Self at Risk: Self-Esteem and Quality of Life in Cancer Patients Undergoing Surgical Treatment and Experiencing Bodily Deformities

Self-esteem is an important factor determining QoL after surgical procedures leading to bodily deformities associated with cancer treatment. However, there are few data on which components of self-esteem are most closely related to QoL. The article presents two studies that aim to fill this gap. Study 1 concerns changes in global self-esteem and QoL in patients treated surgically for oral cancer (n = 35); Study 2 concerns changes in explicit and implicit self-esteem and QoL in women with breast cancer undergoing mastectomy (n = 96). The study was longitudinal with two measurements: before and after surgery. Both studies used the EORTC QLQ-C30 and Rosenberg's SES questionnaires. In Study 2, the Implicit Association Test (IAT) was additionally performed. The patients' global QoL and self-esteem deteriorated after surgery. In Study 1, patients with higher initial self-esteem showed a greater range of decreased self-esteem and QoL than patients with initially low self-esteem. In Study 2, the largest decreases in various dimensions of QoL and explicit self-esteem were observed in women with fragile self-esteem. A group of women with high explicit and implicit self-esteem showed the best QoL after mastectomy. Cancer patients with high, fragile self-esteem are at risk of the greatest deterioration in QoL and self-image after cancer surgery. These people should be given special psycho-oncological care.

Lower implicit self-esteem as a pathway linking childhood abuse to depression and suicidal ideation

Identifying the potential pathways linking childhood abuse to depression and suicidal ideation is critical for developing effective interventions. This study investigated implicit self-esteem-unconscious valenced self-evaluation-as a potential pathway linking childhood abuse with depression and suicidal ideation. A sample of youth aged 8-16 years (N = 240) completed a self-esteem Implicit Association Test (IAT) and assessments of abuse exposure, and psychopathology symptoms, including depression, suicidal ideation, anxiety, and externalizing symptoms. Psychopathology symptoms were re-assessed 1-3 years later. Childhood abuse was positively associated with baseline and follow-up depression symptoms and suicidal ideation severity, and negatively associated with implicit self-esteem. Lower implicit self-esteem was associated with both depression and suicidal ideation assessed concurrently and predicted significant increases in depression and suicidal ideation over the longitudinal follow-up period. Lower implicit self-esteem was also associated with baseline anxiety, externalizing symptoms, and a general psychopathology factor (i.e. p-factor). We found an indirect effect of childhood abuse on baseline and follow-up depression symptoms and baseline suicidal ideation through implicit self-esteem. These findings point to implicit self-esteem as a potential mechanism linking childhood abuse to depression and suicidal ideation.

Explicit and Implicit Self-esteem and Aggression: Differential Effects of Agency and Communion

Previous work has shown that self-esteem is related to aggression and violence. However, self-esteem is a multidimensional construct, and so we isolated self-esteem related to agency (e.g., competence and assertiveness) and self-esteem related to communion (e.g., warmth and morality) using both explicit and implicit techniques and examined their relationship to two forms of aggression (proactive and reactive aggression) in two samples. In an undergraduate sample (N = 130), high levels of explicit agency were associated with increased aggression but only for those with low implicit agency. On the other hand, high levels of either explicit or implicit communion showed reduced proactive aggression, while high levels of explicit communion were also associated with low levels of reactive aggression. In a community sample of people with problems due to homelessness (N = 101), we found that high levels of explicit communion were also associated with lower levels of both forms of aggression. The results show that different aspects of self-esteem, namely agency and communion, have quite different relationships to aggression and that implicit measures of these self-evaluations are also important constructs in the prediction of aggression. Implicit measures of self-esteem could be used by clinicians to understand the motivations behind an individual's aggression and its management.

The Neural Correlates of the Abnormal Implicit Self-Esteem in Major Depressive Disorder: An Event-Related Potential Study

Implicit self-esteem (ISE) has been considered a critical factor in the development and maintenance of major depressive disorder (MDD). Further investigating the event-related potential (ERP) characteristics underlying abnormal ISE in MDD would be helpful for understanding the neural mechanism of MDD. For this purpose, 32 MDD patients and 31 age- and sex-matched healthy controls (HCs) were enrolled in this study. The Rosenberg Self-Esteem Scale (RSES) was used to evaluate explicit self-esteem (ESE), and a self-esteem go/no-go association task (GNAT) was used to assess ISE. Electroencephalograms were synchronously recorded when performing the self-esteem GNAT. Behavioral data and ERP characteristics under different conditions were analyzed and compared within and across groups. The results showed that compared to HCs, MDD patients had significantly lower RSES scores and self-D scores of GNAT, which reflected lower levels of ESE and ISE, respectively. No significant correlation was found between RESE and self-D scores, and only RESE scores were significantly negatively correlated with the Hamilton Depression Rating Scale (HAMD) score. The averaged centroparietal go-P3 amplitude under the self-positive condition was significantly smaller in MDD than in HCs. Moreover, HCs had a significantly larger average centroparietal go-P3 amplitude in self-positive than in self-negative conditions, while this pattern was opposite in the MDD group. The neural activity patterns for other conditions were similar between MDD and HCs. Our results suggested that patients with MDD have a decreased level of both ESE and ISE, and ISE might be more independent of clinical symptoms. Decreased neural processing that implicitly associate self with positive conditions (and relatively increased implicit association between self and negative conditions) might be important neural correlates for abnormal ISE in MDD.

Brain responses of dysphoric and control participants during a self-esteem implicit association test

Previous studies have reported lowered implicit self-esteem at the behavioral level among depressed individuals. However, brain responses related to the lowered implicit self-esteem have not been investigated in people with depression. Here, event-related potentials were measured in 28 dysphoric participants (individuals with elevated amounts of depressive symptoms) and 30 control participants during performance of an implicit association task (IAT) suggested to reflect implicit self-esteem. Despite equivalent behavioral performance, differences in brain responses were observed between the dysphoric and the control groups in late positive component (LPC) within 400-1,000 ms poststimulus latency. For the dysphoric group, self-negativity mapping stimuli (me with negative word pairing and not-me with positive word pairing) induced significantly larger LPC amplitude as compared to self-positivity mapping stimuli (me with positive pairing and not-me with negative pairing), whereas the control group showed the opposite pattern. These results suggest a more efficient categorization toward implicit self-is-negative association, possibly reflecting lower implicit self-esteem among the dysphoric participants, in comparison to the controls. These results demonstrate the need for further investigation into the functional significance of LPC modulation during IAT and determination of whether LPC can be used as a neural marker of depressive-related implicit self-esteem.

The self-esteem implicit association test is valid: Evidence from brain activity

A distinct challenge of implicit self-esteem research is the dubious validity of measures for implicit self-esteem. We conducted two event-related potential (ERP) studies to examine whether implicit self-esteem measured by the Implicit Association Test (IAT) actually reflects the automatic self-evaluation. We adopted the regular IAT and the Go/No-go Association Task (GNAT), respectively, to measure implicit self-esteem in two studies. We focused on the P300 that reflects the stimulus evaluation process. Study 1 revealed that participants responded faster to self pairing with good than to self pairing with bad whereas self pairing with bad elicited a delayed P300 compared with self pairing with good. Study 2 replicated these findings and further highlighted that the index of implicit self-esteem based on reaction time is correlated with that based on P300 latency. Our results suggest that implicit self-esteem assessed by the IAT measures automatic self-evaluation, thus providing neural evidence for the validity of implicit self-esteem.

Self-Schemas and Self-Esteem Discrepancies in Subclinical Paranoia: The Essential Role of Depressive Symptoms

Background : Self-concepts are being intensively investigated in relation to paranoia, but research has shown some contradictory findings. Studying subclinical phenomena in a non-clinical population should allow for a clearer understanding given that clinical confounding factors are avoided. We explored self-esteem, self-schemas, and implicit/explicit self-esteem discrepancies in three non-clinical groups with different psychopathological traits and a control group. Methods: Participants with elevated trait-paranoia (n = 41), depressive symptoms (n = 34), a combination of both traits (n = 32), and a control group (n = 71) were assessed on implicit and explicit self-esteem, self-schemas, depression, and paranoia. A dimensional approach with the total sample (n = 208) was also used to complement the information provided by the group approach. Results: All groups presented similar and positive levels of implicit self-esteem. Trait-paranoia participants had similar levels of explicit self-esteem and self-schemas compared with the control group. However, the group with a combination of trait-paranoia and depressive symptoms showed the lowest levels of positive self-schemas and self-esteem. Furthermore, this group and the control group displayed implicit/explicit self-esteem discrepancies, although in opposite directions and with different implications. The dimensional approach revealed associations of trait-paranoia and depressive symptoms with poor explicit self-esteem and self-schemas but not with implicit self-esteem. Conclusions: Trait-paranoia participants showed different self-representations depending on whether depressive symptoms were present or not. The interaction between subclinical neurotic and psychotic traits entailed a detrimental self-representation that might increase the risk for psychopathology.

Explicit and implicit self-esteem in youth with autism spectrum disorders

Although the link between self-esteem and psychopathology has been well established, studies on self-esteem in individuals with autism spectrum disorder are lacking. In this study, we aimed to (1) compare explicit and implicit self-esteem of youth with autism spectrum disorder to typically developing peers and to (2) explore relationships of implicit-, explicit-, and discrepant self-esteem measures with co-occurring internalizing and externalizing problems in youth with autism spectrum disorder. For this purpose, 25 individuals with autism spectrum disorder and 24 individuals as age- and intelligence quotient–matched controls aged 8–16 years participated in this study. Results showed lower explicit self-esteem in autism spectrum disorder compared to typically developing youth and no differences in implicit self-esteem between groups. In youth with autism spectrum disorder, low explicit self-esteem was related to co-occurring depression symptoms, whereas lower implicit self-esteem was related to externalizing symptoms. These results show that youth with autism spectrum disorder are at risk for developing low explicit self-esteem, which appears to be related to often co-occurring internalizing symptoms. This emphasizes the need to focus more on self-esteem in assessment and treatment of youth with autism spectrum disorder.

The relationship between explicit self-esteem and subjective well-being: The moderating effect of implicit self-esteem

Explicit self-esteem (ESE) is an important factor influencing subject well-being (SWB). However, the relationship between ESE and SWB is not clear. Due to the complex nature of self-esteem, implicit self-esteem (ISE) might moderate the relationship between ESE and SWB. Furthermore, providing the consistency between ISE and ESE, the interacting effect of ISE and ESE would only be significant for the cognitive component of SWB rather than the emotional component. To examine these assumptions, the present study recruited a total of 134 undergraduate students and measured their ISE, ESE, and SWB using Implicit Association Test (IAT) and self-report measures. The results showed that (a) ESE, rather than ISE, was significantly correlated to SWB; and (b) the interaction between ISE and ESE could significantly predict the cognitive components of SWB rather than the emotional components. Those findings contribute to the further understanding of the relationship between self-esteem and SWB.

Does Inside Equal Outside? Relations Between Older Adults' Implicit and Explicit Aging Attitudes and Self-Esteem

Attitudes toward one's own aging and self-esteem are crucial variables in predicting older adults' physical and mental health and can significantly affect their will to live, cognitive judgement and acceptance of medical treatment. However, little is known about the relation between the implicit attitude toward one's own aging and implicit self-esteem. This research explored consistencies between implicit and explicit attitudes toward one's own aging and between implicit and explicit self-esteem and explored their relations in 70 older adults aged 60–91 years old using the word and picture versions of the Implicit Association Test and standardized scales. The results showed that (a) the explicit and implicit attitudes toward one's own aging represented independent structures, and the implicit and explicit self-esteem also represented independent structures; (b) subjects generally showed positive explicit attitudes toward their own aging and negative implicit attitudes toward their own aging while also showing high explicit self-esteem and relatively low implicit self-esteem; (c) subjects' implicit attitudes toward their own aging and implicit self-esteem were positively correlated, and explicit attitudes toward their own aging and explicit self-esteem were also positively correlated. The more positive the subjects' explicit attitudes toward their own aging, the higher their explicit self-esteem levels were. The more negative their implicit attitudes toward their own aging, the higher their implicit self-esteem levels were. We concluded that older adults' explicit and implicit attitudes toward their own aging and self-esteem are independent structures; older adults' explicit and implicit attitudes toward their own aging have predictive effects on their explicit and implicit self-esteem in different directions, respectively.

Reducing contingent self-worth: A defensive response to self-threats

Previous research shows that people with high self-esteem cope with threats to the self by reducing the extent to which their self-worth is contingent on the threatened domain (Buckingham, Weber, & Sypher, 2012). The present studies tested the hypothesis that this is a defensive process. In support of this hypothesis, Study 1 (N = 160), showed that self-affirmation attenuates the tendency for people with high self-esteem to reduce their contingencies of self-worth following self-threat. Furthermore, Study 2 (N = 286), showed that this tendency was more prevalent among people with defensive self-esteem than among those with secure self-esteem. The present studies imply that reducing contingent self-worth after self-threat is a defensive process. We discuss implications for theories of contingent self-worth.

Self-compassion moderates the predictive effects of implicit cognitions on subjective well-being

This study examined whether self-compassion may regulate the effects of implicit cognitions (automatic and preconscious responses) on the subjective well-being of Australian adults (N = 132). As hypothesized, self-compassion moderated the predictive effects of 2 implicit cognitions (positive attention bias and implicit self-esteem) on 2 indicators of subjective well-being (life satisfaction and depressive symptoms). Low implicit self-esteem and weak positive attention bias predicted more depressive symptoms and lower life satisfaction only for participants who were low in self-compassion. These results extend previous research knowledge by indicating that self-compassion may not only buffer the impact of explicit (deliberate and conscious) cognitive processes on well-being but may also regulate the effects of preconscious cognitive processes on mental health outcomes. Theoretical and treatment implications are discussed.

Narcissistic Traits and Explicit Self-Esteem: The Moderating Role of Implicit Self-View

Objective: Whilst the relationship between narcissism and self-esteem has been studied for a long time, findings are still controversial. The majority of studies investigated narcissistic grandiosity (NG), neglecting the existence of vulnerable manifestations of narcissism. Moreover, recent studies have shown that grandiosity traits are not always associated with inflated explicit self-esteem. The aim of the present study is to investigate the relationship between narcissistic traits and explicit self-esteem, distinguishing between grandiosity and vulnerability. Moreover, we consider the role of implicit self-esteem in qualifying these associations.

Method: Narcissistic traits, explicit and implicit self-esteem measures were assessed among 120 university students (55.8% women, M_age = 22.55, SD = 3.03).

Results: Results showed different patterns of association between narcissistic traits and explicit self-esteem, depending on phenotypic manifestations of narcissism. Narcissistic vulnerability (NV) was linked to low explicit self-evaluations regardless of one’s levels of implicit self-esteem. On the other hand, the link between NG and explicit self-esteem was qualified by levels of implicit self-views, such that grandiosity was significantly associated with inflated explicit self-evaluations only at either high or medium levels of implicit self-views.

Discussion: These findings showed that the relationship between narcissistic traits and explicit self-esteem is not univocal, highlighting the importance of distinguishing between NG and NV. Finally, the study suggested that both researchers and clinicians should consider the relevant role of implicit self-views in conditioning self-esteem levels reported explicitly by individuals with grandiose narcissistic traits.

The costly burden of an inauthentic self: insecure self-esteem predisposes to emotional exhaustion by increasing reactivity to negative events

BACKGROUND AND OBJECTIVES

A long research tradition has investigated the impact of stress on university students by assuming that individuals have a limited reservoir of resources, and that negative events and circumstances progressively drain resources thereby producing exhaustion. A recent research tradition, instead, has focused on the detrimental consequences of discrepant levels of implicit (ISE) and explicit (ESE) self-esteem on the development of stress-related symptoms. The present research attempted to merge the aforementioned approaches, with the aim of explaining significant predictors of stress.

DESIGN

Within the framework of a Longitudinal Structural Equation Model, we followed a moderated-mediated approach.

METHOD

A sample of university students (N = 209; 66% females) completed a questionnaire battery including measures of ISE, ESE, perceptions of negative events, and emotional exhaustion. Participants were assessed once a week for eight consecutive weeks.

RESULTS

ISE significantly moderated the relationship between ESE and negative events; in turn, the latter significantly predicted emotional exhaustion. Monte Carlo method for assessing mediation showed that negative events significantly mediated the relationship between incongruent self-esteem and emotional exhaustion.

CONCLUSIONS

The detrimental role of incongruent self-esteem has been corroborated. Practical implications and suggestions for future research dealing with stress in a university setting were provided.

Bad Roots to Grow: Deficient Implicit Self-Evaluations in Chronic Depression With an Early Onset

OBJECTIVE

Implicit self-esteem, which is based on associative learning processes, is considered to be constituted earlier in life than explicit, verbalized self-esteem. While depressed individuals report negative explicit self-esteem, research has predominantly demonstrated equivalent levels of implicit self-esteem of depressed and healthy individuals. We further illuminate this finding by theorizing and empirically demonstrating that chronically depressed individuals show particularly low levels of implicit self-esteem when depression had an early onset.

METHOD

We applied measures of implicit (name-letter test) and explicit (Rosenberg Self-Esteem Scale) self-esteem in chronically depressed patients with an early onset (N = 17), a late onset (N = 13), and an episodic depression (N = 29).

RESULTS

As expected, patients with an early onset showed lower implicit self-esteem than the 2 other groups.

CONCLUSION

Implicit self-esteem may function as a marker of how deeply negative self-views are internalized. Furthermore, the distinction between early and late onset of chronic depression seems to be valuable for classification and potentially treatment of unipolar depression.

Discrepancies between explicit and implicit self-esteem and their relationship to symptoms of depression and mania

OBJECTIVES

Self-esteem is a key feature of bipolar symptomatology. However, so far no study has examined the interaction between explicit and implicit self-esteem in individuals vulnerable to bipolar disorder.

DESIGN

Cross-sectional design was employed.

METHODS

Thirty children of parents with bipolar disorder and 30 offspring of control parents completed Hamilton Rating Scale for Depression, the Bech-Rafaelson Mania Scale, the Self-esteem Rating Scale and the Implicit Association Test.

RESULTS

No differences between groups were revealed in levels of explicit or implicit self-esteem. However, bipolar offspring showed increased levels of symptoms of depression and mania. Furthermore, depressive symptoms were associated with low explicit self-esteem, whilst symptoms of mania were associated with low implicit self-esteem. When self-esteem discrepancies were examined, damaged self-esteem (i.e., low explicit but high implicit self-esteem) was associated with depression, whilst no associations between mania and self-esteem discrepancies were found.

CONCLUSIONS

Not only explicit, but also implicit self-esteem, and the interactions between the two are of relevance in bipolar symptoms. Clinical implications and future research directions are discussed.

PRACTITIONER POINTS

Explicit as well as implicit SE, and particularly their relationship, are relevant for mental health. Fluctuations in implicit SE may serve as an early indicator for risk of bipolarity. Psychotherapeutic approaches may be more suitable for one kind of SE challenge than the other.

Rank perception and self-evaluation in eating disorders

OBJECTIVES

Heightened sensitivity to social comparison and negative self-evaluation have been implicated in the development and maintenance of eating disorders (EDs). This study used behavioral tasks, as well as self-report measures, to examine processing of social rank-related cues and implicit self-concept in participants with EDs.

METHOD

Fifty healthy participants (HCs), 46 people with an ED, and 22 people recovered from an ED (REC) undertook an attentional bias task using social rank-related cues and an implicit self-evaluation task. In addition, they completed self-report measures of social comparison, submissive behavior, and shame.

RESULTS

People with EDs showed vigilance toward social rank-related stimuli and lower implicit positive self-evaluation than HCs. Self-report data confirmed the behavioral findings and showed that people with EDs had higher levels of unfavorable social comparison, submissive behaviors, and external and internal shame than HCs. People who had recovered from an ED showed an intermediate profile between the two groups.

DISCUSSION

People with EDs have heightened sensitivity to social rank-related cues and impaired self-evaluation at an automatic level of processing. Some of these biases remain in people who have recovered. Interventions which aim to remediate social threat sensitivity and negative bias about self and others might be of benefit in EDs.

Implicit self-esteem in borderline personality and depersonalization disorder

Self-perception is disrupted in people with borderline personality disorder (BPD) and depersonalization disorder (DPD), fluctuating with sudden shifts in affect in BPD and experienced as detached in DPD. Measures of implicit self-esteem (ISE), free from conscious control and presentation biases, may highlight how such disruptions of self-concept differentially affect these two populations on an unconscious level. We examined ISE using the Implicit Association Test, along with measures of emotion, behavior, and temperament, in BPD (n = 18), DPD (n = 18), and healthy control (n = 35) participants. DPD participants had significantly higher ISE and were more harm avoidant than BPD and control participants, while BPD participants had more "frontal" behaviors and impulsivity and less self-directedness and cooperativeness than DPD and control participants. Thus, while BPD and DPD commonly overlap in terms of dissociative symptoms and emotional irregularities, differences in self-esteem, behavior, and temperament can help identify where they diverge in terms of their cognition, behavior, and ultimately underlying neurobiology.