Worthlessness

Worthlessness can be described as a feeling of desperation and hopelessness. Individuals who feel worthless may feel insignificant, useless, or believe they have nothing valuable to offer the world. People diagnosed with depression often report these feelings, and children who were neglected or abused may carry a sense of worthlessness into adulthood. When worthlessness leads one to experience thoughts of suicide or causes other immediate crisis, it may be best to contact a crisis hotline or seek other help right away. 

• Understanding Worthlessness
• Psychological Issues Associated with Worthlessness
• Therapy to Address Worthlessness
• Case Examples

Understanding Worthlessness

Worthlessness, a feeling that may cause an individual to feel as if they have no significance or purpose, can have a significant negative effect on emotional health. A recent study conducted by researchers at Seoul National University found that feelings of worthlessness were significantly associated with lifetime suicide attempt in adults who reported major depression and had also experienced trauma. The study concluded that, among symptoms of depression, worthlessness had the strongest association with lifetime suicide attempt.

Feelings of worthlessness may develop into a prolonged state of negative mood, but they can also affect physical health. A study evaluating the relationship between mortality and worthlessness in Chinese men 65 and older found worthlessness, out of all other symptoms of depression, was the only independent predictor of non-suicidal mortality in the approximately 2,000 individuals studied. Five years after the study, 18.2% of the men who had reported feelings of self-worthlessness, but only 9.9% of the men who did not report feeling worthless, had died. This may be due to a variety of reasons, such as the likelihood that individuals experiencing feelings of worthlessness may be less likely to seek preventative health care or engage in health-promoting behaviors and may be more likely to smoke or engage in other behaviors shown to negatively affect health. They may also be more likely to lack social support. The study's authors suggested worthlessness should be recognized as a risk factor in mortality, especially in Chinese men older than 65.

Psychological Issues Associated with Worthlessness

In the Diagnostic and Statistical Manual, worthlessness is associated mainly with depression, but these feelings might also appear as symptoms of schizophrenia, anxiety, or on certain personality spectrums. Strong feelings of worthlessness in children may be indicative of peer conflicts or neglect or abuse and should be taken seriously.The feeling of worthlessness may also be related to other feelings, including hopelessness, guilt, persistent sadness, or loss of motivation.

Worthlessness may present in different ways. An individual might experience: 

• Heavy, dull pain in the body
• Negative thoughts about oneself
• Tearfulness, despondency
• Social anxiety
• Loss of life purpose, diminished interest in life
• Thoughts of suicide

An individual who feels worthless may:

• Withdraw from relationships
• Abuse alcohol or drugs
• Have diminished emotional expression
• Continually verbalize negative thoughts
• Become lethargic
• Neglect self-care/activities of daily living, such as showering, eating, and washing one's clothes

Therapy to Address Worthlessness

When one's feelings of worthlessness go unaddressed, they may rapidly become overwhelming and interfere significantly with the ability to function. It may be difficult to cope with these feelings without professional help, and when worthlessness occurs as a symptom of depression or any mental health condition, other than immediate crisis, therapy is often beneficial. 

Cognitive behavioral therapy, a type of therapy that helps individuals adjust their thoughts in order to positively influence emotions and behavior, has been shown to be effective for treating feelings of worthlessness. Treating the condition that worthlessness occurs as a symptom of can also be a helpful method of treating feelings of worthlessness. When an individual experiencing depression receives treatment for depression, for example, feelings of worthlessness are likely to abate.

Case Examples

• Feeling unlovable and insignificant: Greta, 29, sees a therapist. She reports that she feels like crying all the time and that once she starts crying, she finds it difficult to stop. She feels insignificant, believing no one cares for her, and she tells the therapist she thinks she has no value as a person and no one will ever love her. Antidepressants, prescribed by a previous therapist, have helped her a little, but she says they cause her to feel anxious and lose sleep. They also have sexual side effects, and Greta believes her last relationship ended as a consequence of these side effects, which led to an increase in her feelings of worthlessness. She says she has considered suicide briefly, but not seriously, and admits to the therapist that she drinks too much and too frequently. After a few sessions, Greta reveals a sense of frustration with the path her life has taken and deep feelings of anger toward her parents, whom she describes as critical and distant. She tells the therapist that she chose her college and career in an attempt to win their approval, but her plan failed, leaving her unhappily employed at a job she does not enjoy. Therapy—and hard work in her personal life—helps Greta develop a sense of competence and increases her motivation to work toward what she truly desires for herself. This strengthens her sense of self, and she reports feeling hopeful for the future, which, she tells the therapist, she thought she would "never feel again." 
• Experiencing worthlessness while questioning sexual orientation: Derek, 14, is brought to therapy by his parents, who report that he shows little emotion, has withdrawn socially, and is suddenly performing poorly in school. His parents suspect drug use, telling the therapist that Derek's older sister showed the same signs when she was using drugs, but Derek strongly denies any drug use. The therapist meets alone with Derek and discovers he is questioning his sexual orientation and is afraid to tell his parents, who, he states, will not "let" him be gay. He tells the therapist there must be something wrong with him, and he must have a "disease" that makes him "think about other boys." Through several sessions, the therapist works with Derek to address the negative beliefs he holds, relaying facts about sexual orientation without trying to convince Derek of anything. He tells Derek many young men have thoughts about other boys as part of normal sexual development, whether or not they later identify as gay, bisexual, or queer. He also tells Derek research has shown homosexuality is a normal sexual orientation, not a disease or an illness. After a few sessions, Derek reports an improvement in his depressed mood. He has been able to focus on his schoolwork and household responsibilities, and his parents are pleased with his progress. He tells the therapist he is not yet ready to tell them what caused his distress. Derek also expresses a wish to join a queer youth group, and the therapist helps him find a group nearby. Derek continues to attend therapy sessions on occasion and reports that the youth group is extremely helpful. 

References:

1. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
2. Mental Health; Investigators from Seoul National University Report New Data on Depression (Feelings of worthlessness, traumatic experience, and their comorbidity in relation to lifetime suicide attempt in community adults with major depressive disorder). (2014, August 11). Mental Health Weekly Digest, 44.
3. Wong, S., Leung, J., & Woo, J. (2011). Main content area The relationship between worthlessness and mortality in a large cohort of Chinese elderly men. International Psychogeriatrics, 609-615. http://dx.doi.org/10.1017/S1041610210000724