Social Anxiety Help is a founding regional clinic of the National Social Anxiety Center (NSAC):
A physician starts playing a harsh mental tape in her head every time a new patient calls: What if I make the wrong diagnosis? I'm a terrible doctor. How did I get into medical school?
An executive loses his job and despite 25 productive years, he tells himself: I'm a loser. I can't provide for my family, and I'll never be able to again.
An eminent scholar is offered a top post in the Obama administration and his first reaction is: They must have made a mistake.
If these real-life examples sound familiar, you may have a caustic commentary running in your head, too. Psychologists say many of their patients are plagued by a harsh Inner Critic -- including some extremely successful people who think it's the secret to their success.
An Inner Critic can indeed roust you out of bed in the morning, get you on the treadmill (literally and figuratively) and spur you to finish that book or symphony or invention.
But the desire to achieve can get hijacked by harsh judgment and unrelenting fear. "There's a healthy version and an unhealthy version," says Daniel F. Seidman, a clinical psychologist at Columbia University Medical Center in New York. In some cases, he says, "people may achieve a lot, but they are totally miserable about it."
Unrelenting self-criticism often goes hand in hand with depression and anxiety, and it may even predict depression. In a study of 107 patients in the latest issue of Comprehensive Psychiatry, David M. Dunkley at Jewish General Hospital in Montreal and colleagues found that those who were most self-critical were the most likely to be depressed and have difficulties in relationships four years later, even if they weren't depressed to begin with.
Self-criticism is also a factor in eating disorders, self-mutilation and body dysmorphic disorder -- that is, preoccupation with one's perceived physical flaws. "We have expanded what we expect of material success and physical appearance so that it's completely unrealistic," says Robert L. Leahy, a psychiatrist and director of the American Institute for Cognitive Therapy in New York.
Many people's Inner Critic makes an appearance early in life and is such a constant companion that it's part of their personality. Psychologists say that children, particularly those with a genetic predisposition to depression, may internalize and exaggerate the expectations of parents or peers or society. One theory is that self-criticism is anger turned inward, when sufferers are filled with hostility but too afraid and insecure to let it out. Other theories hold that people who scold themselves are acting out guilt or shame or subconsciously shielding themselves against criticism from others: You can't tell me anything I don't already tell myself, in even harsher terms.
It's unclear whether women berate themselves more than men do -- or just talk about it more readily. "The issue with men is, we don't really know what they're thinking. They're trained not to admit to any qualms or emotional pains," says Marianne J. Legato, an internist and founder of the Partnership for Gender-Specific Medicine at Columbia University. But she frequently sees men suffering from the "I'm a fraud" syndrome.
"They drive themselves to succeed, and when they do, it makes them frightened," Dr. Legato says. "They think their colleagues and their club mates are going to find out they are not who they're pretending to be." Such thinking is particularly prevalent in people who have achieved success quickly, she adds. "Just hearing that they are not alone in these thoughts can be tremendously liberating."
Techniques from cognitive behavioral therapy can also be helpful in changing patterns of thought that have become painful. "I often see professionals -- doctors, lawyers -- who believe that if they didn't flog themselves, they wouldn't be as successful. Part of my work is to break through that belief," says psychologist Katherine Muller, director of the Psychology Training at Montefiore Medical Center in Bronx, N.Y. "People usually succeed in spite of their Inner Critics, not because of them."
Among the suggestions she and other experts offer for putting your Inner Critic in its place:
Monitor your thoughts. Jotting down your self-critical judgments -- I'm a loser, I'm stupid, I'm ugly -- in a journal or a personal-digital assistant is the first step to mastering them: That process alone may decrease the intensity and frequency. Also note the situations in which these feelings occur and see if you can spot patterns.
Evaluate your judgments. Define your terms and examine whether your standards are arbitrary or fair. If you think you're a "bad person," are you a bad person all the time? Are there times when you are adequate? Dr. Muller says patients often find that their views are internally inconsistent. "I'll ask, 'What does a loser look like to you?' The patient is picturing a guy in sweatpants sitting around the house drinking beer. I say, 'Is that what you did yesterday?' And he'll say, 'Well, no.' "
Also, try to depersonalize what is really beyond your control. "Some people think, 'My portfolio is down 35% -- what's wrong with me?' As opposed to, 'What's wrong with the market?' " Dr. Leahy says.
Collect objective data. Challenge negative thoughts with hard facts. Keep a short list of your achievements on a note card and pull it out when your self-criticism threatens to overwhelm you. Or look back at your own CV and review what you've accomplished. "Focus on the fact that you made it as a scholarship student -- not that nobody asked you to dance for two years," says Dr. Legato.
Conviction or condemnation? Recognize the difference between thoughts that are critical and those that are constructive, suggests Therese J. Borchard, whose Beyond Blue blog on Beliefnet.com often deals with such issues. If you overeat at a picnic, thinking "I am a fat pig" is a condemnation, she says, whereas thinking "I'll try to start eating better tomorrow" is a conviction. Dr. Leahy agrees: "Your goal should be improvement, rather than putting yourself down."
Re-evaluate your values. Make sure that whatever you are beating yourself up about is worth striving for. Some goals, like kindness, integrity, and being self-disciplined, enhance the meaning and quality of life, whereas others only feed into your sense of defectiveness, Dr. Leahy says. "Some people think, 'I can get Botox and then I'll be lovable.' But the way to be lovable is to do lovable things," he adds.
Breaking the habit of self-criticism can pay big dividends in mental and physical health. "The way you see yourself can be challenged and changed, and it can literally create new neural pathways in your brain," says Dr. Legato. "And as your thinking improves, your immune system improves, your digestion is better, you don't compensate by overeating or drinking, and your anxiety levels go down."
You may find you have mental and emotional energy left over for many other things -- including helping other people feel better about themselves.
How Self-Critical Are You?
For each of the following statements, indicate the number that best describes how you feel most of the time.
1 - Totally disagree; 2 - Disagree very much; 3 - Disagree slightly; 4 - Neutral;
5 - Agree slightly; 6 - Agree very much; 7 - Totally agree
__ 1. It is difficult to be happy unless one is good-looking, intelligent, rich and creative.
__ 2. People will probably think less of me if I make a mistake.
__ 3. If I do not do will all the time, people will not respect me.
__ 4. If a person asks for help, it is a sign of weakness.
__ 5. If I do not do as well as other people, it means I am a weak person.
__ 6. If I fail at my work, then I am a failure as a person.
__ 7. If you cannot do something well, there is little point in doing it at all.
__ 8. If someone disagrees with me, it probably indicates he does not like me.
__ 9. If I fail partly, it is as bad as being a complete failure.
__ 10. If other people know what you are really like, they will think less of you.
__ 11. If I don't set the highest standards for myself, I am likely to end up a second-rate person.
__ 12. If I am to be a worthwhile person, I must be the best in at least one way.
__ 13. People who have good ideas are better than those who do not.
__ 14. I should be upset if I make a mistake.
__ 15. If I ask a question, it makes me look stupid.
A total score of 54 and above indicates a high level of self-criticism and perfectionism, 39 is average and 24 or less represents a low level.
Source: Dysfuntional Attitude Scale by Weissman, A.N. & Beck, A. T., 1978; Imber, et al., 1990
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