Self-esteem scores of the pain-prone patients were significantly lower than for the other three groups, who did not differ significantly from each other. The pain-prone patients were given a 12-week treatment programme involving psychological intervention. Further self-esteem scores were obtained for them and the controls. Treatment was associated with a significant increase in self-esteem for the pain-prone group, while the controls showed no significant difference from their earlier self-esteem scores. This result is discussed in terms of the importance of therapy directed at the psychological dimension of pain-prone patients. Science Direct
We know that chronic pain can affect self-esteem over time. Even if you were a confident person it can be worn down by chronic pain and often depression
Self-esteem: “Self-esteem is often defined as an individual’s self-perception of his/her abilities, skills, and overall qualities that guides and/or motivates specific cognitive processes and behaviors. ” NCBI
Lower self-esteem is hypothesized to predict:
Worse daily mood, as indicated by higher negative affect and lower positive affect.
More frequent stressful thoughts and higher severity ratings for stressors.
Fewer social interactions and less perceived pleasantness in social interactions.
Greater disease-specific symptom severity (defined by reported symptom restriction and interference and disease-specific symptoms). NCBI
Our study demonstrated that, among patients diagnosed with asthma or rheumatoid arthritis, individuals who had lower self-esteem reported more negative affect, less positive affect, greater stress severity, and greater symptom severity during their day to day lives than individuals with higher self-esteem. Patients with chronic disease, who already face additional medical and psychosocial burden, may benefit from interventions designed to bolster self-esteem in the ongoing context of self-care.NCBI (read for full study which is rather interesting)
The first thing that can happen to our self-worth and self-esteem is life experiences. When we had no chronic pain, if one remembers such a time, or when our pain didn’t compromise our functionality, there is no impact to self-esteem.
However, when functionality suffers in any capacity in life we begin to develop beliefs about that. For example work. Our performance may suffer. We may make more mistakes. We may miss work. We may be unable to focus or concentrate. All these things may make us feel like we are FAILING and we need to TRY HARDER. And when we do try harder and that just makes us worse and ‘fail’ more and get sicker…. well then we personally are a failure. And our self-esteem tanks.
We may take a long-term leave of absence from work. And when we return our skills have stagnated, as they do with everyone, but we are given no time to adjust and already we have a lower self-esteem so then we feel useless and stupid and worthless.
Basically, it is our skills and talents that we had and a level of competency we had and had pride in, that deteriorate due to loss of overall functionality that decreases of self-esteem. Because when this happens in life we are not as appreciated, as valued, seen the same way. We can be reprimanded. We can be demoted. We can be punished. Something we took immense Pride in… is now something we are ashamed of. Who we are is now something we are ashamed of.
We lose our self-confidence when presented with tasks we would never have had a problem with before. We become hesitant expressing opinions on topics we used to consider ourselves experts at. Things we used to value about ourselves, and others valued, are no longer things we value. And we generally, at this point, have nothing to replace it with, We see ourselves as dumber. As less competent. Less reliable. Less dependable. All the traits we rather scorned in other people are things we now see in ourselves and so how can we value ourselves?
Therefore, the lack of belief in ones own ability to manage pain, cope and function despite persistent pain, is a significant predictor of the extent to which individuals with chronic pain become disabled and/or depressed. Nevertheless, these mediators did not eliminate the strong impact that high pain intensity has on disability and depression. Therefore, therapy should target multiple goals, including: pain reduction, functional improvement and the enhancement of self efficacy beliefs. Science Direct
We develop a lack of belief in our own abilities to cope and function based on our life experience where functionality has decreased and we have experienced problems with work, goals, achieving desires, and our accomplishments. We have floundered. Sometimes for a very long time… sometimes a slow consistent decline. Sometimes to the point of becoming disabled. Our perception then is that we can’t do much at all… so why bother. Our self-esteem in our own capabilities has been trashed. What we thought we could do with ease… we couldn’t, not even with a lot of effort. And now it feels monumental to even try anything because that Feeling of failure and worthlessness and self-loathing… hurts a lot. And who the hell wants to face that every time we try something and fail… yet again? So as the study above says, this and the feelings associated with it can lead to depression.
We do not value the accomplishments we do make. The things we Can do, don’t seem to have any value compared to what we Could do. So we find some things we can do. Whoop-de-do. They are small and insignificant and we do not value them at all. We still feel worthless and have no self-esteem. I had this conversation with my psychologist about my writing and blogging. Yeah, I said, I can do them… with effort. Yeah, I enjoy them and they distract me from pain and so I continue to do them because I value the activity. But I didn’t Value it as something of Worth like I did working. It doesn’t make money, for one. Or not much. A wee bit. But he made me list all the things of value to writing and blogging and made me see it in a better light. I mean, I knew those things logically by my trashed self-esteem and self-worth wouldn’t allow me to Feel those things. So even when we come to the realization we have to focus on what we can do and not what we can’t… sometimes we do not value those things or get as much satisfaction from them or feel as productive when we do them.
So what do we do about this chronic pain induced self-esteem issues?
- It is always good to remind yourself that you have value as a person and it isn’t always what you can do that counts but who you are.
- Explore new ways to express yourself. Creative ways. New hobbies. What I like to say is that we have a lot to say we just lack the ways to show it. And hobbies are one way we can use to get our emotions out in a positive way. They are a pain distraction. They make us feel productive.
- Finish grieving your former self. Say ‘That was who I was then and no one stays the same forever. This is who I am now. And I will become something new in the future. There is nothing wrong with who I am now. Just different’
- Celebrate small achievable goals every day. Every accomplishment, no matter how small, when you have chronic pain is Meaningful and should be acknowledged for what it is… and achievement. I write them down in my health journal. I did such and such and I have the goals of such and such for tomorrow. I never feel guilty if I do not achieve them… only that I make plans for things. And I acknowledge everything I do.
- Lose the negativity of ‘I can’t do anything anymore’ to ‘I can still do things I just have limits and have to modify my activities’
- Nudge your limits a little. We feel like we cannot function at all. And we fear the feelings that come with failure. So two steps here. First, if you do not achieve something it is NOT A PERSONAL FAILURE, it is a physical limitation. Secondly, engage in a task you want to do by knowing you limit and then nudging it slightly to see if you can do just a wee bit more. Not a WHOLE lot more. Just a wee bit. And maybe next time a wee bit more. And slowly we engage more and more. Same with exercise… you can’t just jump in and exercise (or yeah it will hurt like hell for weeks) you start infinitely slow and increase infinitely slow.
- Always include things you enjoy to do in the day. Not need to do. Not have to do. But enjoy to do. And value those things as much as every other thing you do. In fact, do what I did and make a list of why those things are valuable. (gives you joy, pain distraction, gives other people joy, makes you feel productive, passes the time, is your passion,… so many things you can put there).
- Another one specifically for self-esteem is to write down 10 awesome traits about yourself. Don’t worry if you can’ the first time. You can work up to it. But everything you list… think about that thing and think why you like that about yourself. Why you appreciate that about yourself. Why others appreciate that trait in you. Damn it, you do rock!
- Have self-compassion for when you are not able to do things. When you need to pull out of the self-care tricks you have and you cannot function or do things. Have some self-compassion for yourself instead of judgement. You don’t feel well. You are having a bad day. You need to rest.
- Remove that sense of Blame and Shame from your self-talk about your illness. This is not your fault. You do not own this. You are not responsible for it. There is no shame in it. All we have… is to cope with the consequences of it… we are responsible for our treatment but we are not to blame for it happening. Remind yourself if someone else was suffering like you, you would have immense empathy… and yet you have none for yourself? So treat yourself like you would treat another.
I don’t have all the answers to this. It took some time to recover my self-worth and low-self-esteem as a result of not being able to function at work and from a decade of severe depression. It is difficult when I felt so ineffective and functionally worthless to society. It was a day by day of looking at what I was saying to myself and saying something different. To focus on what I could do instead of thinking on all those things I could not do. To learn to value the things I could still do.
I’m a bit of a poor example of this because I’ve had Imposter Syndrome for as long as I remember. I never thought I was good enough at anything despite any evidence. I would explain it away or explain it to external factors to myself. I was also chronically ill young which got worse as I got older. And that just made this issue worse as I got older. And then when I hit the workforce well, it tanked, it really tanked and I believed I was literally worthless and incompetent and stupid. So I don’t even know what self-confidence feels like except in getting good grades… I knew I’d ace an essay or a test even though I never felt smart, which I know is a contradiction but it is how I rolled as a kid.
I am trying to build it back up.. And MORE than I ever had. And it is working. I have more self-worth and self-esteem than I ever remember having even though I am capable of less. In fact, I am the most disabled I have ever been in my life and the least functional I have ever been in my life. I feel I have value in the small amount I can do. I feel I have value as a person. I feel I can stand up for myself.
It takes a lot of time. And I can’t say we will ever fully get it all back. Because in a sense we are not really valued by society… and that we feel and we cannot help but internalize some of that.
Chronic pain and self-compassion
Chronic illness and self-identity
Chronic illness and our sense of self