Mel Schwartz, LCSW

Low Self-Esteem: A Missed Diagnosis

According to the National Institute of Health, one in every two Americans will ultimately be diagnosed with some form of mental illness. What’s behind this staggering rate of malaise? Aside from the psychiatric/pharmaceutical collusion that tends to overly pathologize normal life challenges and transmute them into mental illness, I’d offer that the primary culprit is low self-esteem. Yet the DSM – the psychiatric bible for diagnosis – offers no diagnosis of self-esteem. My experience informs me that marginal self-worth manifests through an array of dysfunction, including but not limited to depression, anxiety, ADHD, codependence, failed relationships and, even more tragically, lives lived out in mediocrity.

We focus on the more specific diagnosable illnesses that result from marginal self-worth because we have medications that treat them, notwithstanding their questionable results. But there is no pill to offer someone with low self-worth, so there’s no revenue to be generated. Moreover, as a culture, our intellectual proclivity is to focus on the symptom and disregard the underlying and perhaps complex circumstances that contribute to the devolving of a human life. This is due to our drive to over simplify and seek quick solutions to the very complex tapestry of a human life.


The Veil of Symptomatology


I’ve been working with a middle-aged woman on the challenges that she endures around her sense of self. Her inner voice is particularly critical and she often berates herself, obviously exacerbating her dilemma. By helping her to witness how her thoughts have participated in how she actually experiences her life, she came to see that her beliefs became self-fulfilling prophecies. During a recent session, she shared with me that she had begun taking meds for ADHD. I asked her how she came to believe that she suffered from this affliction. She shared the following story.

She has a high-pressured job and often has to read intricate reports containing essential material that informs her decision-making. When reading, she struggled when coming across information that she didn’t easily understand – and it became her habit to put the report aside at such times. She concluded that what she was suffering from was attention deficit. I explored this further with her and she revealed that at such times, she’d reflect that she was too unintelligent to “get” the material. So she relieved herself by casting it aside.

I proposed to her that if she weren’t so critical of herself, it might provide the opportunity to feel more at peace when her comprehension was feeling challenged. Many people don’t at first undestand something, but they do afford themselves the time necessary for it to sink in. The issue at hand wasn’t likely about attention deficit, but that this individual couldn’t tolerate how she felt about herself. “I’m so dumb” was a core belief about herself that she clung to, notwithstanding her success. This belief, as both cause and effect of her self-esteem challenge, had in my opinion resulted in her symptom of ADHD.

I often see anxiety and depression occurring as a consequence of low self-value as well. A confident and secure relationship with your own self makes it less likely that you’ll suffer from these conditions (but, of course, doesn’t guarantee it). These afflictions can certainly exacerbate low self-esteem and mask the genuine source of the disorder, as they take center stage.

A young man with whom I was working was diagnosed with an acute anxiety disorder, which meds had been unsuccessful in ameliorating. His disorder manifested particularly as a social anxiety, and he become increasingly reclusive. While attending college, he would literally speak with no one, only attending classes and then retreating to the safety of his bedroom in his father’s house. There was no denying his anxiety, or the severity of it. As I endeavored to search with him for its roots, he shared some fundamental beliefs he had about himself.

His core belief was that he was somehow worthless. This self-reference had been inculcated from a very dysfunctional family system. More normative societal and familial values and behaviors were largely absent, and so he grew up with a diminished view of himself. Over time, this expanded into his retreating from reasonable engagement with his peers. He didn’t feel worthy enough to have friends and eventually his lack of interpersonal skills set up an avoidant complex. He had good reason to sequester himself, and the more he did so, the more incompetent he felt. As a result, his life became tragically limited, absent of any healthy interactions with others. He felt depressed, as he should have, since his circumstances were indeed depressing. This is what I call a “situational depression,” in that feeling depressed makes perfect sense in this scenario.

The psychiatrists with whom he had consulted prior to working with me alternatively diagnosed him with either depression or anxiety. He no doubt suffers from these disorders, but they are a result of his low-self value. In order to give him the opportunity to surface a healthier self-esteem, my work with him focused on his core beliefs about himself and the ensuing thoughts that confirmed those beliefs.


Failed Relationships


I was recently facilitating a web conference called The Marriage Mastery Workshop, during which the matter of self-esteem began to surface. The manner in which one’s unresolved issues – and their struggle with unworthiness and self-value – impact relationships is both deep and destructive. To the extent that your relationship with another mirrors your relationship with your own self, we can only begin to appreciate what occurs. So much of the pain experienced and dramas that unfold are rooted in the mediocrity of each party’s measure of their own worth. Relationships are challenging, but to burden them with one another’s self-esteem obstacles dooms them to unhappiness. The problem becomes even more critical as marginal self-value tends to decimate generative dialogue, with people either defaulting into silence and resentment or pointless blame. However, two people with healthy measures of self-esteem, engaged in a relationship with each other, stand a significantly greater chance of success.

The question now arises as to how we can overcome this scourge of low self-esteem. This is accomplished by challenging our fundamental beliefs around authenticity and vulnerability and by learning to reframe how we see ourselves. It further requires breaking free from the groove of self-denigrating thoughts that obstruct a healthy relationship with self. This is altogether achievable but requires a willful intention to turn the corner and value yourself. My next article, to be posted shortly, will explore this in greater detail.

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I agree! Ilissa Banhazl, marriage and family therapy, Glendora
How do we work with this? Slowly and caringly for a while…

Matthew Selznick

HI Ilissa,
Will be posting next article on this subject in a few days and offering an upcoming webconference as well. Stay tuned.


Thank you for this fantastic article. It’s very helpful.

Matthew Selznick

Delighted to hear that Mary


Excellent article. Can’t wait for the next! Thanks.

Matthew Selznick

Thanks Irene..Just a few days away.


Awesome! You beautifully articulated a complex problem that has a simple cause, effective treatment and positive outcomes!

Matthew Selznick

I appreciate that Daron.

Ruud Backus

Inspiring article, looking forward to the follow-up. In the process of restoring self-esteem one needs not only knowledge but also wisdom and timing

Matthew Selznick

It’s complex yet also simple, as with most things.

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