Low Self-Esteem Explained
If you’ve been to therapy, you know that the first session can feel…awkward. A stranger you’ve never met is trying to make the room feel comfortable while asking questions about your life.
They ask about your family, your symptoms, your relationships, your likes, and dislikes. They ask what brought you into therapy and what you hope to change. It’s a lot, and it can feel overwhelming.
At the end of that session, insurance companies require a diagnosis. For some, the label can feel validating; for others, it might feel limiting or uncomfortable. Either way, the diagnosis isn’t a definition of who you are—it’s a tool to help therapists understand the patterns and experiences you bring into the room.
One symptom I commonly see across different diagnoses and life stories is low self-esteem. It quietly shapes how you see yourself, relate to others, and navigate daily life.
Low Self-Esteem and the DSM-5
Low self-esteem is not a diagnosis on its own, but it appears explicitly or implicitly as a criterion in several DSM-5-TR categories.
Disorders Where Low Self-Esteem Is Explicit
Personality Disorders (Cluster B & C)
Borderline, Avoidant, Dependent, Narcissistic (fluctuating), Schizotypal
Depressive Disorders
Major Depressive Disorder, Persistent Depressive Disorder
Feeding and Eating Disorders
Anorexia Nervosa, Bulimia Nervosa
Body Dysmorphic Disorder
Gender Dysphoria
Disorders Where Low Self-Esteem Is Common But Not Diagnostic
Social Anxiety Disorder
Post-Traumatic Stress Disorder (PTSD)
Substance Use Disorders
Attention-Deficit/Hyperactivity Disorder (ADHD)
Approximately 9–10 DSM-5 diagnoses include low self-esteem as a formal diagnostic element, while it is clinically significant in many more disorders.
What Low Self-Esteem Looks Like
Low self-esteem can show up in many ways. Common patterns include:
Negative self-talk: “I’m not good enough” or “I always mess up.”
People-pleasing or over-apologizing: Putting others’ needs above your own to avoid conflict.
Fear of failure or avoidance: Holding back because of anticipated judgment.
Difficulty accepting compliments: Downplaying successes or feeling undeserving.
These patterns are common and don’t mean something is wrong with you. Low self-esteem is often a learned response to life experiences.
Why It Happens
Low self-esteem usually develops over time. Contributing factors include:
Childhood experiences & attachment: Early interactions with caregivers shape how safe and worthy we feel.
Social comparison: Measuring yourself against others can reinforce feelings of inadequacy.
Trauma or invalidating environments: Being dismissed or ignored can leave lasting impressions.
Low self-esteem may be common, but it’s not permanent. With attention, patience, and intentional effort, it can shift—and so can the way you see yourself in the world.
Therapy provides a safe space to explore these patterns without judgment and understand how they affect your life today.
Small Steps Toward Growth
Building self-esteem doesn’t happen overnight but small, intentional steps can make a difference:
Journaling prompts:
“What is a strength I often overlook?” or “When have I succeeded despite fear?”
Challenging negative self-talk:
Pause and ask, “Would I say this to a friend?”
Celebrating small wins:
Notice achievements, no matter how minor.
Practicing self-compassion:
Treat yourself with the same kindness you offer others.
Take a moment to notice where low self-esteem shows up in your relationships, work or personal goals. If you’re someone who likes a good workbook, I suggest the fourth edition of Self-Esteem: A Proven Program of Cognitive Techniques for Assessing, Improving & Maintaining Your Self-Esteem by Matthew McKay, Ph.D and Patrick Fanning.
Every step you take toward self-awareness is a step toward greater confidence and well-being.
You can reclaim a sense of worth and agency in your life!
With care,
Ronelle
