After reading your stories and those of some of the people you interview, it seems to me like admitting to other people that you experience self-loathing can be just as fraught as experiencing it. So what made you decide to write this book?

Watching how much my mother suffered. She died in 2011 without "recovering" from her low self-esteem. I gave her a memorial service that 75 people attended, and people kept coming up to me and saying, "Your mother was wonderful." They were sobbing and I thought, my god, if Mom was here she would still argue, "Well, they don't know the real me." That experience, plus my own life, made me realize how much so many people suffer with this.

In the book you talk about the historical trajectory of self-esteem, which wasn't always such an oft-discussed thing. What was life like for you in those pre-self-affirmation days?

I was in elementary school in Los Angeles around 1966. The world was waking up and there were hippies and such, but for kids it was still the old days. It was a time of discipline, obedience, and respect for grown-ups. Kids' "selves" were not a topic. Self-esteem was just a word; it was alien, abstract. Los Angeles in the seventies was a very looks-centric time, just as this is a very looks-centric time, and I felt like an ugly outsider—but in those days it was pretty common for girls to say things like, "Oh, I'm the most hideous person at the beach!" Everyone did that.

It wasn't until college when I met the person that I'm now married to that I started to feel like an extreme case. He was very complimentary and absolutely did not understand when I argued with him. He'd tell me, "Your problem is not that you are ugly or a bad person. Your problem is that you think that." But like a typical person with low self-esteem, I refused to accept it until very recently.

What is reality for someone who is self-loathing? Because in a sense, the self-loathing person believes that he or she is the realist.

It depends on the person and what their fixation is. Some people think they're really stupid; some people think they're weak; some people think they're ugly. Whatever it is, it colors their daily life. You dress as fast as possible to hide your body without looking at yourself in the mirror because you can't stand it—and then you've put on an outfit that maybe isn't the most flattering. You become fake because you're covering up your own self-loathing, and you can't really pay attention to your spouse, or your boss, or the friend that you're going out with, since part of you is absorbed in, how do I look? How do I sound? Terrible?

That reminds me of an anecdote in the book about the man whose partner moved across the country to be with him, but he still felt insecure about their relationship. He sent text messages and left Post-It notes all over the house and in his boyfriend's car asking, "Do you love me?" over and over again. How does self-loathing affect people's relationships, whether familial, or romantic, or professional?