What Is The Relationship Between Personality Disorders And Self-Esteem?
The concept of “self-esteem” generally refers to a person’s sense of their overall personal worth, value, abilities, and morals. Essentially, it can be thought of as a person’s opinion of themselves. The phrases “self-worth,” “self-regard,” and “self-respect” are often used interchangeably with self-esteem and may indicate the same concept.
Self-esteem generally encompasses the following:
- How a person sees themselves and their sense of personal identity
- Sense of competence and worthiness
- Sense of security
- Sense of belonging and community
- Self-confidence
Psychology researchers often divide self-esteem into two different categories: explicit self-esteem and implicit self-esteem. Explicit self-esteem can be defined as the idea of self that people are able to access and articulate. It could be defined as how someone describes themselves when they are asked to reflect on who they are through a test designed to measure self-esteem, such as a questionnaire.
Conversely, implicit self-esteem typically refers to the unconscious, intuitive sense of who one is. It usually can’t be evaluated by asking someone to verbalize descriptions of themselves, which, by nature, would cross over into explicit self-esteem. Implicit self-esteem usually needs to be measured by tests that assess unconscious attitudes, such as a word association measurement like the Implicit Association Test. In this test, researchers can assess how closely people associate positive words and concepts with themselves, which may reflect their sense of implicit self-esteem.
Researchers have examined self-esteem differences in this way because there can often be a wide gap between a person’s sense of explicit self-esteem and implicit self-esteem. This gap can be associated with certain types of mental health conditions, including personality disorders, and may be effectively addressed with the help of a licensed mental health professional.
Which personality disorders are associated with high self-esteem and low self-esteem?
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), the definition of a personality disorder is “an enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.”
Borderline personality disorder
Borderline personality disorder (BPD) is perhaps the most striking example of a mental health condition that can be heavily impacted by self-esteem concerns. An unstable sense of self tends to be a defining characteristic of BPD and part of its diagnostic criteria.
BPD patients can demonstrate a pattern of emotional instability that may negatively impact how they perceive themselves. This situation may then evolve into a vicious cycle, in which low self-esteem then contributes to further emotional instability.
For many people with BPD, self-esteem can be highly dependent on their perceptions of their relationships with other people, which they often interpret as potential sources of rejection or abandonment. Within these relationships, a phenomenon known as “splitting” may occur, which can be seen as a defense mechanism to protect against the risk of rejection or abandonment.
A person with BPD may initially idealize another person with whom they are in a relationship, romantic or otherwise, but then “switch” to devaluing and criticizing that person for no particular reason. This process is often referred to as “splitting” because people with BPD often perceive others (and by extension themselves) as either “all good” or “all bad,” with no possibility of integration between a person’s positive and negative qualities – hence, a “split.” This tendency can have a significant negative impact on the self-esteem of a person with BPD.
Avoidant personality disorder
Avoidant personality disorder (APD) may be associated with the lowest self-esteem levels of the 10 personality disorders in the DSM-V. APD patients can be excessively introspective, to the point where they are exceptionally self-conscious and constantly evaluating themselves, usually with negative conclusions. They often perceive themselves as being different from other people in an inferior sense.
APD patients can be unsure of their identity and frequently have an unusually low sense of self-worth. They typically view themselves as socially inept. As with borderline personality disorder, this perception can become a vicious cycle: The social difficulties a person with APD experiences can lead to low self-esteem, which may then exacerbate future social difficulties.
Ultimately, people with APD can form such low opinions of themselves that they start to interpret all social interactions through a negative lens, which can lead to the tendency to avoid social interaction entirely. This avoidance of social interaction can be seen as the defining feature of the disorder.
Dependent personality disorder
Low self-esteem can be a critical component of dependent personality disorder. With individuals who have dependent personality disorder, low self-esteem most often manifests as a lack of self-confidence and self-efficacy, usually resulting in a belief that one is entirely incapable of taking care of oneself and needs to wholly depend on other people.
People with dependent personality disorder may not have the confidence to initiate projects (or even conversations) on their own. They may need continual reassurance from other people and may not be able to make decisions without incorporating advice from others, or they may defer decision-making entirely. They may automatically agree with other people because they do not trust or value their own thoughts, opinions, or emotions. All of these tendencies can be extreme manifestations of exceptionally low levels of self-esteem.
Antisocial personality disorder
Antisocial personality disorder (ASPD) is usually considered an “egocentric” disorder, meaning that one of its diagnostic criteria is a tendency for individuals to completely disregard other people’s emotions and needs and focus solely on their own. Achieving their own personal goals and gratifications may be how people with ASPD build a sense of self and self-esteem, often by using power, manipulation, exploitation, and control of other people.
People with ASPD may have disordered self-esteem, but it is typically in the opposite direction of the personality disorders discussed above. While borderline personality disorder, avoidant personality disorder, and dependent personality disorder symptoms may all involve low self-esteem, individuals with ASPD tend to have a higher sense of self-esteem. If an external event leads to doubt or disturbs their sense of self, people with ASPD tend to exert dominance over other people to regain a sense of self-worth.
Finding support for living with a personality disorder impacted by self-esteem
Help is available for all types of personality disorders. Therapeutic techniques, such as dialectical behavior therapy and cognitive behavioral therapy, can be effective in both reducing symptoms of certain personality disorders and improving self-esteem and overall well-being.
In-person therapy appointments may not always be feasible or comfortable for people with a distorted sense of self, however. Online therapy can be a beneficial alternative in these circumstances, as it may remove some of the social pressure. With online therapy, users can speak to their therapists through online chat, phone call, or video call to suit their comfort levels.
Research has found that online therapy and traditional in-person therapy may have similar treatment outcomes, including when working with people with personality disorders. One study found that completing a course of online therapeutic treatment showed promise in reducing the symptoms of several personality disorders.
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