THIS IS WHERE I'D PUT MY HEALTHY SELF-ESTEEM... IF I HAD ANY! Those with Narcissistic Personality Disorder may act like they have lots of self-esteem, but psychiatrists argue they lack real and stable self-esteem, and compensate by feigning it. They over-value what little esteem they do get, pseudo-esteem or real, and fiercely guard it out of anxiety. With a tendency to see their worth as all-or-nothing, they may flip between conceitedness and feelings of worthlessness, leading to anger-storms and depression.