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The Dysfunctional Family Illness

Chapter 1: The Dysfunctional Family Illness
Laying the Foundation:

Personality Traits of Low Self-Esteem
By: James J. Messina, Ph.D.


What is the state of your self-esteem?

DIRECTIONS: For the statements below, writed down the rating which is most true of your level of exhibiting these behaviors in your life. Use the following rating scale:

        1 = never

        2 = rarely

        3 = sometimes

        4 = frequently

        5 = almost always


1  2  3  4  5  ( 1) I seek approval and affirmation from others, and I am afraid of criticism.

1  2  3  4  5  ( 2) I guess at what normal behavior is, and I usually feel as if I am different from other people.

1  2  3  4  5  ( 3) I isolate myself from and am afraid of people in authority roles.

1  2  3  4  5  ( 4) I am not able to appreciate my own accomplishments and good deeds.

1  2  3  4  5  ( 5) I tend to have difficulty following a project through from beginning to end.

1  2  3  4  5  ( 6) I get frightened or stressed when I am in the company of an angry person.

1  2  3  4  5  ( 7) In order to avoid a conflict, I find it easier to lie than tell the truth.

1  2  3  4  5  ( 8) I have problems with my own compulsive behavior, e.g., drinking, drug use, gambling, overeating, smoking, use of sex, shopping, etc.

1  2  3  4  5  ( 9) I judge myself without mercy. I am my own worst critic, and I am harder on myself than I am on others.

1  2  3  4  5  (10) I feel more alive in the midst of a crisis, and I am uneasy when my life is going smoothly; I am continually anticipating problems.

1  2  3  4  5  (11) I have difficulty having fun. I don't seem to know how to play for fun and relaxation.

1  2  3  4  5  (12) I am attracted to others whom I perceive to have been victims, and I develop close relationships with them. In this way I confuse love with pity, and I love people I can pity and rescue.

1  2  3  4  5  (13) I need perfection in my life at home and work, and I expect perfection from others in my life.

1  2  3  4  5  (14) I seek out novelty, excitement, and the challenge of newness in my life with little concern given to the consequences of such action.

1  2  3  4  5  (15) I take myself very seriously, and I view all of my relationships just as seriously.

1  2  3  4  5  (16) I have problems developing and maintaining intimate relationships.

1  2  3  4  5  (17) I feel guilty when I stand up for myself or take care of my needs first, instead of giving in or taking care of others' needs first.

1  2  3  4  5  (18) I seek and/or attract people who have compulsive behaviors (e.g., alcohol, drugs, gambling, food, shopping, sex, smoking, overworking, or seeking excitement.)

1  2  3  4  5  (19) I feel responsible for others and find it easier to have concern for others than for myself.

1  2  3  4  5  (20) I am loyal to people for whom I care, even in the face of evidence that the loyalty is undeserved.

1  2  3  4  5  (21) I cling to and will do anything to hold on to relationships because I am afraid of being alone and fearful of being abandoned.

1  2  3  4  5  (22) I am impulsive and act too quickly, before considering alternative actions or possible consequences.

1  2  3  4  5  (23) I have difficulty in being able to feel or to express feelings; I feel out of touch with my feelings.

1  2  3  4  5  (24) I mistrust my feelings and the feelings expressed by others.

1  2  3  4  5  (25) I isolate myself from other people, and I am initially shy and withdrawn in new social settings.

1  2  3  4  5  (26) I feel that I am being taken advantage of by individuals and society in general; I often feel victimized.

1  2  3  4  5  (27) I can be over responsible much of the time, but I can be extremely irresponsible at other times.

1  2  3  4  5  (28) I feel confused and angry at myself and not in control of my environment or my life when the stresses are great.

1  2  3  4  5  (29) I spend a lot of time and energy rectifying or cleaning up my messes and the negative consequences of ill-thought-out or impulsive actions for which I am responsible.

1  2  3  4  5  (30) I deny that my current problems stem from my past life. I deny that I have stuffed-in feelings from the past which are impeding my current life.




Add the ratings written down for the 30 items. This score indicates the degree to which you are affected by low self-esteem.



0-30             Not affected by low self-esteem.

31-45           Traces of low self-esteem. Take preventive action to reduce its impact on your life.

46-61           Presence of mild low self-esteem in your life. Take steps to treat this.

62-90            Presence of moderate low self-esteem. Take steps to treat this as soon as possible.

91-120          Presence of severe low self-esteem. Take steps to treat this immediately.

121-150        Presence of profound low self-esteem. Take immediate steps to treat this and seek out professional help to assist you in this process.


The thirty items in this inventory are behavioral descriptions of the impact of low self-esteem as described by Janet Woititz in Adult Children of Alcoholics (1984); by Robert Subby in Children of Alcoholics; by Alanon in Did You Grow Up with a Problem Drinker, and by Sharon Wegsheider-Cruse in Choice Making (1985). These authors call this problem co-dependency. These statements are also signs of low self-esteem from which many people in our society suffer, not always because they come from a family of an alcoholic but because they come from a dysfunctional or high-stress family. Drinking may never have been a problem, yet the people from these families often experience the same problems in adulthood as do adult children of alcoholics.

What is co-dependency?

Co-Dependency is characterized by preoccupation and extreme dependency (emotionally, socially, and sometimes physically) on a person or an object. Eventually, this dependency becomes a pathological condition affecting the co-dependent in all other relationships.


Co-Dependency is an illness. It is a chronic condition of behavioral compulsions, delusions, and of emotional denial and repression resulting in a life-style of low self-esteem, and a feeling of powerlessness that can lead to medical complications.


What are the three major symptoms of co-dependency?

  • Denial: This is denial that the condition exists. The word “I” is never used, instead the third person is used in describing a problem. This can lead to a chronic state of delusion.
  • Compulsions: Including smoking, eating, working, spending, alcohol, drugs, gambling, sex, relationships.
  • Problems in relationships: “Why am I always hurting in my relationships?” Problems result from the chronic state of repression of feelings.
What complications come from co-dependency?
  • Low self-worth: I am not worthy of a better life-style.
  • Scarcity principle: It is better than what I've been used to, so I should be satisfied with what I've got. This results in perceived powerlessness: "I'd better not rock the boat.'' Safety is survival.
  • Medical complications: Including ulcers, high blood pressure, colitis, heart problems, asthma, allergies, cancer, and any "closing down'' of the body functions.
  • Repression: The unconscious “holding in” of feelings comes from the rules of repression in dependent high-stress families.
Rules of Repression:
  • Never confront an authority!
  • Authority rests in the parents, no matter what.
  • Feel rotten inside, but never let others know how you feel.
Repression results in feelings of:
  • Inadequacy: “never good enough”
  • Anger: feeling “locked up”  it is not nice to show anger.

What are some of the negative consequences of low self-esteem to your life-style?

  • Insecurity about who you are and lack of belief in yourself
  • Inability to open oneself to others and inability to trust others
  • Inability to make decisions because of confusion and fear of making a mistake or of disappointing others
  • Anxiety in the face of the need to change and the fear of change
  • Inability to have spontaneous fun or the inability to play for relaxation and pleasure
  • Problems in establishing intimacy with others and problems in interpersonal relationships
  • Lack of objectivity and openness to a variety of alternatives in decision making, and a tendency to resort to “black and white'' judgments
  • Problems in handling anger, either by denying its impact on one's life or by not being able to control it, thereby experiencing chronic hostility
  • Chronically affected by the need for approval and acceptance by others; affected by the fear of abandonment, fear of rejection, and disapproval
  • Excessive use of masks to hide true feelings; the use of exaggeration and lies in order to avoid conflict or disagreements
  • Inability to take direction from or to be controlled by others, rather to seek to control self and manage or direct others
  • Chronic seeking out of others for whom one can feel responsible
  • Inability to feel like one has done “good enough'' on the job or at home; a tendency to be a workaholic
  • Inability to say one deserves “good things'' in one's life; a tendency to always place self last
  • Chronic sense of depression, discomfort, or inadequacy
  • Chronic sense of feeling different from others; keeping away and isolating oneself from others
  • Inability to reward oneself for one's own goodness and accomplishments
  • Addiction to novelty, challenge, differences, risks, thrills
  • Compulsive behavior. e.g. alcoholism, chemical dependency, food, gambling, sex, excitement, money, shopping, smoking
  • Being overly serious, unable to see humor in one's plight as a human being
  • An overriding sense of guilt and inadequacy
  • Inability to forgive and to forget past harms and hurts from others
  • Meeting others with similar problems and marching up with them in relationships
  • Inability to let go of problems, such as fear, guilt, anger, or other negative aspects in one's life
  • Inability to tune into one's own feelings, but usually able to identify and to be sensitive to the feelings of others
  • Inability to face one's problems and the need to change, a tendency to use denial
  • Overreacting to things and acting impulsively, often getting oneself into problem situations which need lots of work to straighten out
  • Can be meticulous, fastidious, overdemanding, and perfectionistic; or can be slovenly, lackadaisical, and irresponsible
  • Can become frustrated when realizing the magnitude of problems and the immensity of effort required to solve them
  • Often looks quite successful, happy, contents, healthy, and together to others; it comes as a shock to self and others that one actually has a problem and needs help
What are the categories of people vulnerable to low self-esteem
  • Children of parents or grandchildren of grandparents who came from a co-dependent or dysfunctional family system
  • Children of dependent parents (alcohol, drugs, gambling, food, shopping, sex)
  • Children of workaholic parents
  • Children of mentally ill parents
  • Children raised in a high-stress environment
  • Children raised in an environment where feelings are not openly expressed, experienced, or welcome
  • Children who have experienced the divorce of their parents
  • Children who have experienced the loss of a parent or significant other in their childhood
  • Children raised in an absolutist or fundamentalist environment
  • Raised in a family headed by a single parent due to divorce, death, or absence due to career
  • Adults who have been hurt badly in a relationship, in marriage, in school, at work, or in the community
  • In a relationship with someone and/or married to someone who is dependent (alcohol, drugs, gambling, food, shopping, sex, etc)
  • In a relationship with someone or married to someone who is a workaholic
  • In a relationship with someone or married to someone who comes from a co-dependent family system
  • Members of a family in which a child with a developmental disability is born and reared
  • Members of a family in which a chronically ill family member is cared for
  • Members of a family in which a compulsive individual lives
  • Compulsive or dependent individuals once they are treated and enter recovery

Is low self-esteem an illness?

  • People with low self-esteem feel insecure. They are not sure what normal is, and they are not comfortable with themselves or with others. They are experiencing behavior over which they have no control, just as a person with cancer has no control over the cancer. This uncontrollable nature of the behavior makes it an illness; therefore, the behavior is “sick” behavior.
  • There is a commonality between people who behave this way based on their families of origin or current relationships, and there is a degree of predictability surrounding these behavior patterns. Commonality and predictability of the symptom behavior make it an illness and a condition to be treated as such.
  • There is a describable and predicable pattern of the life cycle in persons with this condition. This pattern of life cycle makes it understandable as an illness or a disease, just like heart disease or cancer.
  • One of the negative side effects of low self-esteem is that its victims often suffer high-stress illnesses, such as ulcers, colitis, high blood pressure, heart disease, and cancer. Because there are other diseases related to this behavior, it fits the definition of an illness or disease.
  • There are definite treatment modalities, which, if applied, can lessen the symptomatology of these problems. Because it is susceptible to amelioration by an applied treatment, it fits the definition of an illness or disease.
  • Low self-esteem as a state or being can be handed down and transmitted across generations. The ability to cross generations makes this an illness or disease that is highly contagious.
  • This condition can be described in terms of degree of severity, just as a physical illness or disease. This is another reason why it is described and treated as an illness or disease.
  • Certain strains of low self-esteem can be resistant to treatment or amelioration and, as such, require more dramatic interventions. Because these behaviors are not always amenable to a stereotyped treatment, it is an illness requiring an individualized approach to treatment.
  • There is a course in the history of the illness from (1) incubation, (2) acute stage, (3) chronic state, (4) expiration. Because there is a progressive nature to this condition it fits into the illness or disease model for consideration, discussion, and treatment planning.
  • Low self-esteem can be a terminal condition, resulting in death through suicide, murder, accident, alcoholism, drug abuse, food disorder, heart disease, cancer, stroke, or some other form of physical breakdown. Because it can be terminal, it fits the description of an illness or disease.

Steps to take to treat low self-esteem.

Step 1: Before you can take steps to clear up your case of low self-esteem, you must first find out its impact on you. Complete the survey in Section I. What is the impact of low self-esteem on your life, and at what level do you have the condition?


Step 2: If your rating was at the mild level or higher, proceed. Answer the following questions in your journal:

  • How is my life a reflection of the definition or co-dependent in Section II?
  • What is the level of severity of this condition on my life-style?
  • How are the three major symptoms of co-dependency, described in Section III, present in my life?
  • What is the state of my self-esteem?
  • How does my behavior reflect my belief in the scarcity principle, which says my life is better than what I've been used to, so I should be satisfied with what I've got?
  • What medical complication of low self-esteem have I had, do I have, or do I have a propensity for having?
  • What are the specific negative life-style consequences of my condition?
  • What specific characteristics of my background, my previous history of relationships, my family of origin, and my previous work history make me a candidate for low self-esteem
  • On which specific symptomatic behavior traits of low self-esteem do I feel no control?
  • At what stage of the illness of low self-esteem do I believe I am? Why?
  • What steps have I taken to address the low self-esteem symptomatic behavior traits which I possess? How successful were these behavior traits treated, ameliorated, or cured?

Step 3: Now that you have a full description of your low self-esteem condition, answer the next ten questions in your journal to clarify your motivation to change or to treat your current behavior patterns:

  1. How comfortable am I with the term “co-dependency?'' If I don't like the term, which term would be more acceptable to encourage me to get help for myself? Neurotic? Insecure?
  2. How comfortable am I with the concept of my behavior traits being described as symptoms of an illness? If I don't feel comfortable describing my behavior as “sick,'' what term would be more acceptable to motivate me to change?
  3. How comfortable am I with looking at my family of origin as one of the sources of my current problems? What alternative explanation of the origin of my problems is more acceptable to motivate me to get help?
  4. How comfortable am I in looking at my problems? Do I deny their existence, both now and in the past? What steps am I willing to take to overcome denial of my problems?
  5. How comfortable am I in expressing or experiencing my feelings regarding my problems? What would I prefer to have happen in order to help me address my problem behavior? What alternatives are offered to me in my circumstance? What if there aren't any?
  6. How angry am I getting in just reading this material and in answering there questions? What does this anger tell me about the presence of low self-esteem in my life.?
  7. How guilty do I feel about the inference that my parents' or spouse's problems are a root of my current problems? How can I change this perception to a nonaccusative, healing approach to treat my problems?
  8. How easy is it for me to accept the reality that everyone does the best they can, given their level of knowledge and awareness of their problems; and that no one purposefully sets out to screw up or to make other people sick? What other rational beliefs so I need to develop in order to give myself permission to pursue the remediation of my low self-esteem?
  9. How comfortable am I in accepting that I need help for my ``sick'' behavior when I have or am currently living with someone whom I believe to be really sick with alcoholism, compulsive eating disorders, drug abuse, compulsive gambling, or other compulsive disorders? What can be done to assist me in overcoming my loss of pride in order to accept my need for help?
  10. What will my future look like if I don't get help for my low-esteem? What can be done to fully motivate me to get help for myself now?


Hopefully, answering these ten questions has motivated you to accept yourself as a person with low self-esteem who is in need of help and support. Go to Step 4.


Step 4: Once you have accepted the fact that you need help to treat your low self-esteem condition, try some of the following pathways. One, two, or more of them in combination may be “just what the doctor ordered'' for your specific condition:

  • Enter into a Self-Esteem Seekers's Anonymous (SEA's) Group.
  • Enter into individual, marital, or family counseling with a licensed or certified mental health counselor.
  • Enter into a support group for adult children of alcoholics (ACOA).
  • Enter into a residential treatment program for 7 to 28 days.
  • Use the Tools-for-Coping Series as a self-help guide to reorganize your life.
  • Enter Alanon or Alation and begin a 12-step program of recovery.
  • Enter Alcoholics Anonymous, Narcotics Anonymous, Gamblers Anonymous, or Over-eaters Anonymous to address your compulsive behavior.
  • Read literature on co-dependency, dysfunctional families, and children of alcoholics.
  • Enter an alcohol, chemical dependency, or eating disorders residential or out-patient treatment program to address your compulsive problems.
  • Attend workshops or seminars on co-dependency and dysfunctional family-related issues.


Step 5: Once you have used the helping strategies in Step 4, you should be on the road to recovery from your low self-esteem. If you still feel stuck and not fully motivated to change, return to Step 1 and begin again.