Dr. Potter encouraged vigilance (not hyper-vigilance): Be aware of what you track in and out of your house and be mindful of where you set your belongings when you visit public spaces.

READ MORE: Stress is a Beauty-Buster

Even through vigilance, you might track some home. But don’t panic. If you spot bed bugs in your home, call a professional pest management company. If you rent, check the laws in your state; your landlord may be responsible for the bill.

Most importantly, don’t let bed bugs get in the way of enjoying your life. Don’t avoid movie theaters, thrift stores and socializing out of fear of bed bugs. If you do find that you aren’t able relax because of bed bug-induced fear or if you already suffer from mental illness and sense it worsening, you should seek help from a mental health professional.

“If bedbugs become an issue, either because one has an infestation or someone you know has an infestation, it’s important to think of more than just the physical aspects—the bites, the cosmetic effect of the bites, the stress and effort of eradication,” adds Dr. Adler. “People should take care of their mental health and not neglect it. If [bed bugs are] causing anxiety or stress, don’t ignore that. Treat it like you would an infected bite.”