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  Key Messages

  • People with bipolar disorder often view themselves negatively
  • Bipolar disorder stigma – self, social and structural -- is real
  • Increased self-compassion and decreased self-stigma can improve quality of life

  Take Action

  • Find tools to support self-compassion
  • Explore whether self-stigma is an issue for you
  • Address negative self-perceptions with Cognitive Behavioural Therapy (CBT) techniques

  Learn more

Why self-esteem is important to your quality of life

Boosting self-esteem has been a popular pursuit on the path to mental wellness. We naturally believe that high self-esteem, defined as our assessment of our own value1, is linked with an improved quality of life.   

But self-esteem, in and of itself, may be overrated. Research on the topic shows that self-esteem (although potentially related to happiness, initiative and persistence after failure) is more often the result of accomplishments and skills than a direct cause of good outcomes.2,3 Additionally, we need to be careful, as inflated self-esteem can lead to narcissism (or ‘self-admiration’), self-absorption and lack of concern for others, which often hurts people or pushes them away3. On the other hand, very low self-esteem can lead to depression, low motivation and suicidal thoughts2.

A basic problem with self-esteem is that it involves comparing yourself to a social standard (e.g. “how good am I compared to everyone else?”)3. Yet most people can’t be better than everyone else, especially not all the time. Failures, flaws, imperfections and pain are inevitable for everyone at different points in our lives. What’s needed, as with most things in life, is balance: feeling good enough about yourself to stay motivated and inspired, but avoiding the belief that artificially boosting your self-esteem will change your life. In itself, it probably won’t. And besides, quick self-esteem “boosts” are hard to come by.4

Still, having a healthy relationship with yourself is vital to wellness, and that’s where the concept of self-compassion comes in. The concept of self-compassion includes the desire to ease your suffering and heal yourself with kindness. It involves developing an attitude of non-judgment and kindness towards yourself and towards your own pain, flaws and failures. It involves seeing your experiences as part of a larger common human experience6. Rather than needing to compare ourselves to others to establish our self-worth, self-compassion means seeing struggle as part of the human condition. Instead of needing to feel better than someone else to maintain self-esteem, self-compassion allows a person to take comfort in knowing that everybody shares a common humanity – both in our suffering and our imperfections.  

Self-compassion doesn’t imply passivity, though. In fact, acceptance and non-judgment towards the parts of yourself that you’d like to change can actually make it easier to pay attention to what needs to change, and can help you to effectively change it6


Self-compassion has been shown to help people suffer less and have better quality of life4. In particular, research studies show that self-compassion is linked to lower levels of stress, anxiety and depression5 as well as better resilience to negative events6. It’s also linked to feelings of happiness, optimism, gratitude, autonomy (or ‘independence’), competence, connectedness to others, self-determination, emotional intelligence, wisdom, initiative, curiosity, flexibility and life satisfaction7.

Having a kind and accepting relationship with yourself is especially important when you live with bipolar disorder. Studies show that people living with bipolar disorder can have a negative view of themselves8. Even more, people living with bipolar disorder may encounter stigma: negative stereotypes and attitudes (e.g., of being different, damaged or undesirable in some way).

Stigma is experienced at three levels: structural (in organizations like hospitals or workplaces), social (in society and in relationships) and internalized (self-stigma, or stigmatized beliefs that a person directs towards him/herself).

Structural stigma is often found in healthcare settings, where people feel dismissed because they live with mental illness. Others who engage in paid work legitimately fear that disclosing their diagnosis to their employers or colleagues might impact how they’re perceived in the workplace, or might even limit their opportunities.

Social stigma is felt in relationships. It refers to people who don’t live with mental illness making unjustified negative assumptions about people who do. For instance, automatically assuming that having a mental illness must make it very difficult to hold down a demanding job.

Self-stigma is where a person directs those stereotypes and negative beliefs about people with mental illness towards him/herself. For example, thinking “I’m not good enough because I have bipolar disorder”. It’s challenging enough to live in a world where others might stigmatize you, but to believe these negative views makes it even more difficult to live with the condition. Self-stigma can contribute to false negative beliefs about your ability to achieve your goals. It’s also related to the failure to seek treatment, and with ending treatment too early. A research study of self-stigma in people living with bipolar disorder found that participants frequently experienced it—identifying shame, self-blame, self-doubt, low self-judgment and self-loathing as part of their daily experience of living with bipolar disorder9. These participants reported that self-stigma greatly affected their quality of life. However, one study found that people who live with mental illness felt hopeful when they talked about the importance of taking responsibility for their thoughts and feelings, learning about their illness, and building strong relationships.

How you can take action

Self-compassion is a portable source of support, available 24 hours a day, 7 days a week, even when family and friends are unavailable. Just like you would put a Band-Aid on a physical cut, self-compassion is a way of caring for your emotional wounds. You can choose to improve your self-compassion and to reduce self-stigma. Self-compassion isn’t something you inherently have or don’t have: it’s a commitment you can practice. Just like developing any habit, it takes a bit of effort to establish this new behavior. But even a few weeks of self-compassion practice has been shown to decrease suffering and improve wellness

13.

The first step in this practice is learning to be sensitive to your own needs and distress, so that you can be warm and kind to yourself13. If it’s hard for you to pay attention to your inner experiences (such as thoughts, body sensations and feelings), mindfulness training or the help of a therapist may be useful.

There are a variety of exercises to practice self-compassion. Some involve the practice of noticing your judgments and trying to cultivate a gentler and more supportive attitude towards yourself so that you get into the habit of engaging in compassionate responses automatically.  It’s important to continually remind yourself that it’s human to make mistakes and have imperfections, and that you are not alone in your suffering. Finally, you can practice being mindful by keeping your attention on the present moment, even when it includes suffering. In this way, you might learn to let go of rumination about negative experiences, while staying aware of your distress and needs and also while providing support for yourself13.   

Self-compassion can be especially important when a person is first diagnosed with bipolar disorder. Self-compassion helps to counter stigmatizing thoughts (e.g., of being ‘damaged’ or ‘weak’) and instead helps you to adopt an attitude of accepting human vulnerabilities and imperfections. Similarly, it can be helpful to notice when you get stuck in “should” statements: for example, “I should be able to manage my symptoms without help”, “I should snap out of this depression”. At times like these, accepting your challenges and providing yourself with gentle self-care can go a long way in empowering you to seek help and to live better with bipolar disorder. If you notice that you have a lot of unhelpful “rules” or “should” statements in your life, it’s helpful to explore where these rules came from and the pros and cons of living with them. If you see these rules to be unhelpful, see if you can try to adopt healthier rules that allow room for more acceptance in your life. This will take a lot of practice: noticing when you fall into old habits, then trying to commit to your healthier new rules.

There is not a lot of scientific literature on effective ways to stop self-stigma; however, Cognitive Behavioural Therapy (CBT) strategies can be helpful if you struggle with a negative self-image. If you have unjustified or exaggerated negative beliefs about yourself, you can have a self-image that is unnecessarily bleak or discouraging. One helpful strategy is to identify when you have distorted negative thoughts about yourself, for example, “Because I got one question wrong on the test, I’m a failure” or “No one called me today, so I must be unlovable”. Or you may catastrophize, for example, thinking, “I’ve ruined everything” or “I will never change”. These thoughts often lead people to avoid trying or to be passive, which may actually reinforce negative thoughts. But once you learn to become aware of unhelpful thought patterns, you’ll have the ability to evaluate them. Try checking the facts by asking yourself:


  • Do these thoughts help me?
  • Am I seeing the complete picture?
  • What other perspectives might there be?
  • What would I say to a friend in the same situation?
  • Am I ignoring any positives in this situation?
  • What would be the most helpful action here?

Last, you can try to shift your focus to the important task of identifying your positive qualities and accomplishments, judging these in terms of your own values. If you strongly value being helpful to others, then you focus your attention on times when you have supported other people. The more you focus on your own positive behaviors or qualities, the more you can experience a gradually increasing sense of self-worth. As an extension of this approach, try setting behavioural goals: activities that you are going to begin or increase that reflect your personal values. Once again, if you place a high value on being helpful to others, then set yourself the homework of assisting another person once in the next week: try to be specific about what you will do and for whom, then plan to do this at a particular time during the week.