My self-esteem gets distorted when I am in pain.  Maybe I am having an anxiety attack or meltdown. I am overstimulated. I'm having a trauma flashback. Rejection dysphoria is keeping me from seeing the big picture. Or maybe it's something else. Whatever the cause, the pain can make me see myself differently.

For example, when I am in pain, I can't always tell the difference between the pain and low self-esteem, or how each is impacting my thoughts and feelings. If I want to disappear, is it because I'm feeling so critical of myself? Or because the pain is so bad? If I'm in pain, is it a result of my bad self-esteem? Or is my bad-self esteem being caused by the pain? Everything is mixed up, and meanwhile, the pain is making it hard to think at all.

Eventually, I come out of the period of pain, but the confusion lingers. And the confusion definitely does impact my self-esteem.

Share questions (it's okay to think out loud):

• Do your self-esteem or sense of self change when you are in physical and/or mental pain?
• What is the relationship between pain and self-esteem in your life?
• Where does pain arise in your life? From your surroundings? Thoughts? Neurobiology? Trauma? Other?
• When you think back on a time when you were in pain, how do you remember your self-esteem/sense of self at the time?
  
• Any tools, resources, or strategies that helped you think about these or similar things?
• Anything else to add?