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Personality / Capacities

Capacity to Regulate Self-Esteem

Everyone has a way of feeling good or bad about themselves, and most of us take ours so much for granted that we can hardly imagine another. Nancy McWilliams describes the conditions that support a person’s self-regard as working “like water to the fish”: pervasive, long-standing, and nearly invisible to the person who lives in them. She calls self-esteem what analysts sometimes call healthy narcissism, and suggests a handful of questions for understanding it: How secure is it? What is it based on? What undermines it, and how is it restored (McWilliams, 1999, p. 158)?

The PDM-3 defines this capacity as one’s overall sense of self-worth, including a nuanced appraisal of one’s positive and negative qualities. Quoting Rosenberg (1989, p. 31), it describes good self-esteem as the feeling that one is “good enough,” a person of worth, without necessarily considering oneself superior to others. It also includes a sense of internal control and self-efficacy, and self-compassion: meeting one’s own failures and pain with kindness and seeing suffering as part of shared human experience (Lingiardi, Muzi, & Bornstein, 2026, p. 721).

The key word is regulation. Healthy self-esteem is neither unrealistically high nor unrealistically low, and confidence rises and falls sensibly with circumstances. People who regulate it well can balance their wish for approval with the demands of reality and the needs and rights of others (pp. 721–722). Everyone’s self-esteem wobbles after a rejection or a failure; the question is how far it falls and what it takes to recover.

Across the Range

The PDM-3 offers three anchor points on its five-point scale (Lingiardi et al., 2026, p. 722). Ratings of 4 and 2 fall between them.

5: Healthy
The person keeps a stable, realistic sense of well-being, confidence, and vitality across contexts, even under stress or conflict. Confidence fits inner and outer reality. Self-evaluation is balanced and flexible, appreciating both strengths and flaws, and failures, inadequacies, and suffering are met with kindness and acceptance toward oneself and others.
3: Mild to moderate difficulties
Self-esteem is generally adequate but can be knocked off balance by strong emotion and stress. It may be compromised by envy, entitlement, rage, and a tendency to blame shortcomings on others or on circumstances, or diminished by shame and a sense of failure. Self-worth may swing noticeably, and harsh self-criticism may partly serve to restore a fragile sense of value.
1: Major to severe difficulties
The person may show pervasive self-centeredness, unrealistic ambitions, and certainty of being superior or envied, often with hatred and envy of others; or intense feelings of unworthiness and shame; or swings between these poles. There may be severe feelings of emptiness, a gap between inner experience and outward behavior, and an inability to take satisfaction in accomplishments. Failure or criticism may be met with hostility toward others or ruthless self-denigration.

The manual adds an important point: what shows on the surface may not be the whole story. Conscious self-approval can defend against unconscious negative feelings, so that a grandiose self-image disguises harsh inner criticism; and conscious self-criticism can mask less conscious grandiose expectations (p. 722). Difficulties here, sometimes framed as falling short of one’s ego ideal, can show up as envy, a desperate need for admiration, harsh self-criticism, or a relentless pursuit of visible achievement (p. 722).

How It Develops

According to the PDM-3, self-esteem begins in relationships with primary caregivers. When parents’ attuned responses make a baby feel lovable, with a life that matters to others, the infant takes in a sense of well-being, self-respect, and vitality. Children of abusive or neglectful caregivers may instead come to feel deeply rejected, insufficient, and unlovable (Lingiardi et al., 2026, p. 721). Parents’ own self-esteem matters too: the manual describes parents who push children to fulfill ambitions that compensate for the parents’ own feelings of inadequacy (p. 749).

Self-esteem is also shaped by what a family and culture admire. McWilliams notes that families and subcultures idealize remarkably different things, and that the best single question for learning about someone’s self-esteem may be “What do you admire in people?” (McWilliams, 1999, p. 160). She also cautions that cheap praise does not build self-esteem; it tends to produce self-deception, a sense of fraudulence, or private shame (p. 161).

The PDM-3 calls adolescence the most challenging developmental stage for self-esteem. Rapid physical, psychological, and social change, constant comparison of the real self with an ideal self, and sensitivity to peers all put it under strain; for many young people it stabilizes or even rises in middle and late adolescence (Tanzilli & Malberg, 2026, p. 431). In later life, people often have to mourn and reshape their self-image as abilities and roles change. A favorable view of aging and a sense of self-efficacy support self-esteem, while sensory losses and growing dependence can undermine it (Del Corno & Plotkin, 2026, p. 911).

How It Shows Up in Personality

Every personality style has its own self-esteem structure, which is part of what makes styles feel so different from the inside. The PDM-3 offers several examples. People with an obsessive style tend to base self-esteem on thinking, and compulsive people on doing (McWilliams & Shedler, 2026, p. 680). In the morally masochistic version of self-defeating personality, self-esteem is tied to deprivation and suffering, so that the greater the sacrifice, the greater the sense of virtue (p. 671). The traditional picture of the hypomanic personality includes inflated self-esteem (p. 670), while people with a depressive style of the self-critical kind may see themselves as irredeemably bad (McWilliams, 2011, p. 265).

The narcissistic style is organized around this capacity. The PDM-3 describes an inner emptiness that requires recurrent infusions of affirmation; when affirmation comes, there may be elation and grandiosity, and when it fails, depression, shame, and envy. It also describes a quieter, shy version, in which people feel depleted while privately preoccupied with the success they believe the world has denied them (McWilliams & Shedler, 2026, p. 688). People with narcissistic styles tend to protect wounded self-esteem by idealizing and devaluing others (p. 689). At the extreme, the manual points to Kernberg’s “malignant narcissism,” inflated self-esteem combined with aggression and suspiciousness (Lingiardi et al., 2026, p. 722).

Level of organization matters as well. McWilliams describes people organized at the borderline level as bouncing between feeling all-good and all-bad, lacking an integrated sense that as long as they live by reasonable standards they are good enough (McWilliams, 1999, p. 163). For many people with depressive and obsessive-compulsive psychologies, by contrast, the difficulty is a notoriously demanding conscience that makes it hard to feel adequately positive about themselves (p. 162).

How Different Thinkers See It

Freud, the superego, and early dissenters

McWilliams observes that Freud treated self-esteem as somewhat peripheral to the neuroses that interested him, and that classical theory approached it mainly through the superego: children internalize their parents’ values and make self-esteem depend on living up to them. Two members of Freud’s early circle took self-esteem more seriously: Adler, with his attention to feelings of inferiority, and Rank, with his focus on the individual will (McWilliams, 1999, pp. 161–162).

Heinz Kohut and self psychology

Kohut placed self-esteem at the center. Self psychologists use the term “selfobjects” for the people who support our self-esteem through affirmation, admiration, and approval, functioning both as outside others and as part of our self-definition. We all need them, McWilliams notes, but people with narcissistic difficulties need them so much that other aspects of relationship pale (McWilliams, 2011, pp. 182–183). Kohut saw pathological narcissism developmentally, as normal growth that ran into difficulty; McWilliams pictures his view as a plant stunted by too little water and sun, and therapists drawn to his formulation recommend unwavering empathy (pp. 188–189). McWilliams translates the self psychological attitude as “First, preserve the client’s self-esteem” (McWilliams, 1999, p. 166).

Otto Kernberg

Kernberg viewed pathological narcissism structurally, as investment in a pathological self-structure rather than a normal one that failed to mature, and recommended tactful but persistent confrontation of grandiosity and interpretation of defenses against envy (McWilliams, 2011, pp. 188–189). McWilliams writes that most analysts she knows find Kohut’s view fitting for some patients and Kernberg’s for others (p. 189).

Jacobson and A. Reich

Among the post-Freudian contributions that McWilliams credits with deepening the understanding of narcissism are Jacobson’s work on the self, as distinct from the ego, and A. Reich’s 1960 paper on pathological forms of self-esteem regulation (McWilliams, 2011, p. 177).

Rosenberg and research on self-esteem

Rosenberg’s view of self-esteem as feeling “good enough” anchors the PDM-3’s definition (Lingiardi et al., 2026, p. 721), and his Rosenberg Self-Esteem Scale (1965) appears among the manual’s suggested tools (Tanzilli & Malberg, 2026, p. 450). More recent research has added self-compassion and the distinction between explicit self-esteem and implicit self-esteem, which can diverge; the PDM-3 associates such gaps with diminished adaptation and cites research connecting them to narcissism and unstable self-esteem (Lingiardi et al., 2026, pp. 721–722, 743, 745).

Examples

The blood donor

In studying people who devoted their lives to saving and helping others, McWilliams found that when they were prevented from doing good deeds, they became depressed. She describes a woman who became significantly dysphoric after a cancer diagnosis, not only because she feared for her life but because her hospital would no longer let her donate blood regularly, something central to her sense of her own value.

Nancy McWilliams, Psychoanalytic Case Formulation (1999), p. 159

The agnostic and the churchgoer

A patient of McWilliams who prided herself on her agnosticism was hurt and confused by a boyfriend’s sexual restraint and concluded that he found her unattractive. McWilliams suggested that, as a practicing Catholic, he might believe premarital sex was wrong. The patient could hardly believe anyone still thought so, but he did: he was attracted to her, yet could not have felt good about himself acting against his values. Self-esteem rests on different foundations for different people.

Nancy McWilliams, Psychoanalytic Case Formulation (1999), p. 160

Emilia’s private verdict

In a PDM-3 case illustration, Emilia, an 84-year-old former bookseller, had been admired by customers and neighbors as a generous person, yet privately believed there was something intrinsically evil or inadequate in her, and that people would reject her if they knew her better. At the center was an old accusation from her late husband that she had not been a good mother, which she had come to share. After her daughter told the psychologist that Emilia had been a tender, affectionate mother, Emilia seemed much relieved. She was rated 3 on this capacity.

Lingiardi & McWilliams (Eds.), PDM-3 Online Supplement (2026), pp. 39–43

History

In the first PDM (2006), this capacity appeared as “level of confidence and self-regard” (Stern, 2009). The PDM-2 called it the capacity for self-esteem regulation and quality of internal experience (Gori et al., 2025), and the PDM-3 shortened it to the capacity to regulate self-esteem, with a definition that includes self-compassion (Lingiardi et al., 2026, p. 721).

Within psychoanalysis, McWilliams dates self-esteem’s arrival at center stage to about the 1970s, with a flood of writing and research on pathological narcissism, which she describes as defined by the inability to regulate self-esteem reasonably and consistently through internal standards (McWilliams, 1999, p. 161). Earlier threads include Adler and Rank, Wilhelm Reich’s “phallic narcissistic character” (McWilliams & Shedler, 2026, p. 688), and the humanistic psychology of Carl Rogers, whose attunement to clients’ fragile self-worth, McWilliams suggests, prepared therapists to appreciate Kohut (McWilliams, 1999, pp. 161, 164). The Kohut–Kernberg debate of the 1970s and 1980s still frames much clinical thinking about self-esteem (McWilliams, 2011, p. 188).

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