Self-esteem and mental health

Self-esteem and mental health are closely tied. Low self-esteem can be a symptom of a mental health condition, a risk factor for one, or both at once.¹ Understanding the link can help you decide what kind of help makes sense.

This page explains how self-esteem connects with depression, anxiety, eating disorders and alcohol or drug use. It also explains why simply "boosting" self-esteem is not the whole answer, and how healthy self-esteem differs from narcissism.

Cause, symptom, or both?

Self-esteem and mental health can affect each other in two directions.

Low self-esteem as a symptom. Negative views of yourself and feelings of worthlessness are part of depression. When depression is the cause, treating it often brings self-esteem back.^1,3 Long stretches of anxiety, pain, illness or relationship trouble can also wear down confidence over time.¹

Low self-esteem as a risk factor. Low self-esteem can make depression, anxiety, eating disorders and suicidal thoughts more likely in the future. This is true even at times when you feel fine.¹ A long-term study in New Zealand followed children from birth into adulthood. As adults, teens with low self-esteem had poorer mental and physical health than teens with high self-esteem. They also had worse job and money prospects and more criminal behavior. This was not explained by teen depression, gender or family background.⁷ Studies like this show a link over time. They cannot fully prove cause.

Not everyone with low self-esteem becomes depressed. Many people instead have dips in mood that pass.¹²

Depression

Feelings of worthlessness, guilt or helplessness are among the signs of depression.³ So it can be hard to tell where low self-esteem ends and depression begins.

Researchers have tested two ideas:

• The vulnerability model. Low self-esteem comes first and raises the risk of depression.
• The scar model. Depression comes first and leaves self-esteem damaged afterward.

A 2013 review combined 77 long-term studies, with people from childhood to old age. Both effects showed up, but low self-esteem predicted later depression about twice as strongly as the reverse. The pattern held across ages and for men and women.² In plain terms, low self-esteem is one risk factor for depression. The effects were small, though. Genes, biology, stress, hard life events and many other things matter too.³

The authors suggested that, if the effect is causal, helping people with low self-esteem might also lower their risk of depression.² See Depression and What causes depression.

Anxiety and social anxiety

In the same review, 18 studies looked at anxiety. Low self-esteem predicted later anxiety, and anxiety predicted later low self-esteem, by about the same small amount.²

Social anxiety disorder has some features in common with low self-esteem. People with it have an intense fear of being watched or judged. They may go over their performance afterward and focus on their flaws. They often avoid social situations.⁴ CBT, including gradual exposure to feared situations, is a leading treatment for social anxiety.⁴ See Social anxiety and Anxiety.

Eating disorders and body image

Low self-esteem and perfectionism are among the things that make an eating disorder more likely. So is being criticized about your eating, body shape or weight.⁵

Self-worth that rests on appearance is a particular risk. In a study of college freshmen, basing self-worth on looks, approval and competition was linked with more disordered eating and heavier drinking.⁹ Social media can add to the pressure. The U.S. Surgeon General warns that it may fuel body dissatisfaction and low self-esteem, especially in teenage girls. Comparing yourself with others online is linked with disordered eating.⁶

See Eating disorders, Eating disorders in later life and Body image.

Alcohol and drug use

Some people with low self-esteem drink or use drugs to cope.¹ Self-worth that depends on outside approval has been linked with heavier drinking in young adults.⁹ See Substance use and Alcohol in later life.

Relationships, work and health

A 2022 review looked at research on what self-esteem predicts over time. Higher self-esteem was linked with better relationships, school and work outcomes, mental and physical health, and less antisocial behavior. These links held across age, gender and ethnic groups.⁸

The effects were modest, about the size of other well-known factors such as a growth mindset or secure attachment.⁸ Self-esteem helps, but it is one piece of a bigger picture.

Why "boosting" self-esteem is not the whole answer

If low self-esteem is bad for you, it might seem the answer is to pump it up. Research suggests a more careful approach.

Positive statements can backfire. In two experiments, people with low self-esteem repeated a statement like "I'm a lovable person." Afterward they felt worse than people who did not repeat it. People with high self-esteem felt slightly better.¹⁰ When a statement clashes with what you believe, it may remind you of all the reasons you think it is false.

Chasing self-esteem has costs. When people stake their worth on success, looks or approval, they spend energy protecting their image. This can get in the way of learning, relationships, independence and long-term health. Short-term good feelings are often outweighed by long-term costs.⁹ The authors suggest focusing on goals that are bigger than yourself, or good for others as well as you, and treating mistakes as chances to learn.⁹

Inflated praise is not the same as warmth. Children whose parents saw them as more special than others became more narcissistic over time. Children whose parents were warm developed healthier self-esteem.¹¹

What works better. Aim for a steady, realistic and kind view of yourself. That means:

• Treating depression, anxiety or eating problems directly
• Testing harsh beliefs against the facts, as CBT does
• Being kind to yourself when you struggle, which is what self-compassion means
• Doing things that matter to you, whether or not you feel confident

See Building self-esteem and Therapy for low self-esteem.

Healthy self-esteem vs. narcissism

Narcissism means feeling superior to others and entitled to special treatment. It is not just "too much" self-esteem. One study followed 565 children ages 7 to 12. Narcissism grew when parents overvalued their child. Healthy self-esteem grew from parental warmth.¹¹ Researchers who study self-esteem stress that the two must be kept apart.⁸

For narcissistic personality disorder and other personality conditions, see Personality disorders and Personality.

Notes for later life

In the 2013 review, the link between low self-esteem and later depression held across ages, including older adults.² Losses, illness and retirement can shake self-worth in later life. Depression is treatable, and most people with depression benefit from treatment.³ See Self-esteem in later life and Depression in later life.

When to get help

Talk with a doctor or mental health professional if:

• Low self-esteem comes with low mood, loss of interest, or hopelessness for two weeks or more³
• Fear of judgment keeps you from work, friends or activities
• You are restricting food, bingeing, purging or exercising to make up for eating
• You drink or use drugs to cope with how you feel about yourself

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.