How to manage anxiety when living with visible difference

Feelings of anxiety and worry can be common for people living with a visible difference or disfigurement. They can be driven by worries that other people will stare at or judge you – and this can have a significant impact on your ability to function in day-to-day life.

On this page, we explore what anxiety is and what it feels like, how it can be connected to visible difference and how to manage anxiety. We’ll introduce ways to control anxious thoughts and anxiety management techniques you can use.

What is anxiety?

Anxiety describes feelings of worry, unease or fear. Everyone feels anxious from time to time. Anxiety is the body’s natural response to situations that make us feel nervous or scared – such as an exam, interview or hospital appointment. Some level of anxiety is good and can help us to perform or prepare. However, constant anxiety or extreme anxiety in everyday situations is less helpful to us.

Anxiety puts the body on “high alert”. Adrenaline is released and the heart beats faster, boosting oxygen to the limbs, preparing us to fight a threat or run away from it. This “fight or flight response” is designed to protect us from danger. But it can be hard to live our day-to-day lives if we feel anxious all the time or in everyday situations. Learning how to manage anxiety is important if continual worry interferes with your life.

How does anxiety affect us?

How you may feel:

• Nervous, worried or on-edge.
• Feeling that something awful is going to happen.
• Tense, frightened and uptight.
• Constantly stressed and pressured.

How you may think:

• Constantly going over the same worries or thoughts.
• Trouble focusing or concentrating.
• Trying to find a solution but feeling like you are going round in circles.
• Your mind is racing and you are thinking about lots of worries at once.

How your body may react:

• Faster breathing or breathlessness
• Palpitations (an irregular heartbeat)
• Feeling sick
• Chest pains
• Headaches
• Sweating
• Loss of appetite
• Feeling faint
• Needing the toilet more frequently

Visible difference and anxiety

Everyone experiences anxiety from time to time. However, people living with a visible difference or disfigurement may experience staring, comments, questions, or other difficult things. If you feel that others are judging or scrutinising you, this can make the most basic, everyday situation challenging. If you have acquired a visible difference, this can affect your sense of identity, leading to feelings of anxiety. Some people with visible difference can feel so anxious they avoid going out or doing things. Learning how to manage anxiety won’t stop these challenging situations from happening – but it will make you more resilient and less avoidant.

“It wasn’t until I attended an annual sports day event at work that I had to really confront my anxiety around vitiligo. I felt that familiar panic of having to expose my skin and wanting to cover up.

I decided to send an email round to my colleagues to let them know how I felt. I was taken aback by just how supportive their responses were.

For the first time, I had spoken up about my anxiety and was pleasantly surprised to receive kindness, empathy and support from my peers. I actually felt fine about wearing the same clothes as everyone else. Unexpectedly, this was the start of a new, empowering journey for me.”

Kirpal (read more about Kirpal’s experience)

How to manage anxiety

There are many different anxiety management techniques and approaches you can adapt to help you cope, including:

Identifying your anxieties

“Knowing” your anxiety is a good way to start managing your feelings:

• What are you anxious or worried about? For example, “I am worried about going to work on public transport because people will stare”.
• How does the anxiety make you feel and behave? For example, “This will make me feel exposed and vulnerable and I will try to hide my face”.
• How does this worry affect your life? For example, “I try to avoid going on public transport or feel very anxious when I do”.
• When do you worry most? For example, “I worry about this on weekdays when I have to go to work the next day”.

Managing anxious thoughts

One of the best anxiety management techniques is to ask yourself questions:

• “Can I do something about this right now?” If the answer is no, focus on something else. If your mind wanders back to your worry, refocus it again on the task at hand or focus on your breathing.
• “What would my friends or family say?” Ask yourself what a friend or family member would say to you in this situation. Chances are they would be kind and loving and tell you that you can cope.
• “Is my worry based on fact or opinion?” Thoughts are not facts and recognising this can be useful. If your worry hasn’t happened yet, it is likely to be your assumption that is making you anxious.
• “Am I predicting the worst-case scenario?” Worry often focuses our minds on what could go wrong. Try to think about all possible outcomes, including the good ones. Think about other times you were anxious or worried – did it always turn out badly?
• “Am I trying to read other people’s minds?” If someone turns away from you, you might start to worry this is because of your appearance, but actually it may be for many reasons. We don’t know what other people are thinking, so try not to read their minds.
• “How have I coped before?” Think about all the things you have overcome so far. How have you coped with challenges in the past? What does “coping” mean to you?
• “What have I achieved?” If it feels like a bad day, remind yourself of what you have achieved. For example, have you got up, got ready, taken the kids to school, prepared a meal? All of these things are important.

Take control of your environment

You can use these anxiety management techniques to help you take control of your environment:

Prepare in advance

• Think of common situations which increase your anxiety – then think of several responses for each.
• If you find journeys on public transport difficult, you could look at your phone or read the paper to divert yourself, count how many people are wearing black coats, try smiling at a nearby commuter.
• You might be worried about an upcoming change, such as starting a new job or going to university. Think about the things that might make you feel less worried and more confident. This might be choosing a new outfit or preparing responses of how you want to talk about your appearance if anyone asks.

Dedicate “worry time”

• Dedicate 10-15 minutes a day to sitting down to think about your worries.
• Think carefully about the timing of this. Choose a time that works for you, when you might be diverted afterwards, for example, after dinner – then you can spend time with your partner or watch TV or read.
• If worries come to mind at other times, don’t tell yourself you can’t worry – that won’t work. Instead, say, “I am going to postpone this until my worry time”.

Create calm spaces

• Think of times of day that you find you feel anxious the most, for example, many people worry more at night.
• Make the space as calm and relaxing as possible, for example, ensure your bedroom is dedicated to rest and sleep by adding low lighting and making it warm and comfortable.
• Go to bed only when you are ready to sleep. You could read or try a relaxation exercise beforehand to help you feel calmer.

Set achievable goals

• It can be hard when everything in life is not as you wish and this can provoke anxiety.
• Think about what you want your life to look like – ask yourself, “is this realistic right now?” For example, if you are having significant health problems, thinking about going to work might not be realistic right now, so set this as a medium- or longer-term goal.
• Make a list of things you would like to do and try to make a plan. Also identify what you have stopped doing and plan how you can restart.
• When making your plan, break it all down into small, manageable steps and be realistic.

Health and treatment concerns: Problem solving and finding information

• It’s natural to feel worried about medical conditions, especially if you have an operation coming up or something that creates apprehension.
• Think about your worries and decide if there is anyone you can speak to about them, such as a medical professional or others who have your condition.
• Think about what you can control in the situation, for example, by taking something to the hospital that comforts you, doing things that help you to relax, or taking someone with you to an appointment.
• If you are very feeling anxious a lot of the time and this is having a big impact on your everyday life or stopping you from functioning, we recommend going to see your GP, who can discuss the different forms of help available, such as talking therapy.

We hope this guide has provided some useful anxiety management techniques and helps you learn how to manage anxiety if you live with a visible difference or disfigurement.