For Bethany Chalmers, managing her tardive dyskinesia (TD) and anxiety can be tricky, especially when it feels like one aggravates the other. The involuntary movements associated with TD sometimes make her feel self-conscious 01, leading to increased fears of being judged or not accepted by others 02. As Bethany explains, heightened anxiety can make her hyperfocus on her TD symptoms and worry that they’re getting worse 03, creating a tough cycle to break.

However, she reminds herself, "all hope is not lost!" Here are four daily coping strategies Bethany uses when her anxiety and TD worries threaten to spiral.

I've been diagnosed with bipolar disorder, tardive dyskinesia, and anxiety. My anxiety disorder means that, along with mood swings associated with bipolar and TD's uncontrollable muscle movements, I often feel extreme worry. And the anxiety doesn't only show up in my thoughts and feelings – I get intense physical symptoms of anxiety, too.

My anxiety can show up at any time and for seemingly any reason. When someone gives me a strange look, I instantly feel dread in the pit of my stomach. My muscles get tight as I wonder whether I did something wrong.

Part of me understands that their weird glance likely has nothing to do with me; I just happened to be in their line of sight while they were lost in their own thoughts. Yet, the grip of anxiety and its never-ending "what ifs" often overshadow everything else.

When I'm anxious, it can sometimes feel like my tardive dyskinesia gets worse. Here's why:

1. I feel self-conscious

When I’m feeling anxious, my instinct is to get as far away as possible from what's causing the anxiety.

Sometimes, though, that's not an option.

Crowded places are one of my anxiety triggers. Being in a busy store can set off symptoms of severe anxiety – but I can't just leave. My work often means going to places that may make me feel uncomfortable.

As my anxiety grows, I become increasingly aware of the symptoms of my TD. Suddenly, I'm convinced my foot twitches and facial tics are getting worse and that everyone in the store is watching me.

I don't know if my TD symptoms are genuinely getting worse or if feeling self-conscious heightens my awareness of every twitch. For example, I've never heard an adult comment on my tardive dyskinesia symptoms in public. But just believing that my symptoms are getting worse causes my anxiety to spiral.

2. I fear that I’m losing control

As well as feeling self-conscious about my tardive dyskinesia, anxiety makes me fear that I'll lose what control I have over my symptoms and how I come across to others.

I notice my twitching feet but can't see my facial tics unless I look in the mirror. When I was first diagnosed, it was looking at my reflection that showed me that I could briefly suppress my TD symptoms if I concentrated.

However, when I'm stressed, my breathing becomes fast and shallow. My racing mind means I can't concentrate on suppressing my symptoms the way I can when I'm calm. So, my TD symptoms show up how they “normally” would if I didn’t suppress them, and feeling self-conscious kicks in.

As my anxiety grows, I become very aware of my TD symptoms. Suddenly, I'm convinced… that everyone in the store is watching me.

3. Increased twitches and tremors 

Stress and anxiety can make it difficult to sleep. As can – as I've found – tardive dyskinesia. The jerks and twitches in my feet and trunk get worse when I'm stressed and when I'm falling asleep.

And the more tired I am, the more susceptible I am to stress, which then has a domino effect on how I manage both conditions.

4. Constant uncertainty 

As I said, no adult has ever made a comment about my TD symptoms. But, as my anxiety reminds me, that doesn't mean it'll never happen.

My anxiety latches onto my having tardive dyskinesia to create a list of "what ifs":

What if people notice my TD symptoms?

What if they get bothered by them?

What if someone says something that embarrasses me?

This does nothing to lessen my anxiety.

4 coping strategies I use to help me manage my tardive dyskinesia and anxiety

While I can't hope to "cure" myself of TD or anxiety, all hope is not lost. I've learned some coping strategies that I would like to share.

1. Controlled breathing 

Going back to the crowded store scenario… when leaving is impossible, which it often is, I've had to find other ways to manage my erratic breathing, tight chest, and racing thoughts.

A controlled breathing strategy, like deep box breathing, can help me manage my anxiety to the point that I feel more in control of (or less worried about!) my symptoms of tardive dyskinesia. 

How to do box breathing:

Inhale slowly and deeply through your nose for the count of four.

Hold your breath for four seconds.

Exhale slowly, through your mouth this time, as you count to four in your head. 

Hold your breath with empty lungs for another four seconds.

Repeat as many times as you need to feel a growing sense of calm. An easy way to remember this technique is 4 x 4 x 4 x 4.

Box breathing is a quick way to recenter myself, and, importantly, it's something I can do while standing in a crowd. As I concentrate on breathing in, holding, exhaling, etc., while counting to four each time, anxious "what ifs" take a backseat as the here and now come back into focus.

2. Focusing on my five senses  

When box breathing has gently brought back the sense of being present in the moment, this mindfulness technique helps to ground me even further. I focus on what I can see, hear, touch, taste, and smell at the very moment.

In the store, I listen to the music coming over the intercom. Do I recognize the song?

I focus on the feel of the shopping cart in my hands.

I notice all the boxes on the shelves and their colors.

Just believing my TD symptoms are getting worse causes my anxiety to spiral.

3. Listening to music 

I find that listening to music can be either 1) a great distraction or 2) a way to channel my nervous energy privately and safely.

In the first instance, calming or orchestral music may be what I need.

But, depending on my mood, sometimes loud and angry heavy metal music seems to help me much more. It doesn't make me more anxious – it gives my anxiety an outlet.

4. Getting social support 

Of course, talking to a trusted friend can help in times of anxiety. For immediate support, I often reach out by text.

If what's causing my stress and anxiety is less immediate and more long-term, meeting someone for lunch or joining a support group is the best way to connect, vent, and swap coping strategies.

All four of these options help me feel more connected and less alone. My anxiety and tardive dyskinesia often feel like they may affect one another. But, by practicing these strategies, I can help myself to manage both.

Sources:

1. Back to contents.

   Meglio M. NeurologyLive, 2020. Tardive Dyskinesia Worsens Quality of Life in Patients With Psychiatric Disorders [Online]. Available at: https://www.neurologylive.com/view/tardive-dyskinesia-worsens-quality-of-life-in-patients-with-psychiatric-disorders [Accessed 1 May 2025]

2. Back to contents.

   Psych Congress Network, 2021. In Online Posts, Patients Share Anger, Insecurity Over TD Symptoms [Online]. Available at: Farrar, M., Lundt, L., Franey, E. et al. BMC Psychiatry 21, 94, 2021. Patient perspective of tardive dyskinesia: results from a social media listening study [Online]. Available at: https://doi.org/10.1186/s12888-021-03074-9 [Accessed 1 May 2025]

3. Back to contents.

   Pellek, A. MedCentral, 2023. Is there a way to hide uncontrolled tardive dyskinesia movements in public? [Online] Available at: https://www.medcentral.com/neurology/tardive-dyskinesia/is-there-a-way-to-hide-uncontrolled-tardive-dyskinesia-movements-in-public [Accessed 1 May 2025]

The information presented is solely for educational purposes, not as specific advice for the evaluation, management, or treatment of any condition.

The individual(s) who have written and created the content and whose images appear in this article have been paid by Teva Pharmaceuticals for their contributions. This content represents the opinions of the contributor and does not necessarily reflect those of Teva Pharmaceuticals. Similarly, Teva Pharmaceuticals does not review, control, influence, or endorse any content related to the contributor's websites or social media networks. This content is intended for informational and educational purposes and should not be considered medical advice or recommendations. Consult a qualified medical professional for diagnosis and before beginning or changing any treatment regimen.

NPS-ALL-NP-01529 MAY 2025