Self-Esteem Research, Theory, and Practice Toward a Positive ...

160 SELF-ESTEEM RESEARCH, THEORY, AND PRACTICEexpectations, using self-handicapping strategies, and avoiding risk. Sucha condition does not warrant a diagnosis; however, it is costly in terms ofmissing out on many opportunities in life. Thus, negativistic self-esteemconstitutes a genuine self-esteem problem of living, but not one that isclinically significant much like the “V-Codes” of the DSM systems.Classical Low Self-EsteemWe also saw in Chapter 1 that some 24 clinical conditions are associatedwith low self-esteem in the DSM. The point of clinical significance can berepresented by the coordinate −5, −5 in the diagram and below simplybecause it divides the quadrant into less severe and more severe areas.Depression is most commonly associated with low self-esteem diagnostically,but it plays a major role in other DSM diagnoses as well, such asanxiety disorders, eating disorders, attention deficit disorder, and soforth. All of these conditions are well documented as involving low selfesteemin one way or another. Although desirable, it is not possible to discussin this book how self-esteem plays a role in all of these conditionsbecause we must stay focused on the central topic. Fortunately, much ofthe literature on those disorders covers that material, so the main pointfor our purposes is quite clear:Prospective studies conducted with children, adolescents, and youngadults, for example, suggest that low self-esteem increases their susceptibilityto a wide range of problematic outcomes and experiencessuch as depression, eating disorders, teenage pregnancy, victimization,difficulty sustaining and forming close relationships, involvement inantisocial behavior, substance use, and suicide ideation and attempts.(DuBois & Flay, 2004, pp. 415–416)Also note that new research is beginning to show the importance ofdealing with low self-esteem in relation to the effective management ofvarious serious chronic mental disorders, such as schizophrenia(McReynolds, Ward & Singer, 2002; Silverstone & Salsali, 2003).Levels of Worthiness-Based Self-EsteemAs should be expected if the matrix is correct, it should be possible to differentiatebetween the two imbalanced types of self-esteem that are oftenconfused with genuinely high self-esteem. Such an off-centered foundationis not the basis on which to build an edifice for living because thiscondition requires constant attention, including a readiness to defendagainst internal, as well as external, threats. However, there is much variationin both worthiness-based and competence-based self-esteem, just as