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Body Dysmorphic Disorder Techniques for Treating Obesessions with Body Perfection
Body Dysmorphic Disorder: Diagnosis & Treatment - 10 CEUs

Section 20
Applying the Dual Nature of Self Esteem to Understanding BDD

CEU Question 20 | CE Test | Table of Contents | Body Dysmorphia
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

Dual Nature of Self-Esteem
Self-esteem as the evaluative component of the self-concept seems to be at once global (general) and selective (specific or situational). This latter attribute lends confusion and may lead to imprecision in applying self-esteem interventions to issues affecting clients. The counselor may be attending to one situational element in the client as a manifest indicator of self-esteem level when another element altogether may be of concern to the client. Self-esteem, then, at once global and selective, seems to be made up of individual constituent elements that vary in importance to the self. Self-esteem seems to be a fluctuating self-attitude influenced by "changing roles, expectations, performances, responses from others, and other situational characteristics" (Demo, 1985, p. 1491). Jane, for example, may have a strong sense of general, or global, self-esteem but may manifest feelings of low self-esteem about the size of her nose or her inability to do math; may exhibit feelings of high self-esteem about her popularity among her peers; and may temporarily show characteristics of low self-esteem when she is in a situation in which she feels incompetent or demeaned by someone important to her.

Therefore, self-esteem seems to vary across different areas of experience and according to role-defining characteristics (Coopersmith, 1981). It seems to be situational—high at one moment or low at another—depending on which specific constituent personal identity element the individual attends to (Harter, 1985; Leahy, 1985; Rosenberg, 1985).Accordingly, the individual may have generally positive attitudes toward the self, possess a good sense of self-worth, but because of certain situations or particular days may feel better or worse about him- or herself (Demo, 1985) at any one time.

This attitudinal perspective that regards self-esteem as at once both general and specific means the person attaches evaluations to many different qualities and aspects of the self and also sums these to form an overall evaluation.

Rosenberg (1965) described self-esteem as a linear combination of individual and specific self-estimates, each weighted by a value and then summed. The weight of each value is dependent on how important the value is to the individual. The person's overall appraisal of self presumably weighs all areas according to their subjective importance and arrives at what Coopersmith (1981) referred to as a general level of self-esteem.

Rosenberg (1979) stated that many personal elements are socially ranked and evaluated, that the individual's sense of personal worth or value (viz., self-esteem) is to some extent contingent on the perceived prestige of the identity element. Therefore, a person's global sense of self-esteem is based "not solely on an assessment of his constituent qualities but on an assessment of the qualities that count [italics added]" (Rosenberg, 1979, p. 18). Wylie (1974) and Gurney (1986) suggested a hierarchical relationship between specific and global self-esteem rather than a qualitative difference between them. Brown (1993), on the other hand, supported conceptualizing self-esteem in terms of global feelings separate from specific self-evaluation, arguing that global self-esteem affects specific self-evaluations, not the reverse. In any case, generalizations cannot be made from either the specific to the global or from the global to the specific. It is precisely this confusion that may result in self-esteem interventions not fitting the needs of the client; the client may feel something entirely different from what the counselor assumes. The counselor may be attending to a different self-element altogether. Or, the counselor may be placing more or less importance on the significance of the element than does the client. For example, John may play the piano exceptionally well, but if it does not matter to him, if this accomplishment carries a low weight, his counselor's well-intentioned validation of his piano-playing skill as a way to bolster his self-esteem is likely to be ineffective.

Relationship to Related Self Terms
Another point of confusion regarding self-esteem may have to do with the construct's close relationship to other similar constructs. Self-esteem is associated with, but not identical to, several other constructs that make up the study of the self, an area with a controversial history of its own (Szymanski & O'Donohue, 1995). Because the self cannot be directly observed, its study has been difficult and open to varying interpretations from the beginning. Many shades of meaning differentiate self-esteem from other closely related terms. Self-concept as the most general of the terms is broadly conceptualized as a person's perceptions of him- or herself that are formed through an individual's experiences with and interpretations of his or her environment (Shavelson, Hubner, & Stanton, 1976). People may appraise themselves on multiple dimensions, making judgments about what they are like (self-concept) and reacting emotionally to an evaluation (self-esteem) (Szymanski & O'Donohue, 1995).Wylie (1974) considered self-esteem to be synonymous with what she called "self-regard," an umbrella term she used to described the attitudes toward the self and that included "self-satisfaction, self-acceptance, self-esteem, self-favorability, congruence between self and ideal self, and discrepancies between self and ideal self" (pp. 127–128).

Self-efficacy refers to a person's assessment of effectiveness, competency, and causal agency (Bandura, 1977; Gecas, 1989). Although White (1963) believed that self-esteem begins with self-efficacy, high self-esteem does not necessarily reflect high feelings of efficacy (Rosenberg, 1985). Self-confidence refers to the "anticipation of successfully mastering challenges or overcoming obstacles [whereas]… self-esteem…implies self-acceptance, self-respect" (Rosenberg, 1979, p.31). Persons high in self-esteem exhibit confidence in their perceptions and judgments and generally believe that they can favorably resolve their concerns through their own efforts (Coopersmith, 1967). Still, global self-esteem seems to be distinct from social confidence (Fleming & Watts, 1980). Keeping in mind the various meanings of these related self-constructs and how they relate to self-esteem will assist the counselor in lessening the confusion surrounding this construct.

Toward the Use of a Consistent Definition of Self-Esteem
Despite variations in how self-esteem has been conceptualized, certain common threads are present. Drawing from the theories that have stood the test of time, which still stand today as landmarks in understanding self-esteem, and that are accepted and widely used, these commonalties and consistencies allow us to form a clearer understanding of the construct. Competence and achievement seem to be integral elements of self-esteem and seem to be intertwined with an evaluation and awareness of self-worth. This awareness is formed, at least in part, from the judgment of and feedback from others. The reactions of significant others play a part in self-esteem levels. In addition, there seems to be more than one kind of self-esteem. The point is, in order to operationalize self-esteem, it may be productive to consider this construct as a self-esteem system. Counselors and other helping professionals, who are those most concerned with affecting levels of self-esteem, need to be precise in how they use this construct. Consequently, this article calls for the consistent use of the following definitions, which are grounded in the professional literature:

Self-esteem: The attitudinal, evaluative component of the self; the affective judgments placed on the self-concept consisting of feelings of worth and acceptance, which are developed and maintained as a consequence of awareness of competence, sense of achievement, and feedback from the external world.

Global self-esteem: An overall estimate of general self-worth; a level of self-acceptance or respect for one-self; a trait or tendency relatively stable and enduring, composed of all subordinate traits and characteristics within the self.

Selective self-esteem: An evaluation of specific and constituent traits or qualities, or both, within the self, at times situationally variable and transitory, that are weighted and combined into an overall evaluation of self, or global self-esteem.

By understanding the meaning of self-esteem and knowing its definitions, the counselor can be precise in its use and judicious in choosing interventions targeted at increasing levels of self-esteem in individuals and in group settings. Global self-esteem seems to be less amenable to change than does selective self-esteem. However, the fact that global self-esteem is composed of selective self-esteem elements may mean that a change in level of overall self-esteem is contingent upon changes in evaluation of these specific, subordinate units within the self-system, which in turn affects the overall, or global, level of self-esteem. By attending to selective self-esteem traits or characteristics that are important to the client manifesting low self-esteem, the counselor may more likely be able to assist that client in ultimately increasing his or her level of overall self-esteem.

Significance Of Self-Esteem
A reason for the preeminence of self-esteem research is that it seems to have motivational significance; much of behavior is determined by how one assesses one's own sense of worth (Gecas, 1982; Rosenberg, 1965; Wylie, 1974). The motivation to maintain and enhance a positive sense of self may be universal because it stimulates dissonance-reducing actions (Gecas, 1982; H. B. Kaplan, 1975; Rokeach, 1979; Rosenberg, 1979). What individuals choose to do and the way they do it may be dependent, in part, on their self-esteem. It seems to be correlated with functional behavioral and life satisfaction (Bednar & Peterson, 1995; Gurney, 1986) and is significantly related to physical and mental well-being (Witmer & Sweeney, 1992). The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994), includes self-esteem among the diagnostic criteria for some mental disorder categories, and self-esteem seems to be related to depression and dysthymia.

Countless studies have been conducted on student self-esteem and academic performance. Factors influencing students' low academic performance point to low self-esteem as both an antecedent and a consequent component. In general, high self-esteem seems to be a consequence of having experienced success (Holly, 1987). Other research, however, suggests that there is no positive correlation between serf-esteem and academic achievement in certain student populations (Ginter & Dwinell, 1994; Pottebaum, Keith, & Ehly, 1986), and it is one's actual ability rather than perceived ability that seems to be a determinant of self-esteem and makes a difference in academic success (Bachman & O'Malley, 1986).

Hundreds of articles substantiate or repudiate self-esteem's antecedent or consequent role in human behavior. These conflicting results underscore further the need for counselors to understand the construct, account for how they use the term, and how they assess it. Mruk (1995) stated that "Measuring self-esteem is important because if this field wishes to achieve a higher degree of reliability and validity, then it must attempt to demonstrate observable,… measurable relationships between self-esteem and the kinds of behavior commonly held to be related to it" (p. 42).
- Guindon, Mary H.; Toward Accountability in the Use of the Self-Esteem Construct; Journal of Counseling & Development, 07489633, Spring2002, Vol. 80, Issue 2

Personal Reflection Exercise #6
The preceding section contained information regarding applying the dual nature of self esteem to understanding BDD.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 20
According to Guindon, what are the three aspects of the self-esteem system? Record the letter of the correct answer the CE Test.

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