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Section 13
Low Self-Esteem: Depression and Anxiety

Question 13 | Test | Table of Contents

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In the last section, we discussed the idea of empowerment as the foundation for healing and how to build it:  through building a sense of responsibility and accountability; through developing an understanding of power and its limitations; and through equipping the client with knowledge and empowering skills.

Many times, I have found that clients with low self-esteem, especially those who suffer from pathological self criticism, seem to also suffer from some form of depression or anxiety. The first trouble we have in this finding, however, is the question of which is the primary disorder?

In this section, we will examine depression and anxiety co-occurring with low self-esteem. We will examine primary depression and primary anxiety disorder. As you read this section, consider your client. Does he or she have a co-occurring disorder?

♦ Primary Depression
The first aspect we will discuss is when depression is the primary disorder. Clients who have primary depression may exhibit low self-esteem. They may display an inability to deal with criticism and poor self appraisal. This depressive state may decrease one’s self-esteem about everyday occurrences. Also, the client may be unable to make up his or her mind about trivial matters.

In conjunction with these symptoms, clients also manifest the tell-tale signs of depression. Some may sleep for long hours during the day. Many experience weight gain, listlessness, hopelessness, or the urge to cry at inappropriate times. Maxine was a client of mine who had originally been referred to me as a pathologically self critical client. However, her level of self criticism did not meet the criteria for pathological self criticism. Instead, many of her other symptoms such as her overeating seemed to affect her daily life more than her low self-esteem.

I asked Maxine how she had been feeling lately and Maxine stated, "Actually, not so good. I just went through a terrible divorce, so I feel like a wreck. I don’t feel like getting out of bed in the morning. But then I feel like a slug for staying in bed. All I want to do is watch tv and eat sugary stuff. This isn’t like me at all. I used to feel great about myself. Now, since there’s no one there that I need to look good for, I’ve stopped trying." As you can clearly see, Maxine fit the diagnosis for depression not pathological self criticism.

♦ Primary Anxiety Disorder
The second aspect we will discuss is when the anxiety disorder is the primary disorder. When a client suffers from a primary anxiety disorder, problems with self-esteem may be a result of the first condition. Many times, if anxiety lasts too long, a client may become self critical and lose self-esteem. Usually, I have found that clients whose anxiety disorder occurs primarily tend to have less intense low self-esteem than those whose depression occurs primarily. Denise was an anxiety disorder client of mine who had reported low self-esteem. 

Denise stated, "When my sister was sick for a long while in the hospital, I was feeling almost as sick with anxiety.  I kept expecting that call with the doctor on the other end saying, ‘We couldn’t do anything for her.’  Even though I knew the cancer was in remission, I had this overwhelming feeling something awful was going to happen. This went on for about three months, and after a while, I felt like it was my fault." As you can see, as a result of her anxiety, Denise had developed low self-esteem.  I explained to Denise that this low self-esteem was a symptom of her anxiety. Her body had been so overwhelmed by worry that it was starting to shut down emotionally. 

♦ Cognitive Behavior Therapy Technique:  Best Case Scenario
To help Denise get through her depressive state and ease her anxiety, I asked her to write out "A Best Case Scenario". For this CBT technique, I asked Denise to think about the best possible outcome to this situation and write it out on a scrap of paper. Denise wrote, "Beth will come home from the hospital, smiling and energized. In a few days, we will be able to take walks again and have our chats over coffee or lemonade, depending on the season. Her cancer won’t come back for a long time, and even if it does, the doctors will treat it once again and she will beat it once again." 

I asked Denise to put this scenario in a place she could easily see it. Denise framed it and put it on her bedside table. Whenever Denise felt like staying in bed, she would look over to see her Best Case Scenario and her anxiety would be somewhat eased.  Think of your "Denise". Could he or she benefit from a "Best Case Scenario"?

In this section, we have discussed depression and anxiety co-occurring with low self-esteem.  We examined primary depression and primary anxiety disorder.

QUESTION 13
What are two aspects of a co-occurring anxiety disorder and depression?To select and enter your answer go to Test.

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