Recently researchers have been looking as much at the depression and lack of motivation (negative symptoms) associated with schizophrenia as at the delusions and hallucinations (positive symptoms) that are usually associated with it. One factor that may contribute to, or be influenced by, depression and lethargy is low self-esteem. Some researchers think that paranoia actually protects against low self-esteem - 'it's not my fault everyone is conspiring against me' - while others argue that people's self-esteem falls as their symptoms get worse. A team of German researchers studied this issue in a sample of 102 people, 58 of whom had schizophrenia. The people with schizophrenia were much more likely to suffer from low self-esteem. Being depressed at the start of the study and taking more antipsychotic drugs were both associated with lower self-esteem after 4 weeks. Drugs might make people's self-esteem worse because of their chemical effects in the brain or because they lead people to develop unpleasant and undignified side effects such as weight gain and drooling. Paranoid ideas were found not to be related to self-esteem although there was a modest link between grandiose delusions and higher self-esteem.
Moritz, Steffen ... [et al] - Course and determinants of self-esteem in people diagnosed with schizophrenia during psychiatric treatment Psychosis June 2010, 2(2), 144-153