Self-hatred can be linked to mental illness. What causes it and how can it be treated?
Shame and low self-worth are among the features of a toxic form of self-loathing that can have serious consequences. (Getty Images: Dmitry Kovalchuk)
Imagine you're at a dinner party having a good time chatting to people and then suddenly … splash!
You knock your glass of red wine all over the plush cream carpet.
You feel awfully embarrassed, and absolutely hate yourself in that moment.
You do eventually forgive yourself. After all, you're only human and can be a klutz sometimes.
But some people experience a much more toxic form of self-loathing than this.
They believe bad things happen to them because they are flawed to the core, according to Blaise Aguirre, a child and adolescent psychiatrist with the Harvard Medical School.
"It's almost karmic," he tells ABC Radio National's All in the Mind.
Loading...When the occasional good thing happens, someone with this level of self-hatred dismisses it as a fluke. They constantly dislike themselves, blame themselves for things that aren't their fault and expect to be punished.
This is a distorted sense of self that can lead to tragic outcomes, Dr Aguirre says.
But what else is involved with self-hatred, where does it come from and what can be done about it?
WARNING: This article discusses the topic of suicide — please take care while reading.
What does 'self-hatred' look like?
People with self-hatred are generally self-deprecating, self-judgemental, self-critical, and have constant negative feelings such as inadequacy, guilt and low self-worth.
While it is an evolving concept that is relatively under-researched, features of self-hatred have been linked with a range of mental issues including depression and suicidal thoughts.
Dr Aguirre's work since 2007 has focused on people with highly self-destructive behaviours.
"When I started reviewing the records and talking to some of my more suicidal patients, they all had this core self-hatred," he says.
A link has been found between self-hatred and thoughts of suicide. (Getty Images: Malte Mueller)
Australian researchers also found a similar link between a person's sense of self and suicidal ideation.
University of the Sunshine Coast psychology researcher Dan Fassnacht and colleagues found people who had thoughts of suicide were more likely to agree with statements such as "I hate myself", "I'm a failure", "I feel disgusted when I think about myself" and "I have no value".
"Tendencies of self-hate are in fact associated with stronger suicidal ideation," Dr Fassnacht says.
Where does self-hatred come from?
While some people can be predisposed to developing self-hatred, such as those who are highly emotionally sensitive, it's not usually easy to pinpoint the origins of the condition.
What is clear is the importance of environmental factors, Dr Aguirre says.
For instance, well-meaning parents or teachers can encourage someone to develop self-hatred.
Dr Aguirre describes the case of a patient he'd been seeing for two years. Once she was 10 minutes late to an appointment with him — due to bad traffic — and felt she was so negligent she deserved to be slapped by him.
It turned out her caregivers demanded perfection from her when she was growing up.
"If she was late, if she didn't get an A, if she didn't hand in her homework on time, she was severely punished," Dr Aguirre says.
"So the message [was] that you cannot fail because if you fail … you'll be rejected."
How can self-hatred be treated?
Self-hatred may be so much a part of a person's identity they don't think it can be changed, Dr Aguirre says.
This means they don't bring it up in therapy.
And since therapists don't tend to ask if people like themselves or not, it is an unaddressed symptom in mental health, Dr Aguirre argues.
He found that some of his patients who had thoughts of suicide did not respond to the treatment he was using (a type of cognitive behaviour therapy or CBT called dialectical behavioural therapy).
When self hatred is so integral to one's sense of self it can be hard to see it as something changeable. (Getty Images: Andriy Onufriyenko)
CBT is often regarded as the "gold standard" in psychological tools. It requires people to separate thoughts and feelings so they can improve the way they feel by changing their thoughts.
But, Dr Aguirre says, people with self-hatred, which is deeply integrated into their sense of self, cannot do this.
He has had success with a therapy that begins by challenging the patient's idea that self-hatred is a core part of their identity.
"A child is not born hating itself … It doesn't have a concept of what hatred is," he says.
"You have to create an understanding that this is a learned construct."
He gets his patients to think about who taught them to hate themselves to help create a "wedge" between self-hatred and their core identity.
And then he teaches his patients to actively but gradually "unlearn" their self-hate.
This involves cultivating self-caring behaviours, whether it be better sleep, healthier relationships, getting fit — even brushing their teeth — and seeing them as small steps towards self-compassion.
A key stage in Dr Aguirre's approach is to create a wedge between self-hatred and core identity. (Getty Images: Jonathan Knowles)
Dr Aguirre documents the journey of people suffering self-hatred who'd had multiple hospitalisations and made near-lethal attempts on their life.
"They've all described huge reductions in their self-hatred. In many cases, [there's] an improvement in how they see themselves," he says.
"It's almost like going to one of those house of mirrors where everything is distorted. And suddenly you see clarity, and you see a mirror that shows you who you really are."
"I'm hoping that this is going to break open a whole new field of research into addressing core self-concepts."
What are the broader implications?
Dr Fassnacht says Dr Aguirre's approach "definitely makes a lot of sense", and that self-hatred could explain why his clinical colleagues find CBT doesn't always work with patients.
And self-hatred is not the only way a person can have a distorted self-concept, and therefore require different treatment.
Dr Aguirre's approach is designed to help patients see their true selves, separate from self-hatred. (Getty Images: Malte Mueller)
For example, another self-concept condition, called "self-ambivalence" makes people ambivalent about their self-worth, morality, or lovability.
One study shows that working on this concept of self results in more effective treatment for obsessive-compulsive disorder.
No matter the condition — from obsessive-compulsive disorder to depression or anxiety to eating disorders — Dr Fassnacht emphasises the importance of tailoring therapy to the individual by better understanding them, and that includes their self concept.
"Sometimes we forget that we are not treating a mental disorder, but we are actually treating a person," he says.
Listen to the full episode Do you hate yourself? Healing from self-hatred on ABC Listen and subscribe to All in the Mind to explore other topics on the mind, brain and behaviour.