I have, in the past, defined true self-esteem as a positive feeling about oneself based on intrinsic attributes, similar to the way that we feel about others for whom we have esteem. What are the benefits of having true self-esteem, and what are the consequences of not having a positive sense of self?

            While there are many mental health issues that can be strongly impacted by low self-esteem, anxiety and depression appear to be the most common. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), low self-esteem is listed as a symptom of Dysthymic Disorder (commonly referred to as Dysthymia), a general depressive disorder. Thus, conventional wisdom suggests that when someone develops dysthymia, his self-esteem takes a hit.

            Self-esteem, however, is typically defined as a feeling that is subject to fluctuations in mood, situation, or surroundings. This is not what I would call self-esteem. Self-esteem, by definition, is not subject to change based on external factors. What the DSM-IV-TR appears to be referring to is what I would term ??self-image.? This is often rather low when a person is depressed.

            Because the common conception of self-image is based on external factors, it would be natural to conclude that boosting one's external sense of self would be part of the solution to depression. Although this might work to some extent in the short-term, it unfortunately only reinforces the initial problem by continuing to focus on self-image as opposed to self-esteem. In the long run, it is very likely that the person would repeatedly succumb to bouts of depression, anxiety, or other issues, due to his continuing negative or non-existent feelings toward himself.

            In fact, rather than low self-esteem being a symptom of depression, I would say that depression is often a symptom of low self-esteem.

Another common symptom of low self-esteem is anxiety. Anxiety can be viewed as a fear of something not clearly defined and/or not logical. People with anxiety will often grasp onto anything to explain their fears. This helps them to "make sense" of the anxiety and to avoid the confused frustration associated with the inability to identify any reason for the fear. For instance, someone whose job is not going well might assume that his anxiety is related to this, ignoring the fact that his job wasn't going any better for some time before he began feeling anxious. He could also be ignoring the fact that his level of anxiety is disproportionate to his job issues.

Although the physical problem is not the underlying cause of the anxiety, it can be related to it. In the instance where someone closely defines himself as based on his job (i.e., "I am a brilliant doctor," or "I'm a powerful CEO"), problems related to his job can have a profound impact on his self-image. This can cause high anxiety, not because of the specific job issue, but because his self-image has been assaulted and he has no internal sense of self on which to rely. Focusing on the job issue as the cause for his anxiety makes it difficult for the person to recognize his fears as reflecting an anxiety disorder. It also makes it more difficult for him to work on the root cause of his anxiety--low self-esteem.

In most cases, the first step is to clearly recognize that the anxiety is in fact due to an underlying issue rather than the "logical" source to which it is being causally linked (e.g., job problems). Once the person recognizes the unconscious nature of the problem, the next step is to grasp the true meaning of sense of self. At that point, the person is finally able to begin working directly on his self-esteem.

Yehuda Lieberman, LCSW-R, QCSW, DCSW is a NYS licensed clinical social worker. He maintains a private practice in Woodmere, NY, where he counsels individuals and couples. He specializes in anxiety and depressive disorders. He can be contacted through his website: www.ylcsw.com, or at 516-218-4200

Yehuda's book, "Self-Esteem: A Primer," is available at Amazon.com or on his website: www.ylcsw.com

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