All About Guilt: How It’s Connected to Health and How to Cope With It

When you think you’ve done something wrong, it can gnaw at you.

Sometimes we feel guilty because we did something that doesn’t line up with our ethics, and sometimes we’re just worried about getting caught. We can also blame ourselves for things that weren’t even in our control.

“Guilt is generally defined as a self-conscious, negative feeling over wrongdoing,” says Tina Malti, PhD, a professor of psychology and the director of the laboratory for social-emotional development and intervention at the University of Toronto in Mississauga, who researches guilt.

The American Psychological Association (APA) defines guilt as a self-conscious emotion, which it describes as reflecting on one’s self-worth or self-value. It’s “characterized by a painful appraisal of having done (or thought) something that is wrong and often by a readiness to take action designed to undo or mitigate this wrong.”

Guilt is related to but not exactly the same thing as shame.

“Shame is also a negative, self-conscious feeling, but it stems from being seen as lesser in the eyes of one’s peers or society at large,” Dr. Malti says. We feel guilty when we have devalued others, whereas we feel shame about the possibility of others devaluing us.

Jennifer Ho, PsyD, a California-based clinical psychologist, explains another difference between the two. Guilt, she says, is a feeling about an action you did that you think was wrong — a behavior that doesn’t necessarily reflect who you are on the whole. Shame is “a sense that you as a person are wrong,” she says.

Though you’ll come across different categorizations of guilt in psychological literature, there aren’t necessarily clear-cut or universally accepted classifications.

A paper from Vanderbilt University in Nashville, Tennessee, that was published in the journal Clinical Psychology Review looked at 23 definitions of guilt and 25 measures of it, and found substantive variation across studies. It also found that the way some researchers measure or define guilt actually embeds other concepts like shame, sin, and empathy that can muddy the findings. The authors note that such discrepancies are rare in the social sciences and express concern that “a lack of conceptual clarity” may make the results of studies less reliable.

Meghan Rose Donohue, PhD, an assistant professor of psychiatry at the Washington University School of Medicine in St. Louis who’s published several studies on guilt, agrees: “It’s kind of a minefield. It’s really complicated. And I think it partially reflects just how complicated it is as an emotion.”

It would be helpful if there was more consistency in the research and clarity around how researchers are measuring guilt and how they’re conceptualizing it, she says.

Despite this, the authors of the Vanderbilt University study conclude that, while the field of study contains a lot of discrepancies, guilt itself often involves a focus on one’s actions or inactions — and real or imagined moral transgressions.

And while different teams of researchers use different concepts about guilt, Malti offers the breakdown that she and her colleagues use to describe various types:

• Ethical guilt, Malti says, is driven by internalized ethical principles. If you believe that you should care for and not harm others, but you do something — or are thinking of doing something — that might cause someone pain, you may feel this type of guilt. For instance, if you’re in a monogamous relationship and are thinking about cheating on your partner, but you know they’d feel hurt, you might feel ethical guilt.
• Non-ethical guilt isn’t about your own moral compass. Instead, Malti says, it stems from concerns about getting caught and punished for your behavior. If you’re thinking about cheating on your partner and your only worry is that they’d be angry at you, you might be feeling this type of guilt.
• Neurotic guilt, Malti says, is when you feel you’ve done something wrong, but your guilt is out of proportion to the amount of wrongdoing you’ve caused. For instance, a child might feel very guilty about their parents’ divorce, even though they didn’t actually do anything that led to the split. (Some researchers also refer to guilt that’s out of proportion as “maladaptive” guilt.)

Another common term is “survivor guilt” regarding emotions about surviving a disaster or catastrophe such as a war, an epidemic, or a car crash when other people did not, as it has been defined in research. It can also be guilt about the things you had to do to survive in such a situation.

Given the aforementioned limitations of the research on guilt, it’s difficult to link the emotion to specific health outcomes with certainty. But here are some ways experts think guilt may relate to well-being.

Guilt May Affect Self-Esteem and Self-Worth

Guilt may affect your self-esteem and self-worth, and can lead to maladaptive behaviors that end up harming you, says Dr. Ho. Unaddressed guilt can lead to behaviors that affect work, relationships, and personal esteem, she says. In her clinical experience, she’s also seen it lead to behaviors that directly harm your health.

For example, she says, take someone who cheats on their partner, then holds onto their guilt for years. To avoid feeling their guilt or to engage in self-punishment, they may start to drink heavily. They also avoid being at home because they don’t feel worthy of their family’s love, so they become an absent parent to their kids. Not only does drinking more alcohol take a toll on their health but all of these behaviors further perpetuate their guilt.

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Guilt May Be Associated With Changes in the Brain

A study published in 2020 in the journal Psychiatry Research: Neuroimaging looked at the brains of preschoolers with depression. As Dr. Donohue, the study’s first author, explains: “We know that guilt is a really important symptom of early childhood depression.”

The study compared two sets of kids. One group experienced preschool-onset depression along with maladaptive guilt, while the other group had preschool-onset depression without maladaptive guilt.

Specifically, Donohue and her coauthors looked to see whether there was any sort of brain signature in the kids with excessive or maladaptive guilt by looking at two areas of the brain that are associated with guilt.

They found that those experiencing depression and guilt had significantly more cortical thinning in the dorsomedial prefrontal cortex than those experiencing depression without maladaptive guilt.

But, Donohue cautions, the study would need to be conducted with many, many more kids for the results to be considered valid and replicable. She also cautions that there is no evidence so far of causation — only an association between depression and guilt, and between guilt and thinning in the brain.

“A lot of people think guilt is automatically maladaptive. They think of it in a negative light,” Donohue says. But guilt can be a positive, healthy emotion, she adds.

“A moderate amount of guilt is typically really adaptive and healthy for your own psychological well-being, as well as your relationships with other people,” she says.

For instance, ethical guilt can help motivate you toward behaviors that are less harmful toward others.

A study that Malti coauthored, published in the Journal of Applied Developmental Psychology, looked at how this type of guilt in children might prevent them from hurting others when they feel angry. The research showed that kids who felt angry and who also felt a high degree of ethical guilt channeled their anger into screaming as an outlet — instead of into hurting another person by punching or kicking them.

“It is very common for anger to result in blowing up and harming others,” Malti says, “but this study shows that anger doesn’t always have to result in harm. We found that children prone to ethical guilt tend to redirect their anger into relatively harmless disruptive behaviors.”

The study suggests that ethical guilt may help you avoid carrying out that hurtful behavior, possibly helping your relationships with those around you.

Researchers also study how guilt and shame lead people to engage in what are called approach-oriented behaviors (such as apologizing or actively trying to repair a situation) and avoidance-oriented behaviors (such as keeping something a secret), says Brian Lickel, PhD, a social psychology professor and the director of the human relations lab at the University of Massachusetts in Amherst.

A study he coauthored in the journal Emotion suggests that guilt has been more often linked to approach behaviors and shame to more avoidant behaviors. Therefore, guilt is often considered more adaptive than shame in many instances.

So not only can ethical guilt prevent you from letting anger turn into violence, it can motivate you to apologize when you do something harmful.

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But guilt isn’t always helpful or healthy — it depends on the type of guilt. Feeling guilty when you didn’t actually do anything wrong — as in the child who feels guilt around their parents’ divorce — is considered unhealthy, Malti says.

As in Ho’s example of the person who cheated on their partner and then starts drinking and spending time away from their family, unaddressed guilt that becomes chronic might also lead to avoidant behaviors, not just approach ones.

Lastly, survivor guilt can be harmful. A study in the Journal of Loss & Trauma showed that guilt about surviving is often intense and distressing for the person experiencing it, and may be associated with having more severe post-traumatic stress disorder.

If you’re feeling bogged down by guilt, below are some tips to help you figure out which type of guilt you’re experiencing and what might help you move through it.

“Healing from guilt can be painful,” says Ho, “but like a wound, it can fester if unaddressed.” In addition, she says, “Guilt often hides other deeper, more painful emotions, and recognizing them can alleviate guilt.”

She recommends the following strategies to help you figure out the nature of your guilt — whether it’s based on actual wrongdoing of yours or is excessive or doesn’t match up with what happened — and what actions and reflections might help you next:

1. Ask yourself if the event you feel guilty about was foreseeable. In traumatic incidents, Ho says, such as sexual assault and war, people may take on an inordinate amount of guilt. Asking yourself if the event was foreseeable can help you determine whether your guilt is justified. (“Sexual assaults are rarely ever foreseeable,” she says. Nor are they the survivor’s fault.) There is often no way you could have predicted what would happen at the time, and you can give yourself space to grieve or feel sad over what happened, she says. And if you’re feeling guilt about someone harming you, consider whether a different emotion might be more helpful, such as anger at the person who hurt you, rather than feeling guilty and blaming yourself.
2. If it was foreseeable, ask if you intended it to happen. If you didn't intend something, Ho says, then give yourself space to feel regret.
3. If you did intentionally do something harmful, remember that there’s more to you than this. Guilt might be appropriate if you knowingly did something harmful, Ho says, but that doesn’t mean you’re a bad person or that the guilt should consume you. She suggests asking yourself: Would a jury sentence me as harshly as I’m sentencing myself? What positive things have I done for people? This question can help you steer away from thinking that this one event defines you as a person: It doesn’t.
4. Consider what you can do to repair the situation. If you’ve determined that you did intentionally harm someone, holding yourself accountable and engaging in reparation work can help. Ask yourself what makes sense for the situation: Can you apologize, donate money or something else, or volunteer to help someone? Making amends can be healing for both you and the person or people you’ve harmed, says Ho.
5. Try self-compassion and acknowledge that forgiving yourself may feel nerve-wracking. Ho points out that forgiving yourself can sound scary and overwhelming. If your guilt has become chronic, realize that the identity of being a “bad” person may feel familiar by now. Ask yourself if you’re holding onto guilt out of fear of what being a “good” person might entail.
6. Ask what systemic forces contributed to your behavior. Ho says it’s extremely important to examine the larger forces surrounding what you did. Were you experiencing hardship? Influenced by the larger culture? “Understanding that individual actions are influenced by the system that we are in can garner greater understanding and self-compassion,” she says.

If you still feel wracked by guilt after this series of self-reflection questions and actions, Ho says, speaking with a therapist can help.

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