Self-esteem and mental illness

Self-worth cannot be expressed in numbers, measured, weighed, read or written down. We do not know any unit of measurement for the value people place on themselves. In psychology, self-worth is defined as the assessment one makes of oneself. It bundles experience, personality, self-confidence and self-esteem, among other things

Why is self-worth so elusive?

Imagine a person in your circle of family and friends to whom you would intuitively attribute high or low self-worth. What do you base that assessment on? What does a person with high or low self-worth do, say, feel, or think? You can probably think of a few signs. Self-esteem researchers look at the following areas, for example:

  • Minds: “I am weak” vs. “I am strong”
  • Feelings: self-loathing/doubt vs. self-confidence/joy
  • Behavior: self-injurious/unhealthy behavior vs. exercise/good nutrition
  • Appearance: unkempt vs. well-groomed
  • Bodily sensations: pain/tension vs. well-being/relaxation

In addition, our self-worth is not uniform and can change. As an example, consider a family man who does very well with his children and experiences great satisfaction in the area of family. Unfortunately, things are not going so well in the job area: Since he has already received a warning, he is worried about his job with the current cost-cutting measures in his company. So his self-worth in the private sphere is high, but in the professional sphere, is less present and, above all, unstable.

Sources of self-esteem

The example makes it clear that self-worth is context and role dependent. Theories of self-concept and self-esteem assume the following domains: Achievement-dependent, social, emotional, and physical self-worth (see Shavelson, 1976). The whole thing can be thought of as a hierarchy in which general self-worth is progressively subdivided from top to bottom.

Self-worth and psyche – a complex relationship

Looking at mental illness in the context of self-worth brings us to the familiar chicken-and-egg dilemma: Which came first? Did low self-worth lead to mental illness? Or was it the other way around?

Low self-worth promotes mental illness
If a person for whatever reason is convinced that he is not as valuable as others, then this can be serious for mental well-being. While this belief can occur unconsciously, it can still be very influential. A good example of someone suffering from low self-worth is an eating disordered patient who suffers from anorexia. Figure and weight play an exaggerated role in self-worth. Since there is a perceived excess weight, the self-worth is accordingly low. This leads to compulsive radical weight loss behavior without regard for one’s own health.

Low self-worth is a symptom of mental illness
In some mental disorders, lowered self-worth is part of the clinical picture. It is then considered a symptom. So for example with the depressive episode or that of the social phobia. Decreased self-esteem occurs here in very many patients and is triggered by the disease. It may even be that the self-esteem before the disease was in large parts inconspicuous!

Important: Too high self-esteem can also be a consequence of mental illness! This is the case, for example, in mania or in some personality disorders. The increased self-worth then leads to self-overestimation and megalomania.

Psychological illnesses put a strain on self-worth
A mental health crisis can severely affect self-worth. Sufferers often wonder why the illness occurred and what they did wrong. In addition to feelings of guilt, there is shame, as there is often still a false belief that mental illness is a sign of weakness. For this reason, working on self-esteem is crucial in the therapy of mental illness.

Self-esteem work in prevention and therapy

The complex interrelationships of self-esteem and mental health show that low self-esteem can a) promote mental illness and b) be a symptom or consequence of the illness. It follows that self-esteem work is significant for prevention and therapy. Often it is about enriching positive and beautiful experiences in life. Patients practice attaching more value to themselves and doing good for themselves.

The following measures can positively influence self-worth:

  • Building enjoyable activities: Patients are encouraged to do more of what is good for them. If the illness is acute, this is often not so easy. Psychotherapy provides support to participate in enjoyable activities again.
  • Pleasure therapy or euthymic therapy: Here, the pleasurable sensation is trained. So joy and pleasure find their place in life again. The resulting positive mood has a positive effect on self-worth.
  • Self-care and needs orientation: With a high risk of mental illness or an already existing disease, those affected can learn to better perceive their own warning signals for overload. After all, self-worth also includes recognizing when one is overstepping one’s own boundaries.
  • Reward: Self-worth also means appreciating your own achievements and accomplishments and rewarding yourself accordingly.
  • Social skills training: People are social beings and draw much self-worth from well-functioning social relationships. Sometimes, however, certain skills are missing from this, but they can be learned. For this purpose, psychotherapists offer social skills training.
  • Change self-esteem-damaging thoughts: Many people have a very radical inner critic. This always provides thoughts such as “I’m not worth anything” or “I can not do well at all”. In cognitive restructuring, we try to get to the bottom of these thoughts and change them.

Perhaps this article has inspired you to think about your own self-worth. It is always helpful to ask yourself the following: What can I do good for myself today? Because every single person is worth taking care of themselves and make their lives as satisfied as possible.


(1) Shavelson, R. J., Hubner, J. J., & Stanton, G. C. (1976). Self-concept: Validation of construct interpretations. Review of educational research, 46(3), 407-441

(2) Walter, D., Rademacher, C., Schürmann, S., & Döpfner, M. (2007). Foundations of self-management therapy in adolescents: SELF therapy program for adolescents with self-esteem, performance, and relationship disorders (Vol. 1). Hogrefe Publishers.

Verena Klein
Autor Verena Klein
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