If the person you love has started shouting in the evenings, pacing the hallway, or pushing away the very help they need, it can be frightening and exhausting. You may be quietly wondering what happened to the parent or partner you knew. I want to say two things clearly at the start. You are not failing them, and they are not being difficult on purpose.
My name is Sabbir, and I am a UKCP-registered psychotherapist and the clinical lead at Tidal Living, where we provide person-centred dementia care at home across London. The single most useful idea I can offer you is this. In dementia, behaviour is communication. When someone can no longer find the words, distress tends to come out as agitation, suspicion, or withdrawal instead. This guide explains why dementia behaviour changes happen, what the common changes are, and practical things you can try at home, including what helps with sundowning and aggression, and when to ask for support.
In a nutshell, low self-esteem is a settled, negative view of your overall worth, different from lacking confidence in a single skill. It usually grows from early experiences and is kept alive by self-critical thinking and avoidance. The encouraging part is the evidence; a 2018 review found structured CBT produced a large reduction in low self-esteem, with an effect size of 1.12. It can change.
What is low self-esteem?
Low self-esteem is a persistent, negative judgement about your overall worth as a person. Unlike a passing low mood or doubt about one task, it is global and stubborn, a background belief that you are inadequate, unlovable, or simply not enough. It shapes how you interpret almost everything that happens to you.
Self-esteem is the opinion we hold of ourselves. With healthy self-esteem, you can accept your strengths and your limits without your entire worth being on the line. With low self-esteem, ordinary setbacks get read as proof of a flawed self. As the NHS puts it, when self-esteem is low we tend to see ourselves and our lives in a more negative, critical light, and feel less able to take on the challenges life throws at us.
It also tends to be self-reinforcing. The belief acts like a filter, so you notice and remember the evidence that fits (“see, I got that wrong”) and quietly discard the evidence that does not (“anyone could have done that”). Over years, that filtering feels like simple realism, which is part of what makes it so convincing. It is worth saying plainly that low self-esteem is common, and it is not vanity, weakness, or a character flaw.
What are the signs of low self-esteem?
Low self-esteem shows up across four areas: how you think, how you behave, how your body and social life look, and how you feel. Most people recognise themselves in several of these rather than all of them. The pattern matters more than any single sign, and it is the persistence over time that counts, not the occasional bad day.
In how you think
The thinking patterns are usually the first thing I hear. There is often a harsh inner critic running in the background, a steady stream of self-blame and unkind labels, where someone calls themselves useless, a fraud, or too much. Alongside it sits a habit of discounting the good, putting successes down to luck or other people while treating failures as proof of who they really are. Many people also compare upward, measuring themselves against others and consistently landing short, a habit that social media tends to sharpen. And they often assume judgement where there is little evidence for it, expecting that others quietly dislike or criticise them.
In how you behave
These beliefs then shape behaviour in fairly predictable ways. People with low self-esteem often avoid challenges, sidestepping new tasks or opportunities in case they fail, and they tend towards people-pleasing, finding it hard to say no, set boundaries, or state what they need. Perfectionism is common too, setting impossible standards and over-checking work to make up for a feeling of not being enough. Praise rarely lands either, brushed off or quietly corrected because it does not fit the way they see themselves.
In your body and social life
It shows up in the body and in social life as well. Posture can close in, eye contact becomes harder, and there is a general habit of making yourself small. Nervous habits and frequent apologising are common, sorry for things that are clearly outside your control. Over time many people withdraw socially, declining invitations, hiding their opinions, and keeping others at a comfortable distance.
In how you feel
Underneath all of it sits the feeling itself, a persistent sense of shame or worthlessness, of sadness, guilt, or not quite deserving good things. There is often a feeling of powerlessness too, a belief that you have little real say over your life or your circumstances.
In practice, the giveaway is rarely dramatic. It is the client who apologises for booking the appointment, who cannot accept a compliment without correcting it, who describes real achievements as though anyone could have managed them. It is also worth knowing that low self-esteem often travels alongside anxiety and depression, as Mind notes, so if several of these signs are persistent and affecting daily life, they are worth taking seriously.
How is low self-esteem different from low confidence?
Self-esteem is your overall sense of worth as a person. Confidence is your belief in your ability to do a specific thing. You can be genuinely confident at work and still have low self-esteem, because competence and worth are not the same thing. This distinction matters, because it changes what actually helps.
| Aspect | Self-esteem | Self-confidence |
| What it is | Your global sense of worth | Belief in a specific ability |
| Scope | The whole self | One skill or situation |
| Example | A skilled manager who still feels unlovable | Nervous at public speaking, fine elsewhere |
| What helps | Addressing core beliefs about worth | Practice and skill-building |
This is why you cannot simply achieve your way out of low self-esteem. Promotions, praise, and good results tend to bounce off, because the belief sits underneath performance rather than depending on it. It is also why advice like “just think positive” or “look at everything you have done” rarely sticks for long. The work has to reach the belief itself, not only the behaviour on top of it.
What causes low self-esteem?
Low self-esteem rarely has a single cause. It is usually built over time from a mix of early experiences, difficult life events, social pressures, and the thinking habits that grow out of them. Because it is learned, often early and without us noticing, it can also be unlearned, which is the whole basis of treatment.
Early life and childhood
Much of it begins early. Growing up with critical or harsh caregivers, where criticism, punishment, or impossible expectations were the norm, tends to be internalised as a simple belief that you are not good enough. A lack of warmth or validation does something similar, because when affection and praise are scarce a child can quietly conclude they lack worth. Bullying and rejection leave their own mark, a lasting sense of shame and not belonging, and struggling at school without enough support can harden into a long-term doubt about your own capability.
Ongoing life circumstances
Adult life can wear self-worth down too. Controlling, dismissive, or emotionally abusive relationships erode it over time. Trauma, abuse, and loss often leave an undeserved residue of guilt and shame that attaches itself to the sense of self. And prolonged stress, whether from work, money worries, or unemployment, is very easy to misread as personal failure rather than circumstance.
Society, media, and comparison
Body image and social comparison are a measurable driver, not a vague worry. In a 2019 survey of 4,505 UK adults by the Mental Health Foundation, 34 per cent said their body image had a negative effect on their self-esteem in the past year, and 20 per cent felt shame because of it. Constant exposure to curated lives online invites comparisons we are almost always set up to lose.
Psychological and health factors
Finally, some of it is held in place by how we are wired and how we are doing. Perfectionism means every small slip can feel like proof of inadequacy. Depression and anxiety warp self-perception and amplify the inner critic, and the relationship runs in both directions. Chronic illness, pain, or sudden changes in appearance can also reduce a sense of control and chip away at body image.
What actually helps with low self-esteem?
Low self-esteem responds to a combination of practical self-help and, where it runs deep, structured therapy. The aim is not to inflate yourself with positive slogans. It is to loosen the grip of an old belief and gather fairer, fuller evidence about who you actually are. You can begin several of these steps on your own this week; firstly, catch the critic in writing. Keep a simple note of harsh self-talk for a week. Naming it as a thought rather than a fact is the first move, and it is the foundation of reframing negative thoughts. Then, test the thought. For a belief like “I always mess things up”, write the evidence for and against it. The word “always” rarely survives contact with the actual facts, as these cognitive reframing examples show.
Thirdly, practise self-compassion, not self-blame. Speak to yourself as you would to a good friend in the same situation. This is a skill, and it strengthens with use. In addition, drop safety behaviours gradually. Over-preparing, over-apologising, and avoiding all keep the belief alive by never letting it be disproved. Finally, set small, achievable goals. Confidence built through action feeds a fairer sense of worth, one small success at a time.
Self-help is enough for some people. When the belief is long-standing, tied to trauma, or wrapped up with depression or anxiety, working with a therapist tends to go deeper and last longer. The NHS guide to raising low self-esteem is a sound, free place to start.
How does therapy for low self-esteem actually work?
The most evidence-backed approach is cognitive behavioural therapy, particularly the model developed by the clinical psychologist Melanie Fennell. It works by mapping how a core negative belief about yourself is kept alive day to day, and then gently dismantling that cycle, piece by piece, using real-world experiments rather than positive thinking. In plain terms, the cycle tends to look like this; the bottom line is that at the base sits a core belief about yourself, often formed early, such as “I am not good enough” or “I am unlovable”. Building upon this are rules and assumptions. To cope with the core belief, you build rules, for example “If I get everything right, I will be acceptable” or “If I keep everyone happy, I will not be rejected”. Life inevitably bumps the belief, through triggers such as a mistake, a criticism, or a comparison. The trigger sparks anxious predictions, which lead to a fearful forecast, such as “They are about to see I am a fraud”, and consequently safety behaviours, so you overwork, people-please, or avoid, to avert the predicted disaster. Because you never actually test the prediction, the belief is confirmed by default, and the cycle tightens.
Therapy works by making this cycle visible and then interrupting it. We soften the inner critic, update the old rules, and run small behavioural experiments that finally allow the prediction to be disproved in real life. Take a composite picture from my practice, with details changed and combined so that no one is identifiable. Someone arrives doing well on paper, a capable professional, who privately believes they are moments from being found out. In the first sessions we are not chasing positivity. We are slowing down, noticing the bottom line, and naming the rules they have been living by for years. The shift comes when they try something small and frightening, sending the imperfect email, accepting help, saying no, and the catastrophe they predicted simply does not arrive. The belief starts to lose its authority.
This is not only clinical optimism. A 2018 systematic review and meta-analysis of CBT built on Fennell’s model found a large summary effect size of 1.12 at the end of weekly treatment (Kolubinski et al., Psychiatry Research). A 2012 randomised controlled trial in a primary care setting found that CBT for low self-esteem outperformed a waiting list and also reduced symptoms of depression and anxiety (McManus and colleagues). If you would like the fuller picture of the method, this complete guide to cognitive behavioural therapy and my guide to cognitive reframing go a level deeper.
When should you speak to someone?
It is worth speaking to a professional when low self-esteem is persistent, when it is affecting your work, relationships, or mood, or when it shades into depression or anxiety. You do not need to be in crisis to deserve support, and seeking help earlier usually means a shorter road.
In the UK you can refer yourself directly to NHS Talking Therapies without going through your GP, or you can speak to your GP first. If you would prefer to work privately with a UKCP-registered therapist, you can read my guide to low self-esteem therapy.
If you are in crisis, or having thoughts of harming yourself, please do not wait. You can call Samaritans free on 116 123 at any time of day or night, or use NHS 111 for urgent help. If a life is in immediate danger, call 999.
The takeaway
Low self-esteem is common, understandable, and treatable. It is a learned belief about your worth, kept alive by self-criticism and avoidance, and it can be unlearned with the right approach. Firstly, low self-esteem is a global, not specific issue. Self-esteem is about your whole worth, which is why it differs from confidence in a single skill. Secondly, self-esteem is built, and thus it can be rebuilt. Early experiences and ongoing pressures shape it, and structured work can reshape it. Thirdly, the evidence is genuinely encouraging; CBT on the Fennell model produces large reductions in low self-esteem.
If you would like to work on this with a UKCP-registered psychotherapist, you can read about how we approach low self-esteem therapy, or get in touch to ask whether it might be a good fit for you. There is no pressure, and asking costs nothing.
Frequently Asked Questions
What are the main signs of low self-esteem?
The main signs are a harsh inner critic, difficulty accepting compliments, avoiding challenges for fear of failure, people-pleasing and weak boundaries, social withdrawal, and persistent feelings of shame or worthlessness. Most people notice several rather than all, and it is the lasting pattern that matters most.
What is the difference between low self-esteem and low confidence?
Self-esteem is your overall sense of worth as a person, while confidence is your belief in a specific ability. You can be confident at a particular task and still have low self-esteem. This is why achievements alone rarely fix low self-esteem. The work needs to reach the underlying belief about your worth.
Can low self-esteem be cured?
Low self-esteem is not a fixed trait, and it responds well to treatment. A 2018 meta-analysis of CBT for low self-esteem found a large reduction in symptoms, with an effect size of 1.12. Rather than thinking of a cure, it is more accurate to say the old belief can lose its grip and a fairer self-view can take its place.
How long does therapy for low self-esteem take?
It varies with the person and the depth of the belief, but CBT for low self-esteem is often relatively brief. Much of the research is based on courses of around ten weekly sessions. Some people need fewer, and those with trauma or long-standing patterns may benefit from longer, which your therapist will discuss with you.
Can I improve my self-esteem on my own?
Yes, many people make real progress alone by noticing and testing self-critical thoughts, practising self-compassion, dropping safety behaviours, and setting small goals. The free NHS self-help materials are a good start. If self-help is not shifting things, or low mood and anxiety are involved, therapy tends to go further.
Sources and further reading
- NHS, Raising low self-esteem. Retrieved 5 June 2026.
- Mind, About self-esteem. Retrieved 5 June 2026.
- Mental Health Foundation (2019), Body image in adulthood (YouGov survey, 4,505 UK adults). Retrieved 5 June 2026.
- BACP, Self-esteem and how counselling can help. Retrieved 5 June 2026.
- Kolubinski et al. (2018), Psychiatry Research, meta-analysis of CBT for low self-esteem. Retrieved 5 June 2026.
- McManus, Waite & Shafran (2012), Behaviour Research and Therapy, RCT of CBT for low self-esteem. Retrieved 5 June 2026.
About the author. Sabbir Ahmed is a UKCP-registered psychotherapist at Kind Soul Psych who works with self-esteem, anxiety, and low mood. This article is for general information and is not a substitute for individual professional advice.