Personality Disorders and Self-Esteem: Understanding the Link

Understanding the Connection Between Personality Disorders and Self-Esteem

Self-esteem—our sense of personal worth, value, abilities, and moral character—fundamentally shapes how we navigate the world. Essentially, it represents the opinion we hold of ourselves. Terms like “self-worth,” “self-regard,” and “self-respect” often refer to this same concept.

Self-esteem typically encompasses:

• Personal identity and self-perception
• Feelings of competence and worthiness
• Sense of security
• Belonging and community connection
• Self-confidence

Psychology researchers distinguish between two types of self-esteem: explicit and implicit. Explicit self-esteem refers to the conscious self-concept that people can access and articulate—how someone describes themselves when directly asked through questionnaires or assessments.

Implicit self-esteem, conversely, represents the unconscious, intuitive sense of self that exists below conscious awareness. This form of self-esteem typically requires indirect measurement through tests assessing unconscious attitudes, such as word association measurements like the Implicit Association Test, which evaluates how closely people connect positive concepts with themselves.

This distinction matters because significant gaps often exist between a person’s explicit and implicit self-esteem. Such discrepancies frequently correlate with certain mental health conditions, particularly personality disorders, which can be effectively addressed through professional therapeutic support.

Personality Disorders and Their Relationship to Self-Esteem

According to clinical definitions, a personality disorder represents “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.”

Many personality disorders stem from distorted self-esteem, potentially leading to chronic feelings of unworthiness and challenging interpersonal relationships.

Borderline Personality Disorder

Borderline personality disorder (BPD) exemplifies a condition profoundly impacted by self-esteem issues. An unstable sense of self constitutes a defining characteristic and diagnostic criterion of BPD.

Individuals with BPD often experience emotional instability that negatively affects self-perception, creating a destructive cycle where low self-esteem further intensifies emotional instability.

For many with BPD, self-esteem heavily depends on perceived relationship quality, which they frequently interpret through lenses of potential rejection or abandonment. Within these relationships, a phenomenon called “splitting” may occur—a defense mechanism protecting against perceived rejection risks.

A person with BPD might initially idealize someone in their life, then suddenly “switch” to devaluing and criticizing that person without apparent cause. This “splitting” reflects how individuals with BPD often perceive others (and by extension themselves) as either “all good” or “all bad,” without integrating positive and negative qualities—hence, a “split.” This tendency significantly impacts self-esteem for those with BPD.

Avoidant Personality Disorder

Avoidant personality disorder (APD) may correlate with the lowest self-esteem levels among personality disorders. People with APD often engage in excessive introspection, leading to extreme self-consciousness and constant negative self-evaluation. They typically perceive themselves as inherently different from others in an inferior way.

Individuals with APD frequently question their identity and demonstrate unusually low self-worth. They generally view themselves as socially inadequate, creating another vicious cycle: social difficulties lead to diminished self-esteem, which then exacerbates future social interactions.

Eventually, people with APD may develop such negative self-perceptions that they interpret all social interactions negatively, leading to the disorder’s defining feature—avoidance of social interaction altogether.

Dependent Personality Disorder

Low self-esteem represents a critical component of dependent personality disorder. In this condition, low self-esteem typically manifests as profound lack of self-confidence and self-efficacy, resulting in the belief that one cannot function independently and must completely rely on others.

Those with dependent personality disorder may lack confidence to initiate projects or conversations independently. They often require constant reassurance, struggle with decision-making without others’ input, or completely defer decisions. They might automatically agree with others because they don’t trust their own thoughts, opinions, or emotions—all extreme manifestations of exceptionally low self-esteem.

Antisocial Personality Disorder

Antisocial personality disorder (ASPD) is generally considered “egocentric,” with diagnostic criteria including the tendency to completely disregard others’ emotions and needs while focusing exclusively on personal desires. People with ASPD often build self-esteem through achieving personal goals and gratifications, frequently using power, manipulation, exploitation, and control of others.

Unlike the previously discussed disorders, individuals with ASPD typically demonstrate higher self-esteem. When external events challenge their self-concept, people with ASPD tend to reassert dominance over others to restore their sense of self-worth.

Finding Support for Personality Disorders Affected by Self-Esteem Issues

Effective support exists for all types of personality disorders. Therapeutic approaches like dialectical behavior therapy and cognitive behavioral therapy can effectively reduce symptoms of certain personality disorders while improving self-esteem and overall well-being.

Traditional in-person therapy may present challenges for those with distorted self-perception. Telehealth mental health services through platforms like ReachLink provide beneficial alternatives by potentially reducing social pressure. With telehealth therapy, clients can communicate with therapists through secure video sessions, phone calls, or messaging based on their comfort level.

Research indicates that telehealth therapy and traditional in-person therapy achieve similar outcomes, including for personality disorders. Studies have shown that completing online therapeutic treatment shows promise in reducing symptoms across several personality disorders.

Takeaway

Many personality disorder symptoms are influenced by distorted self-esteem—whether the lower self-esteem levels associated with borderline, avoidant, and dependent personality disorders or the higher self-esteem connected to antisocial personality disorder. Telehealth or in-person psychotherapy can effectively address both personality disorders and self-esteem concerns, providing accessible pathways to improved mental health and well-being.