A guide to common difficulties with self-esteem

Difficulties with self-esteem are common and can show up in different ways including imposter syndrome, perfectionism, and people pleasing. In this guide I’m going to talk you through what self-esteem is, common challenges I see, and talk about how therapy can help.

What is self-esteem?

Self-esteem is how we perceive and value ourselves. Do we hold ourselves in high regard and have a positive view of ourselves? Can we give ourselves a break when we have tried our best and the outcome isn’t what we wanted? Can we forgive ourselves and ‘let go’ when we make a mistake? These are all signs that we have a ‘good enough’ view of ourselves.

What might difficulties with self-esteem look like?

People with lower self-esteem might tend to see themselves in a negative light, and may not value themselves. They may experience critical thoughts and may feel worthless at times. When things go wrong people with low self esteem will tend to blame themselves. They may also tend to interpret negative interactions with other people as being about them.

‘Imposter syndrome’, perfectionism and ‘people pleasing’ are common ways that difficulties with self-esteem can show up. The clients I work with who experience these are often well functioning people (usually women) with partners, a good career and sometimes young families.

Imposter syndrome is when your confidence in your own abilities and skills does not match what you logically know to be true. You may experience fears about being ‘found out’ despite lots of evidence that you are capable.  

Perfectionism is when we need to give 100% to every area of our lives and we are unable to compromise. It is often accompanied by a fear of making mistakes. For many these difficulties become more apparent when they are trying to juggle work and home life, or when they step up into a mor senior work role. Being unable to tolerate ‘good enough’ in multiple areas of our lives is often a recipe for burnout.

People pleasing is when we put our own needs behind the needs of others. This often results in difficulties putting out point across, asserting boundaries or asking for what we need. This can contribute to challenges within our relationships and can also lead to burnout.

How do difficulties with self-esteem develop?

Difficulties with self-esteem often have roots in childhood. We might have experienced criticism from our parents, siblings or grandparents. We may have experienced bullying at school. Sometimes this is because we were different in some way or perhaps our characteristics were not a good ‘fit’ for the environment we were in. Maybe you were artistic in a very academic family. Perhaps you were bright and loved learning in a school where doing well wasn’t ‘cool’. Or maybe you didn’t feel safe to reveal your gender identity or sexuality. 

If we are different in some way or treated badly, unfortunately we may conclude that we are not good enough in some way. This leads to a negative view of ourselves.  

Gender and self-esteem

High quality research indicates that overall men have slightly higher self-esteem than women (Kling et al., 1999). This effect seems to be present across cultures (Bleindorn et al., 2016). This matches my clinical experience with many more female clients experiencing difficulties with imposter syndrome, people pleasing and perfectionism than males.  In fact, the term ‘imposter syndrome’ was coined in 1978 in response to psychologists observing this phenomenon in ‘high achieving women’ (Clane and Imes, 1978).

I understand this effect as being related to the societal messages that women receive when growing up and as adults. We should always be ‘kind’ and caring, and try not to upset anyone. America Ferrera’s Iconic speech in the recent Barbie movie was a great summary of the unhelpful and contradictory messages that women receive. As women we internalise these messages and it can make it very uncomfortable to step outside of these gender norms.

In contrast men and boys receive messages about being strong and dominant and to not show emotions. If men buy into these messages growing up this can result in a number of mental health challenges and toxic relationship dynamics. These are often very different to the kinds of difficulties that many of my female clients experience.

However I’ve worked with lots of men who do experience difficulties related to their self-esteem and confidence. Usually these are men who have managed to not buy into unhelpful societal messages around control and dominance. They tend to be thoughtful, introverted and may have healthy male role models in their lives.

Clients from the LGBTQ+ community may have experienced discrimination and bullying growing up. Negative attitudes from family members can be very upsetting and difficult to come to terms with. In these situations many clients I’ve worked with have found the LGBTQ+ community a crucial source of support. In general I’ve found that these experiences tend to impact on self-esteem in more nuanced ways that are less gender stereotyped than is the case for straight clients.

Self-esteem across the life course

A recent high-quality review investigated self-esteem throughout the lifespan. It was found that for most people self-esteem will rise from the age of 15 well into adulthood until the age of 60 (Orth et al., 2018). Self-esteem was greatest for individuals aged 60 to 70, with levels beginning to drop after the age of 70. This effect was consistent across different countries and generations, and in terms of gender.

As this study was a high-quality review of lots of scientific data, this can give us some confidence in the findings. What is interesting is that self-esteem peaked for those who were older, which seems to go against the messages that we are often sold by marketing and the media. We are often told that when it comes to our appearance, size and shape we should “look young, have perfect skin and we’ll be happy” etc. This shows us that a large part of improving our self-esteem is psychologically accepting ourselves, rather than achieving, acquiring or looking a certain way.

How difficulties with self-esteem keep going

When we have a negative view of ourselves this often becomes like a ‘magnet’ for negative information. We will tend to notice and remember information that is consistent with our view of ourselves. Let’s say we have a disagreement with a friend; if we have a negative view of ourselves we might think “I am really no good at relationships”. In contrast, if we have a ‘good enough’ view of ourselves we might tend to think “I might not have dealt with that situation well, but I am a good friend overall”. In this instance we are less likely to experience feelings of shame and so we are more likely to make constructive efforts to repair the relationship and move forward.

So difficulties with self-esteem are ‘maintained’ by how we interpret and remember information. This impacts hugely on how we behave. As such people with self-esteem related difficulties can sometimes get caught in a spiral where their negative view of themselves impacts on everyday life and becomes a self-fulfilling cycle.

Not asserting ourselves and not communicating our needs are common in imposter syndrome and people pleasing. This means that we may miss opportunities to become skilled in putting our point across. Keeping quiet also means that we don’t gain confidence in our own perspective and needs.  

People with perfectionist tendencies tend to try to do every task perfectly and try to present themselves in a certain way in every situation. This is different to doing our best, which is healthy most of the time. The problem with perfectionism is that we are all human and we all make mistakes and will let people down at some point in our lives. If we have a good opinion of ourselves we will be able to tolerate this. But if we tend to be perfectionist in how we approach life, we will experience a lot of shame and self-criticism when something goes wrong. So being a perfectionist can be a fragile position to be in, and always striving to do the absolute best will tend to stop us finding out that we are ‘good enough’ without this unhealthy striving.

How life transitions can challenge our self-esteem

Most clients find that when life is settled difficulties with self-esteem can be fairly well managed. However, when we are faced with a life transition, these difficulties can start to effect us. These transitions might include becoming a parent, starting a new job or getting a promotion. For many women (and some men), these kinds of difficulties can start to surface when they are offered leadership positions. Even though these are positive events, they are all situations where we are challenged in new ways and this can bring to the fore difficulties with confidence and self-esteem.

Adjusting to challenging life situations can also challenge our self-esteem. This might include being diagnosed with a health condition, sustaining an injury or losing a loved one. In these situations we are dealing with the losses you have experienced, helping you to adjust, and working with any challenges related to your self-esteem. This can understandably feel overwhelming and so therapy can be particularly beneficial to support you through in situations like this.

How can therapy help with self-esteem?

Therapy often starts with understanding you ‘story’ and where beliefs about yourself have come from.

Here are a few examples:

  • I was bullied at school and this made me feel as though I was different and not attractive.
  • My parents had financial problems and I learned to keep my emotions to myself, as I didn’t want to stress them out. I learned that I had to keep things to myself and that my feelings weren’t important.
  • I was an enthusiastic and creative child and my family weren’t interested in these things.
  • I had health problems that meant I had to have a lot of time off school. This made me feel different and not ‘as good’ as other children.
  • My parent had mental health difficulties and could be critical of me when they were having a bad day.

Understanding how beliefs developed is a crucial part of the process. I often spend time reflecting with clients about the different circumstances and dynamics they grew up in and the ways these have had an impact.

Once we have this understanding, we can start to build helpful strategies and to make change. For many clients we will work on gradually expanding their comfort zone for speaking up or asserting boundaries. We discuss everyday triggers and make sense of these, and spend time changing how we respond to feelings that come up. We may also need to address self-critical thoughts.

For many clients there are early experiences that are impacting on how they feel when faced with current triggers. If this is the case I often use EMDR with clients to process these.

I find that the combination of working on current strategies and processing earlier experiences to be very effective.  If necessary, we can also work on preparing you for future challenges that you might anticipate.

I hope you have found this post helpful. Please contact me  if you would like to book in for an assessment.


Bleidorn, W., Arslan, R. C., Denissen, J. J., Rentfrow, P. J., Gebauer, J. E., Potter, J., & Gosling, S. D. (2016). Age and gender differences in self-esteem—A cross-cultural window. Journal of personality and social psychology111(3), 396.

Clance and Imes (1978) The Imposter Phenomenon in High Achieving Women

Kling, K. C., Hyde, J. S., Showers, C. J., & Buswell, B. N. (1999). Gender differences in self-esteem: a meta-analysis. Psychological bulletin125(4), 470.

Orth, U., Erol, R. Y., & Luciano, E. C. (2018). Development of self-esteem from age 4 to 94 years: A meta-analysis of longitudinal studies. Psychological bulletin144(10), 1045.