By Matt Villano, CNN

(CNN) — Psychiatrist Dr. Blaise Aguirre has become an expert in self-loathing.

No, it’s not because he experiences self-hatred. It’s because he has spent decades studying what he considers an epidemic of adolescents who do.

Aguirre, a longtime child and adolescent psychiatrist at Mass General Brigham’s McLean Hospital in Belmont, Massachusetts, spotlights this research in his new book, “I Hate Myself: Overcome Self-Loathing and Realize Why You’re Wrong About You. ”

Also an assistant professor of psychiatry at Harvard Medical School, Aguirre provides a crash course in self-hatred, explaining what negative self-talk really is, where it comes from, how it can damage a young person’s mental health, and how parents and caregivers can help their teens get through the struggle and learn more constructive ways of thinking.

While it’s certainly a trying time to be a teenager, Aguirre knows it’s not just societal pressures that make life hard. Early experiences and parenting styles can also shape a child’s self-perception and emotional health.

But it’s possible for parents to protect their kids against some of that self-hatred, Aguirre said. And for kids who have experienced self-loathing, it’s also possible for them eventually to reclaim their self-worth.

One type of proven treatment is known as dialectical behavior therapy, or DBT. This is one of Aguirre’s areas of expertise. As founding director of McLean’s adolescent DBT program, called 3East, he put together an array of DBT programs to target reducing self-endangering behaviors as well as the symptoms of borderline personality disorder traits. Aguirre said this approach has saved lives.

CNN recently talked with Aguirre about teens’ self-hatred and why self-perception is such a huge part of how they interact with the rest of the world.

This conversation has been lightly edited and condensed for clarity.

CNN: What is self-hatred?

Dr. Blaise Aguirre: Most people have experienced dissatisfaction in their lives and in themselves. You can have a degree of self-criticism in certain contexts, and that happens to everybody. That’s just part of the human experience.

But what if from very, very early on you were told that you were just not good enough, that you were flawed as a human being? And maybe it wasn’t overtly stated, but it was implied in some way, or at least that as a young mind that’s the way that you interpreted things. Lots of things can lead to that. If somebody has a learning disability, a physical disability or a mental disorder, they can just feel that they’re not good enough. They might think, “I’m not fast enough, I’m not pretty enough, I’m not strong enough.”

There are lots of ways in which we can be unhappy with ourselves. But when the idea of not being enough is so profound that it becomes embedded in how you see yourself and pervades your entire being, it can become self-hatred. When that happens, self-loathing starts to impact a lot of the decisions you make, the jobs you apply to, the schools you go to, the romantic partners you pick. I’m talking about something that is embedded in the core of who a person is. That’s what self-hatred is all about.

CNN: What causes this self-hatred?

Aguirre: Some people have asked me: “Is there a biological underpinning to self-hatred?” The one thing that I’ve seen is that almost all the people I meet who experience core self-hatred are highly sensitive people. People who have big emotional reactions to seemingly small events seem to be much more vulnerable to interpreting the world in a very negative way — and then embedding that interpretation into their concept of self.

Independent of that, in all my interviews, no one reported developing self-hatred in adulthood. It all started somewhere in kindergarten, or in someone’s early years, in middle school. Many of them were young women, many of them had physical and sexual abuse, many experienced a lot of hurtful bullying. Without somebody being there for them, they embedded this information into their minds.

Because they didn’t have perspective, they came to the natural conclusion that there was something very flawed about who they are. It just became integrated in their sense of self. If you teach a young child that 1 + 1 = 3 and you keep teaching it and at the end of the year you give them an exam and you say, “What’s 1 + 1?” they’re going to say it’s 3. The message that they learn, whether intentional or not, is that they’re not worthy and they’re deserving of self-criticism. Once you’ve got this certainty integrated into your sense of self, you’re going to filter all future interactions through that lens.

CNN: To what extent does technology contribute to the problem?

Aguirre: Big companies have learned how to use technology to market to self-hatred. The messages are: You’re not tall enough, you’re not pretty enough, your skin doesn’t look young enough, you’re not thin enough, you’re not strong enough, your muscles aren’t big enough, and you’re not smart enough.

These messages also imply, “If you buy my product, you’re going to be so much better.” That is problematic. We must pay attention to how much we are sending young people the message that if they just did this, they’d be better.

CNN: How is self-hatred different from depression?

Aguirre: Somebody who’s depressed might be very dissatisfied with their life during their episode of depression and say, “I hate how I’m living” or “I hate that I’m not getting out of bed and going to work.” It’s not self-hatred per se, but it’s hatred of the impact of depression, hatred of the circumstances.

For people with core self-hatred, even when depression is treated, the self-hatred persists. I’ve worked with patients who have eating disorders; a lot of these people are perfectionistic and hate themselves because they believe they aren’t the right body size or shape or weight. But when people with eating disorders also have core self-hatred, even when you treat the eating disorder, the self-hatred persists.

There are certainly situations where after you treat an underlying mental health condition the unhappiness and dissatisfaction lifts. But with people who experience core self-hatred, people who have an underlying “undeservedness” and shame, even when you treat the underlying condition, it doesn’t lift.

CNN: To what extent can medication help?

Aguirre: What I see as a psychiatrist is that many of the young people who experience self-hatred are often highly sensitive people who come in on polypharmacy, meaning they are currently taking lots and lots of different classes of medications. With some of them, I’m impressed by the fact that they’re still standing. I think that what happens is that to alleviate the pain of emotional suffering, they go from psychiatrist to psychiatrist hoping to find something that’s going to take away the pain.

Where psychopharmacology sometimes does a person a disservice is how it numbs the person from the pain. If you have a toothache and I keep giving you painkillers to numb the toothache, I might be doing you some damage because you could have an underlying infection that is eventually going to erupt. Numbing a person from their feelings isn’t the right treatment for self-hatred. Self-hatred doesn’t shift with medication.

CNN: What is the right treatment for self-hatred?

Aguirre: For starters, we experts can do a better job of asking about it. In a standard psychiatric questionnaire, they’ll ask you about hearing voices, eating habits, sleeping habits, self-care, energy and guilt. No one asks about self-hatred. In psychiatric evaluations, asking about self-hatred is not standard. We don’t ask about it because patients don’t bring it up — because it’s embedded. They are aware it’s there, but they don’t see it as separate. They don’t see how it’s a problem. We need to target self-hatred in mental health.

We also can do a better job of giving people tools to deal with self-hatred. I use a form of treatment known as dialectical behavior therapy, or DBT, for people who are self-injurious and self-destructive. DBT has four skill sets: mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance.

Many parents will tell you that their children come into DBT treatment without skills and leave with new abilities. For most kids, the ability to apply DBT skills to life’s circumstances and context works very, very well.

We see reductions in suicidal thinking, reductions in self-injury, a better ability to tolerate distress and all those sorts of things. For a lot of those kinds of behavioral deficits, teaching you the skills that are going to manage that deficit is the way to go.

CNN: How can parents change their approach to make things easier for kids experiencing self-hatred?

Aguirre: Validation is important. When a child is really struggling, to authentically listen and not try to reassure them, that can make a difference. Try not to say, “You’re lovable. You’ve got lots of friends. You’re going to be OK,” and instead listen to how painful things are for them.

When they’re done, sit with them and then ask, “Are there things that I’m doing that are perpetuating this? Tell me more about how difficult it is.” The idea is to sit with them without trying to solve the problem, at least until they feel heard and you have a deep understanding of the problem. For highly sensitive kids especially, just listening so that the child begins to have a sense of emotional safety is key. It can make a huge difference on the road to liking themselves a little more.

Matt Villano is a writer and editor based in Healdsburg, California.

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