The Depression Symptom We Don't Talk About Enough

I sat in my van whispering through a conversation that had happened earlier in the day. Had I been too self-centered? Am I often that way?

My mind spiraled over and over through my words, tracing with it a string of similar incidents when I had acted self-centered. My heart raced. Was it ironic that I was showing self-obsession over my own self-focus?

I stopped. I closed my eyes. Focused on my breath. My breath was all I needed to focus on in the moment. I remembered that depression often causes my mind to replay these memories, and that I have committed to living my values, including one of accepting imperfection. I am human!

I felt my breathing slow to normal. The angry tension in my hands was released. Depression did not win this time.

Depression Mixed With Excessive Guilt

Excessive guilt is an often-overlooked symptom of depression, even by clinicians. It's one that is not always volunteered in sessions. Guilt pairs well with shame leading individuals to hide it. Yet, excessive guilt is a common symptom of depression with worsened symptoms of depression correlating with higher levels of depression (Ghatavi et al., 2002). It is insidious.

On the mild side, it may show up as a little extra self-consciousness or sensitivity. At its sharpest, it can lead a person to "delusions of ruin" (Bürgy, 2018), a condition often correlated with thoughts of suicide. Depression mixed with guilt can convince someone that they are worthy of death, that they have destroyed their life to a point of no return, or that others would be better off without them.

It's important to consider what guilt is before we outline a strategy for coping. Guilt is a prosocial emotion that emerges when we have harmed one another or otherwise broken our moral compass. It plays a role in assisting us in living a life that reflects our values.

But depression can take this healthy emotion and twist it into something quite different. Rather than positive reflection, depressive guilt is associated with painful rumination. Its focus is broad allowing someone to travel in their mind back to missteps that may have happened decades ago, playing the story over and over.

Depressive guilt can form around anything including many things that do not break our moral compass. It can cause someone to feel guilt where guilt is not warranted. Depression can even bend our perceptions such that we feel responsibility for things we have had no control over.

Since we remember best what we focus on, someone struggling with depression and this challenge will often report that their memories consist of all the mistakes they have made. The many successes and redeeming moments in one's life can be swept over and not remembered.

While healthy guilt drives us toward positive change, depressive guilt often results in withdrawal and isolation. When extreme, a person might take actions to punish themselves such as skimping on self-care or daily needs. It lacks the purpose that guilt is designed for. On the contrary, sometimes active urges pull us away from our values.

What Can We Do About It

There are a number of strategies for approaching excessive guilt. Self-compassion is an excellent place to start. While a person experiencing this symptom may not see themselves as deserving of compassion, education on the symptom, its commonness in depression, and slowly turning toward self-compassion in small doses can be life-changing. This is the approach of compassion-focused and self-compassion therapies.

It can also help to challenge one's thinking. In cognitive behavioral therapy, processes such as guided discovery can provide a space where someone can explore with a therapist their perceived grievances. The therapist can then assist in challenging areas where depression may be clouding one's view.

Finally, values clarification such as through acceptance and commitment therapy is a way to catch depression when it falsely accuses someone of going against their moral codes. Acceptance and commitment therapy can also change how a person relates to their ruminative thoughts, providing a tool to unhook from the cycle.

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Why Depression Can Make It Hard to Know You're Depressed

In Closing

While excessive guilt is a painful and insidious symptom of depression, it is one that is malleable. With psychotherapy and practice, we can learn to be kind to ourselves, focus on what matters, and challenge these unhelpful thoughts. We can win.

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