Dr. Khalid Hassan | A clinical reflection from therapeutic work at Dr. Khalid Mental Health Clinic
In many families, there may be someone known as difficult, quick to anger, sensitive to criticism, or constantly caught in tension and conflict. The usual questions are often simple: Why did you do that? Why did you speak like that? Why do you make a problem out of everything?
But sometimes the deeper clinical question is different: what happened to this person until their behavior took this shape? This question does not justify harm, and it does not remove responsibility. It simply opens a fairer doorway into understanding. Some behavior that appears disturbing or exhausting may actually function as a defensive strategy in a self that has been worn down by repeated boundary violations and has not found someone who truly hears it.
This is where the article begins: understand the story before judging the behavior.
In clinical work, after this first doorway, we may meet a person who says: “I do not trust myself,” “I feel less than other people,” “I am afraid to speak,” “I am afraid to upset people,” “I blame myself very quickly,” or “Sometimes I get very angry, and then I deeply regret it.” At first glance, the problem may look like low self-esteem only. But when we listen calmly, return to the person’s psychological history, and examine how their relationship with themselves and others was formed, the picture is often deeper than low confidence or a personality problem.
In some cases, the story is not a defect in character. The person may have passed through a stage where they tried to defend themselves, refuse, object, or say: enough. There may have been an internal moment where they tried to move out of excessive submission, people-pleasing, fear of rejection, or an image that had been imposed on them. We can call this moment defiance, but not in the sense of chaos, disrespect, aggression, or a desire to break others. It is better understood as an objection, a defensive strategy, and an early psychological attempt to reclaim the self.
The problem is that this defiance does not always find an environment that understands it. Sometimes it is met with ridicule, intimidation, accusation, humiliation, or descriptions such as sensitive, difficult, ungrateful, disrespectful, or unable to appreciate what is done for them. With repetition, the person begins to doubt themselves: am I really bad? Am I unfair? Is my anger wrong? Does refusing something mean I am ungrateful? Will defending myself break the relationship? Does saying no make me unlovable?
Here begins one of the most complicated cycles of low self-esteem: the person does not only lose confidence in themselves; they lose reassurance about their own right.
Low Self-Esteem Is Not a Simple Phrase
Low self-esteem does not only mean that a person does not see themselves as beautiful, successful, or loved. In many cases, it is deeper than that. It may mean that the person feels they do not fully have the right to have an opinion, to refuse, to get angry, to ask, to set boundaries, or to say: this hurt me.
The person may look calm on the outside, while internally they are living inside a constant court of judgment. They review every word they said, punish themselves for every situation, feel guilt after every objection, and treat every moment of anger as evidence that they are a bad person. This is deeply painful because the person is not only suffering from low confidence; they are suffering from a disturbed relationship with their right to psychological existence.
The Station of Defiance
In the history of many patients, there is an important station: a stage where the person begins to feel internally that they can no longer continue in the same way. They no longer want to please people all the time, remain silent about everything, live in constant fear of upsetting others, or always be the person who carries, understands, justifies, and gives in.
This stage, in itself, is not necessarily pathological. It may be an objection and a defensive strategy in a self exhausted by repeated boundary violations and unable to find someone who listens. When the self is exposed to prolonged pressure, it may try to reclaim its boundaries and say: I exist, I have an opinion, I am in pain, I do not accept this, and I am not merely someone required to please everyone.
But this attempt needs a mature environment, or at least someone who helps it grow in a balanced way. If it finds understanding and containment, it can develop into maturity. If it is met with suppression, ridicule, or intimidation, it may break. If it is left without guidance, it may turn into defensive anger that exhausts the person and those around them.
How Does Defiance Break?
Defiance breaks when the person learns that defending themselves is dangerous. They say no and are accused of having changed. They get angry and are told they lack respect. They set a boundary and are told they are harsh. They ask for their right and are told they are selfish. They object and are told they are overly sensitive. They feel pain and are told they are exaggerating.
Over time, the person no longer hears a situation only as it happened; they hear it through old voices that have accumulated inside them. A small situation today may move an entire history inside them. A small word of criticism may be heard as a complete condemnation of their person. A simple disagreement may feel like a threat to the relationship. An ordinary request may make them feel like a burden, and a natural moment of anger may feel like evidence that they are a bad human being.
The person becomes trapped in an exhausting cycle. If they stay silent, they hate themselves for being silent. If they speak, they fear they have been unfair or exaggerated. If they withdraw, they punish themselves for withdrawing. If they confront, they feel guilty. If they please people, they become tired of themselves. If they please themselves, they fear losing people.
The First Path: Harsh Confrontation
Some people, when their defiance breaks, do not withdraw. Instead, they move into a state of constant defense. They become easily provoked, highly sensitive to criticism, and may interpret every comment as an insult, every disagreement as rejection, every delay as neglect, and every piece of advice as an attempt to control them.
They do not necessarily want to be harsh. Internally, they may feel that if they do not defend themselves strongly, they will be crushed again. So they enter confrontation quickly. They may raise their voice, explain more than necessary, justify more than necessary, and try to prove that they have a right even in situations that do not require such a battle.
From the outside, they may appear difficult, exhausting, or overly sensitive. From the inside, they may be afraid of returning to an old place: the place of silence, injustice, and erasure. Here, simply advising them to calm down is not enough. Anger is not the whole story. Sometimes anger is the guard standing at the door of an old wound.
Treatment does not begin by condemning the anger. It begins by understanding its function. What is this anger trying to protect? What is the person afraid of losing if they do not become angry? Who made them feel that calmness means surrender? And when did self-defense become something that can only happen in a loud voice?
The Second Path: Painful Withdrawal
In other cases, defiance does not turn into confrontation. It breaks and becomes withdrawal. The person does not confront much; they stay silent, smile while distressed, say “okay” while internally broken, apologize even when they are not wrong, and think for a long time before asking for the simplest need.
This person may seem kind and peaceful, but this kindness is not always entirely a choice. Part of it may be fear: fear of rejection, fear of upsetting others, fear of being misunderstood, fear of being a burden, and fear that if they say no, they will feel like a bad person.
Over time, they pay a heavy price. Bitterness accumulates inside. Self-blame increases. The sense of worth decreases. Symptoms may begin to appear: anxiety, sadness, exhaustion, sleep disturbance, poor concentration, or withdrawal from relationships. They do not want to lose people, but in the process of trying to keep people, they may lose themselves.
The Inner Conflict: Am I Bad, or Do I Have a Right?
One of the most complex things we see in these cases is that the person becomes trapped between two internal voices. An old voice tells them that they are bad, too sensitive, difficult, ungrateful, exaggerating, unable to tolerate anything, or the cause of the problem. Another quieter and deeper voice says: but I was hurt; I had a right; I needed someone to hear me; I needed someone to protect me; I needed to say no; I needed not to be blamed for everything.
The problem is that the first voice is often louder. It was repeated many times, came from important people, entered early, and transformed from words said outside into an internal judge living inside the person. So when the patient tries to defend themselves, they are not only facing other people; they are facing an internal judge telling them: be careful, you are going to become bad.
Here appears an important therapeutic knot. How does the person learn to have a right without becoming unfair? How do they say no without drowning in guilt? How do they get angry without becoming afraid of themselves? How do they set boundaries without turning every relationship into a battle? And how do they acknowledge their wound without allowing the wound to lead their entire life?
Why “Trust Yourself” Is Not Enough
People with low self-esteem often hear phrases such as: trust yourself, do not care about what people say, be strong, love yourself. These phrases may be well-intentioned, but they are often not enough.
The problem is not always a lack of information. The person knows they need to trust themselves. They know they are exhausted by sensitivity, withdrawal, and guilt. They know that self-blame wears them down. But they do not know how to stop the internal court. They do not know how to feel safe while refusing, how to disagree without panic, how to get angry without feeling they have lost their morals, or how to set boundaries without feeling they have lost their worth or the love of others.
Therapeutic work here cannot be built on general encouragement only. It requires a precise understanding of how the problem was formed. When did the person begin to see themselves this way? Who taught them that objection is dangerous? How did love become linked to obedience? How did acceptance become linked to pleasing others? How did anger become synonymous with guilt? And how did boundaries become something frightening?
When Defiance Calms Down, and When It Becomes Distorted
It is important to be clear. The goal is not for a person to become defiant toward everything, cut off their relationships, always see themselves as a victim, use their wound as an excuse to harm others, or turn every disagreement into confrontation. That is not maturity.
When defiance becomes distorted, it says: I will not allow anyone to come close to me; every criticism is an insult; every request is exploitation; every disagreement is a threat; I must win in every situation. But when defiance calms down and finds understanding, it says: I hear you, but I have boundaries. I understand your position, but I cannot accept this. I respect you, but I will not erase myself. I may become angry, but I do not want to harm. I may refuse, but I do not need to hate you in order to refuse.
This is the precise therapeutic point: self-defense can shift from a hurtful reaction into a calmer capacity for choice.
Boundaries Are Not Cruelty
Many people with low self-esteem feel that boundaries are a form of cruelty. If they do not reply immediately, they feel neglectful. If they decline a request, they feel they are falling short. If they refuse a visit, they fear they are cutting family ties. If they ask for their time to be respected, they feel arrogant. If they stop a harmful discussion, they fear they cannot tolerate anything.
But boundaries are not against compassion. Sometimes they are a condition for compassion to remain possible. A person who has no boundaries may, over time, become drained, angry, exhausted, or withdrawn. They may give too much and then collapse, remain silent for a long time and then explode, or please people until they lose the ability to know what they actually feel.
Balanced boundaries do not say to others: you do not matter to me. They say: I am also a human being. I also have energy. I also have space. I also have a right to respect.
How Does This Appear in Daily Life?
Low self-esteem may appear in this form in very small situations: a person who cannot ask for their financial right without tension, apologizes for everything before even knowing whether they were truly wrong, accepts harmful relationships because they fear loneliness, or collapses after a small criticism because they hear it as a complete judgment on their worth.
It may also appear in the person who over-defends themselves because, internally, they do not believe their right is obvious; the person who avoids calls and meetings because they fear evaluation; the person who keeps explaining themselves because they do not feel understood; the person who fears saying no and then spends days internally punishing themselves; or the person who becomes very angry, then feels shame after the anger and decides to become silent again.
These are not minor details. They are signs of an exhausted relationship between the person and themselves.
What Happens Inside Therapy?
In therapy, we usually do not begin by forcing the person into confrontation, asking them to forgive quickly, telling them that everything is because of their family or society, or reducing the story to a quick diagnosis. We begin with understanding.
We try to see the person’s internal map: how they see themselves, how they hear criticism from others, how they interpret anger, how they deal with guilt, what kinds of relationships repeatedly trigger withdrawal or explosion, what old sentences still live inside them, and what situations suddenly make them feel like a small child facing a large authority.
After understanding, work begins on building a more balanced internal space. A space that allows the person to say: I am not bad simply because I became angry. I am not selfish simply because I refused. My pain is not evidence of my defect. And I am not required to remain silent in order to be loved.
Then comes calm training in practical skills: how to say no clearly, express distress without accusation, distinguish healthy guilt from old guilt, recognize over-defense, apologize when wrong without self-contempt, protect oneself without being unfair to others, and set boundaries without entering a war.
These steps do not happen all at once. A wound built over years does not change through one sentence. But it can change when the person finds safe understanding, organized assessment, a suitable treatment plan, and enough continuity.
When Is Professional Assessment Needed?
Not every decrease in self-esteem requires long-term therapy. But professional assessment becomes important when it begins to disrupt life: avoiding study, work, or relationships because of fear of evaluation; persistent harsh self-blame; ongoing sadness, anxiety, or sleep disturbance; repeated relationship problems linked to sensitivity to criticism; inability to set boundaries despite being hurt; anger that harms the person or those around them; repeated shame or worthlessness; or thoughts of self-harm or wishing for death.
In such cases, it is better that the person does not remain alone with their harsh interpretations of themselves. A structured psychological assessment may clarify whether the picture is linked to anxiety, depression, the effects of trauma, an early relational pattern, social anxiety, or a mixture that needs a clearer plan. Correct understanding is not a luxury. Sometimes it is the beginning of leaving a cycle the person has been repeating for years.
A Message to the Person Trapped Between Guilt and Their Right
If you are reading this and feel that it touches something inside you, perhaps you do not need to choose between being silent and being aggressive. There is a third path: to be clear without cruelty, compassionate without submission, able to hear others without erasing yourself, able to acknowledge your mistakes without despising yourself, and able to understand your wound without allowing it to lead all your decisions.
Perhaps the problem is not that you are deficient or bad. Perhaps inside you there was a defiance that became frightened, distorted, or broken before it had the chance to mature. Maturity here does not mean returning to the way you were, taking revenge on everyone who did not understand you, or proving your right in every situation.
Maturity means reclaiming yourself calmly. It means learning when to speak, when to remain silent by choice rather than fear, when to come closer, when to create distance, when to apologize, when to stop apologizing, when your anger is a message that needs to be understood, and when the anger itself needs refinement.
This is not an easy journey. But it is possible. Sometimes the beginning is one sentence heard with sincerity: you are not bad simply because you tried to protect yourself.
Important Note
This article is for psychological education and does not replace direct clinical assessment. If low self-esteem is accompanied by severe depression, thoughts of self-harm, wishing for death, severe impulsivity, uncontrolled anger, psychotic symptoms, substance use, or clear deterioration in sleep, eating, or daily functioning, the priority is urgent medical assessment or attending the nearest emergency medical service depending on the severity of the situation.
Dr. Khalid Mental Health Clinic
Dr. Khalid Mental Health Clinic provides remote psychological assessment and follow-up services, with special attention to understanding the Sudanese context, respecting privacy, and building a clear treatment plan suitable for each patient.