Bipolar Disorder and Guilt: Learning to Let Go

Guilt and regret can linger after a mood episode. Making amends without getting stuck in shame can help you move forward with self-compassion.

Key Takeaways

• Because behavior during bipolar episodes may not reflect who you are, separate your self-worth from your symptoms.
• Healthy guilt can prompt an apology and repair, while shame keeps you stuck in self-blame.
• Repairing relationships means taking responsibility, helping loved ones understand bipolar disorder, and allowing them time to heal.
• Managing symptoms while practicing mindfulness and self-compassion can reduce future regret and support long-term recovery.

Ann R. knows that, even on her best days, it can be difficult to deal with the noise and chaos that comes with having a 6-year-old and 4-year-old twins. When she’s pulled down by bipolar depression, though, she finds it almost impossible to be the mother she wants to be. Then the guilt latches on — and won’t let go.

She recalls a mood episode that left her full of remorse. She’d arranged to take time off work to be with her children, but instead of celebrating a festive holiday with them, she retreated to her bedroom in a depressive fog.

“I spent four days in bed,” says Ann, who lives in Connecticut. “I feel guilty about that, and about knowing what I needed to do, but not being able to do it. This is their childhood.”

Looking back at what happened during a mood episode can stir powerful emotions. It’s common to feel embarrassed, humiliated, ashamed, and even worthless. There’s often regret, sharpened by fear that you’ve alienated people in your life. Realizing that you’ve caused hurt and hardship — a major wellspring of guilt — only compounds the pain.

Why Bipolar Disorder Can Cause Guilt and Shame

Guilt can be a useful emotion that helps us humans maintain a moral compass. But when it shifts from healthy self-reflection to an all-consuming trap of negative self-talk, it’s time to stop the blame game and take action.

Denying or ignoring any harm you’ve caused isn’t healthy, but hanging on to negative emotions doesn’t help anyone. It’s important to confront feelings of guilt — which should include a reality check to discover whether those feelings are justified — and then find tools and take actions to get past them.

That’s not to say it will be easy to pry free of guilt’s powerful grip. To ponder just how powerful it can be, note that the expression “weighed down by guilt” can be taken literally.

Multiple studies have found that people who recalled their own unethical behavior reported feeling physically heavier than comparison groups. And in related experiments, physical heaviness also increased guilt feelings, suggesting a two-way link between guilt and sensations of weight.

Some studies suggest unresolved guilt is associated with actual physical ailments, though this is not proof that guilt causes disease.

One study shows that people with higher feelings of guilt — but not of shame — were more likely to have a chronic disease. These included arthritis, back pain, cardiovascular disease, asthma, cancer, and depression or anxiety.

Similarly, researchers found that guilt was associated with changes in gastric rhythms (the electrical rhythm of the stomach), electrodermal activity (the activity of the sympathetic nerves, which help trigger the fight-or-flight response, in the sweat glands), and swallowing rate.

Guilt vs. Shame: What’s the Difference?

As a species, we seem to be hardwired to feel emotional distress over things we know we’re not supposed to do (or things we know we should do, but don’t). Research suggests that early signs of guilt and shame can start showing up in children as young as two years old, though these early emotional reactions are much simpler than the complex feelings we experience as adults.

Although “shame” and “guilt” can be interchangeable in everyday usage, “shame researchers,” like Brené Brown, PhD, a research professor at the University of Houston, draw a distinction between the two states. She’s spent the past two decades studying courage, vulnerability, shame, and empathy.

Dr. Brown defines shame as “the intensely painful feeling or experience of believing that we are flawed, and, therefore, unworthy of love and belonging — something we’ve experienced, done, or failed to do makes us unworthy of connection.” Shame, she says, is unproductive.

Guilt, on the other hand, is “adaptive and helpful — it’s holding something we’ve done, or failed to do, up against our values and feeling psychological discomfort,” she says. (Regret, meanwhile, is when you wish you could change the past.)

So consider this: That guilt you carry can be a useful guide to changing your future behavior. And it may say something positive about you as a person — that you have moral standards, you care, and you have empathy.

Why Mood Episodes Can Lead to Regret

When Brad S., of Los Angeles, lost his job as a computer programmer because of his unmanaged bipolar disorder, he couldn’t keep up child support payments for his daughter — or even keep a roof over his own head. Although he’s in a good situation now and able to meet his obligations, he still feels awful about the hardship his ex-wife endured during that three-year stretch.

He has anguishing thoughts regularly, particularly when he’s alone.

“It’s always the first thing that comes up, more than any of my other thoughts,” he reveals. “It definitely affects my self-esteem. … It tears me apart, knowing what she went through.”

Staying trapped in a cycle of self-recrimination paves the way for depression. Chantea D. Williams, PhD, a clinical psychologist in Atlanta, notes that mindfulness techniques can be powerful tools for cultivating self-compassion, nonjudgment, and acceptance of the past.

“It’s about knowing what happened, but also that it doesn’t make you a bad person,” she says. “It’s about trying to disengage from the negative messages that can come with having a diagnosis and from ruminating thoughts.”

How to Make Amends Without Self-Punishment

Through working with a psychiatrist and psychotherapist, Brad has learned to balance responsibility for the part he played in his ex-wife’s difficulties. He now understands that, given his subsequent treatment and commitment to recovery, he is not the same person who put her there. That alleviates some of the guilt, and the shame is “softer and not as frequent” as it used to be, he says.

Brad has also tried to make amends, asking his ex-wife if there’s anything he could do to make up for those trying years. Making amends means owning up to what you’ve said or done — or failed to do — and trying to set things right. That takes courage, and sometimes requires sacrifice, but it remains bedrock advice for moving past guilt. An inner freedom and ease can grow from the effort, along with the chance to mend relationships.

In some cases, however, the injured party is not ready to forgive and move forward. “For some people, even after an apology, it’s still hard to let go of an action or misstep,” Dr. Williams says.

This is another situation where acceptance and self-compassion come into play. Like your own past actions, another person’s emotions are beyond your control or ability to change. It’s a lesson Brad is practicing.

“I have to accept the fact that she can’t accept what I went through,” he says of his ex-wife. “All I can do is say ‘I’m sorry,’ and do the best I can today.”

How to Repair Relationships After a Mood Episode

Mending relationships may be easier when the people in your life become more educated about the realities of bipolar disorder.

Kyra H., of British Columbia, Canada, has bipolar 1 and often lashes out at her parents when she’s trapped in depression. They try to be helpful by reminding her that the episode will pass and she’ll feel better again. She’ll snap back that they’re wrong and don’t understand her.

Over time, she has seen how a greater understanding of her mental health condition has helped her mother, in particular, let go of pain and resentment when Kyra’s bipolar symptoms are involved.

“Now if I say hurtful things, she realizes it’s not me who actually feels that way,” Kyra says. “When I’ve apologized in the past, she’s taken it with a grain of salt. But now, she accepts it a bit easier.”

Demian C. Brown, a psychotherapist in Toronto, notes that feeling guilty can cause insidious harm to a relationship, quite apart from any stress created by your actions or words.

“It can be a catch-22,” he says. “You feel bad because of what you’ve done, so you can’t get close to the person you’ve upset. That leads to feelings of detachment, isolation, and lower self-esteem that gets reflected back by the people around you — and that can actually bring on future mood episodes.”

His advice: Be brave. Learn how to talk about conflict, which is a natural part of life, to increase the chances of a resolution. Make it clear that you accept responsibility for what you’ve done, empathize with the other person’s pain, and apologize.

“It’s ownership, but it’s not blame,” he says.

How Stigma Can Turn Into Self-Blame

Demian Brown raises another important issue about guilt and bipolar: A sense of self-blame just from having the disorder.

“I think people feel existential guilt about having an episode, and it’s self-traumatizing. … People beat themselves up, but I think the problem is based more on stigma than on what they’ve done,” he notes.

Even when you know intellectually that having bipolar isn’t your “fault” — any more than having asthma would be — that kind of guilt can cling tenaciously. Overcoming self-stigma is a personal journey, but finding peer support, learning more about bipolar as a medical condition, and using self-help strategies, like affirmations (“I am not bipolar, I have bipolar,” for example) may be helpful.

How to Prevent Future Regret

Whether you are trying to make amends to the people around you or grappling with your own emotions, taking preventive action to minimize future damage matters enormously.

Kyra did just that after going on a three-month spending spree during a manic episode. She went on trips to Seattle and Calgary, bought clothes and shoes, and ate out regularly at nice restaurants, all courtesy of a few credit cards. The final tally: about $10,000.

“I just felt like I had all the money in the world,” she says. “But afterward, I had all this shame and guilt about the whole thing. I felt I let myself down because I’d gotten myself in this financial hole, and also felt guilty that my parents were going to find out.”

She then had to accept what happened, realize she had to move on, and take action to learn from her mistakes — and prevent them from happening in the future, she explains.

Kyra began by cutting up her credit cards. She then spoke with a credit counselor and several financial institutions before applying for a consolidation loan.

“Just knowing I was doing something to remedy some of the mistakes I’d made helped me feel a lot better about moving forward,” she says.

Ann took a similar path in coping with her guilt over the Christmas that wasn’t. There’s no changing the past, of course, but she took steps to stave off future mood shifts that would affect her ability to be present for her kids.

Most important was finding medication she could tolerate. Ann recognized the connection between her depressive episode and the decision she’d made to stop taking her meds because of serious weight issues. She also found a new primary care doctor — one who would take her concerns more seriously — and began working with a nutritionist to get her eating habits back on track.

“This way, when my kids grow up and understand this illness, they can look back and see I was the best person I could be every day,” says Ann, who maintains a blog to advocate against stigma.

Separating Your Identity From Your Diagnosis

Something you did during an episode isn’t the same as who you are — bipolar disorder describes an experience, not your character or worth, making it essential to focus on separating identity from diagnosis.

How Therapy Can Help With Guilt and Shame

Talking with a therapist gives you a safe, nonjudgmental space to process past actions, release heavy feelings of remorse, and quiet harsh inner criticism. Proven approaches like cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) can help you build self-compassion, learn healthy ways to cope, and remember that your symptoms do not define who you are.

When Guilt or Shame Becomes a Warning Sign

Ann still grapples with a larger sense of shortcomings as a parent — feeling disconnected, easily frustrated, and unable to mask her mood symptoms. In a perfect world, she’d be completely stable and supportive, or at least better able to separate her bipolar disorder from her family life.

In this imperfect world, however, Ann focuses on another goal: “To look myself in the mirror and say, ‘I gave it my all.’ If I can do that, I have nothing to be guilty about.”

When persistent guilt or shame turns inward into overwhelming despair, it can be a critical early warning sign of a worsening depressive episode or suicidal ideation. If unaddressed, these feelings can stall recovery and signal that your current treatment plan needs adjustment with your healthcare provider.

FAQ

How do I handle guilt over things I said or did during a manic episode?

Acknowledge what happened with honesty, but extend grace to yourself. Recognizing that hypersexuality, overspending, or irritability can be symptoms of mania — rather than fully reflecting who you are when you’re well — can help reduce overwhelming shame while still making room for accountability. 

How can I apologize to loved ones I hurt while unwell?

Take ownership of your actions without making excuses, express genuine empathy for their feelings, and share the concrete steps you’re taking to support your stability and repair trust moving forward. 

What if the people I hurt aren’t ready to forgive me?

Rebuilding trust takes time, and you cannot control another person’s emotional timeline. Apologize sincerely, demonstrate consistency through ongoing care and follow-through, and focus on self-compassion while giving them the space they need.

Can guilt and shame actually trigger a new mood episode?

Guilt and shame do not automatically trigger a new mood episode, but ongoing rumination appears to be linked with worse mood symptoms in bipolar disorder and can increase vulnerability, especially for depression. Shame is more strongly tied to depressive symptoms than guilt in research, and rumination helps explain part of that link.

How can I stop replaying embarrassing moments from past episodes in my head?

When a painful memory pops up, mindfulness-based skills may help you relate to the thought differently. You might notice the thought without judging yourself, gently anchor yourself in the present moment, and remind yourself that you are working on staying well now.

Editorial Sources and Fact-Checking

bpHope follows strict sourcing guidelines to ensure the accuracy of its content, as outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, people with lived experience, and information from top institutions.

UPDATED: Printed as “Letting Go of Guilt,” Summer 2015