How to manage your anxiety

No matter what you struggle with (BDD, OCD, an eating disorder, etc.), compulsions arise from extreme anxiety.  I’m not going to pretend to understand the intricacies of other disorders, but I do know that the methods of managing anxiety work the same for everyone.  I’m going to speak in terms of my experience with BDD, but you should be able to substitute your own thought patterns and compulsions and get similar results :) Go team!

The end of the world

When I look in the mirror, I become extremely anxious.  I see tons of imperfections, and all I want is to remove them from my face and body.  I see acne, clogged pores, ingrown hairs, uneven skin tone and dryness.  I start to think that no one will be attracted to me if I continue to look the way I do, that everyone will be disgusted by me, that I am worthless, I will never succeed in life.  Negative thoughts begin swirling in my head until I literally feel that I am drowning in them.  I can barely catch my breath; it feels like a family of elephants is sitting on my chest.  My head starts pounding, my legs are weak and my insides feel like they are shaking and about to crumble.  Sometimes I get extremely nauseous and dizzy as well. 

For those of you who do not struggle with a body image or anxiety disorder, this may seem like a completely blown-out-of-proportion series of thoughts.  I agree to some extent, but you have to realize that neurological disorders are not meant to be rational.  That’s part of the reason that they are so frustrating to deal with in the first place.  When I see a blemish on my face I don’t think, “oh crap a pimple” like the majority of the human race.  I think “oh no, here it comes – the end of the world is upon us.  Why am I the ugliest person in the universe?  I can’t believe that I am so unworthy of love.”


BDD is sneaky in that it offers a quick release from the grip of extreme anxiety.  I would imagine other disorders offer compulsions that promise similar results.

All I have to do to stop feeling like I’m going to pass out is pick at my face.  In the moment, it is a no-brainer.  Collapse into a heap of pain and sweat on the floor, or scratch at my imperfections, which I want to remove from my face anyways. Done.

This is the habit we all want to overcome.  We want to stop restricting what we eat, purging, picking, cutting, measuring or any other harmful habits we use to get rid of anxiety.  In order to do this, we need to learn another way to stop feeling so anxious.

A new way to manage

I always thought that fighting anxiety was the best way to get rid of it.  If damaging thoughts entered my mind, I would try to ward them off and convince myself that they weren’t true.  I spent a lot of time and effort fighting against my own mind – trying to make myself believe things that I never really accepted.

In therapy, I’ve been learning another way – allowing anxiety to enter my body and acknowledging (and welcoming!) damaging thoughts.  This is counterintuitive, but it has been working.

The steps

~ When you begin to feel anxious, and your compulsions are trying to take over, stop what you are doing and acknowledge your anxiety.  Do not try to ignore or overtake it.

~ Take a seat.  Find a chair and sink into it.  Close your eyes.  Let your arms and legs hang limp and your head droop forward.  Try to relax the muscles of your body.

~ Begin taking deep breaths.  The anxious thoughts are still going to be floating around in your head.  Let them.  Just breathe.

~ Decipher your thoughts.  Exactly what is floating through your mind?  If you do not follow through with your compulsion (picking, purging, cutting, etc.) what is going to happen?  Be specific.  What does the future hold for you if you avoid your compulsions?  How awful will that existence be?  This will cause your anxiety to increase.  This is good.

~ Use your imagination.  Visualize your worst-case scenario.  Pretend you are living it out. 

For me, I imagine that my face is covered with acne and blackheads and that, when I go into work, people avoid me because they don’t want to look at me.  I imagine that customers don’t want me to help them and that everyone whispers behind my back.  My dad shuns me.  I end up old and alone because no one wants to date or marry me.  I never get my dream job because I am too hideous.  I die unhappy and unfulfilled.  I am a disgusting waste of life.
What is your worst-case scenario?  Think about how this makes you feel, and how anxious you become.

~ DO NOT give in to your compulsions.  Even if you feel like you have no other choice.  Even though your anxiety is currently spiking into the stratosphere.  Even though you are thoroughly upset.

~ Live in this.  Live in this moment.  Keep thinking those thoughts.  Keep listening to your anxiety.  Acknowledge it.  Be fully aware of how your body is reacting, how hard your mind is working, how awful you feel.

~ Keep breathing.  Breathe through this.  It hurts like hell, but it’s going to work.

What happens when you work through these steps is that your anxiety spikes.  It gets really intense really quickly. 

However, your anxiety cannot remain at this level, as it’s impossible for humans to function during intense anxiety (which is why you should be sitting, by the way).  Usually, we use our compulsions in order to remove the anxiety and get on with our lives.  In doing so, we override our natural habituation systems.

By listening to our anxiety and allowing it to spike, but NOT using our compulsions, we allow our habituation system to take over, as it naturally should.  We sit in the anxiety until our bodies can no longer handle it, and we habituate, or get used to, being anxious. Our anxiety slowly but surely decreases. 

Habituating to habituating

Over time, your body learns that it does not need to turn to compulsion to decrease the anxiety it is experiencing.  All it takes is some intense focus, deep breathing and will-power. 

My homework assignment this week was to avoid picking as much as possible.  I have been using the technique above to manage my anxiety when I feel like scratching in the mirror.  One night, I lowered my anxiety from an 80 (on a scale of 1-100) down to a 35.  It took about half an hour, but it was well worth it.  I didn’t pick for the next two days.

In the past couple of days, my anxiety has never gone back up to an 80.  It has actually been spiking around a 40 and quickly decreasing to a 20.  My picking has gone down substantially, and I am not feeling as much of a craving to run to the mirror as I used to.


This week has been, and continues to be, extremely difficult.  I am operating with a base level of anxiety around a 15 (instead of a 0, where I would like to be) and this is causing me to feel very tired.  However, to say it’s worth it would be an extreme understatement.  Since I am not picking as much, my skin has been given time to heal.  I have to say, it looks better than it has in a long time.  I am able to see my efforts paying off, which makes me want to continue down this path.  

My life is changing in ways I never thought it would.  I am still not fully recovered, and I will continue to take medication and go to therapy, but I am gaining tools to deal with my compulsions.  I am winning.

Let me know if these steps work for you, or if you are finding them difficult and need some extra advice.  I’m an anxiety expert ;)

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