During an investigation into the self-esteem of early rheumatoid patients and controls matched individually by age and sex, it was found that at their first visit to out-patients, patients had lower self-esteem. The items of low self-esteem showed a similarity with features of the rheumatoid personality. An observation that the word attractive in the Carlson Adjective Checklist was rarely used by both groups, and that items at the beginning and end of the checklist were less often ticked, led to a second study of 67 undergraduates where the position of the word attractive was experimentally varied in three forms of the scale. The results show that position only marginally affects response to this item. Probability analyses confirm that the word attractive is used very rarely by patients, rarely by healthy adults and less often than expected by healthy students, possibly demonstrating the respective effects of pain and illness, and age. Attractive tends to be included in the self-concept only after self-esteem reaches a relatively high level.