The Debilitating
Obsessive Thoughts andGuilt of Young Adults
Rapid Report
Mental Health Million Project 2022

Summary
The Mental Health Million Project has revealed a global decline in the mental health of successively
younger generations. The most common mental health symptom characterizing this decline reported
by young adults in 2021 was, unexpectedly, debilitating Obsessive, Strange or Unwanted Thoughts at
41% (along with feelings of sadness, distress and hopelessness). Another symptom of unexpectedly
high prevalence was debilitating feelings of Guilt & Self Blame at 37%. These were 3.3 and 2.6 times theprevalence in their parents’ generation (age 45-64), respectively. In this report we explore the nature of theobsessive thoughts and guilt that plague young adults.
We show that the predominant nature of such debilitating obsessive thoughts was around relationships
with others, with a prevalence of 20% in the 18-24 age group, four times that of their parent’s generation.
Following this in prevalence were obsessions over something negative that happened in the past andsomething negative that could happen in the future. While the lowest in prevalence was an obsession
with celebrities, it was a full 12-fold higher among 18-24 year old’s relative to their parents’ generation.
The predominant source of debilitating guilt and blame was feelings of disappointing or letting people
down, with a prevalence of 13% in the 18-24 age group, 2.6 times the prevalence in their parents’ generation.
The next most prevalent were guilt over something that happened in the past and something that was notyour fault. While lowest in prevalence was guilt over one’s race or gender, it was 11 times higher amongthe 18-24 age group compared to their parents’ generation. Obsessive thoughts around cleanliness andorderliness typically associated with obsessive compulsive disorder (OCD), and survivor guilt that is
typically associated with post-traumatic stress disorders (PTSD), were relatively low in prevalence.
Overall, the types of obsessive thoughts and guilt that are debilitating young people today are distinct fromthose typically considered in traditional mental health paradigms. Instead, they encompass more broadand varied themes of mental distress that likely arise from the changing socio-cultural environment thattoday's young people inhabit that is characterized by diminished in-person social interaction, a distortion ofsocial bonding within virtual environments, and a dominance of negative information on the Internet.

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Introduction
The Mental Health Million Project has revealed recent trends of significantly diminished mental healthand wellbeing of successively younger generations, in a stark reversal of patterns reported 12 years
ago1,2. In 2021, 44% of those 18-24 years old across 34 countries had a mental wellbeing status that wasin the struggling or distressed range compared to just 7% of those 65 and older3. In the Core-Anglosphereor English speaking developed countries, this trend was even more pronounced, with 54% of those aged
18-24 years distressed or struggling. This trend, observed globally in the Internet-enabled populations of
the world, and supported by other research4,5, is not yet well understood but is likely a consequence of ourchanging cultural, social, technological and environmental circumstance.
The dominant pattern of mental health symptoms prevalent in young adults across the world are distinct
from traditional disorder groupings of symptoms as laid out by the DSM-56. While debilitating feelingsof sadness, distress or hopelessness were most common and reported in 41% of young adults aged
18-24 in 2021, two unexpected symptoms reported as severely debilitating to their ability to function
were the experience of Obsessive, Strange or Unwanted Thoughts also at 41%, and feelings of Guilt& Blame at 37%, 3.3 and 2.6 times the prevalence in their parents’ generation (age 45-64). While there
were differences in the prevalence across countries, the aggregate pattern was largely the same in all
countries. We show select countries in Figure 1 where the sample sizes were largest.
In this report, based on analysis of a sample of 148,398 English-speaking respondents from 19 countries
collected during 2021-22, we probe further the nature of obsessive thoughts and guilt and blame that
plague the younger generations.

Figure 1: Prevalence of debilitating obsessive, strange and unwanted thoughts (left)
and guilt & (self) blame across different age groups
Obsessive, Strange or Unwanted Thoughts

Guilt & (Self) Blame

60%

45%

United States

40%

Canada50%

35%Australia

40%

New Zealand
India

30%

South Africa
Singapore20%% of Respondents% of Respondents

United Kingdom

30%
25%
20%
15%
10%

10%
5%
0%

0%
18-24

25-34

35-44

45-54

Age Group

3

55-64

65-74

75-84

18-24

25-34

35-44

45-54

Age Group

55-64

65-74

75-84

Obsessive, Strange or Unwanted Thoughts
Within a general population, occasional intrusive, or unwanted thoughts are a normal occurrence7,8. In the2021-22 Mental Health Million data, 84% indicate some presence of obsessive thoughts consistent withother estimates suggesting that 80% of the population experience them9. However, they are typically notof a frequency or duration that has a severe impact on a person’s ability to function in daily life. Within theclinical domain, debilitating obsessive thoughts have long been associated with obsessive compulsive
disorder (OCD) where they typically involve either obsessions with cleanliness or orderliness of theenvironment6. However, obsessive, intrusive, or repetitive forms of thinking are also associated with othermental health disorders including depression10, addiction11, eating disorders12, anxiety, autism spectrum
disorder (ASD)13 and attention-deficit/hyperactivity disorder (ADHD)14. More recently, given their risingand broad prevalence, they have been proposed as a cross-disorder (transdiagnostic) factor associatedwith multiple psychiatric disorders and types of psychopathology15.
To understand what constitutes these debilitating obsessive thoughts we asked those individuals whoreported a severe impact of obsessive thoughts on their ability to function (defined as a selection of
8 or 9 on a 9-point life impact scale where 9 represents a constant and severe impact on the ability
to function) to describe the dominant nature of these thoughts by selecting from the following list of
options. Respondents could choose up to 2 options that dominated their obsessive thoughts.

4Here we report the percentage of people out of the total population across all ages, and within each age
group, who experienced debilitating thoughts of each type. Across all age groups the most prevalentobsession related to a “Relationship with one or more people that you know” (9.9%). This was followed
by obsessions relating to “Something negative or bad that happened in your past” (9.0%) and “Possible
disasters that could happen [in the future]” (7.1%). The classic OCD symptoms of obsessing aboutorderliness or hygiene were substantially lower for all age groups (both 2.6%) while the lowest prevalence
were obsessive thoughts relating to a macro issue or current event (1.3%), comments on social media(1.2%), or a celebrity (0.8%) or. Across all age groups 0.3% selected the option ‘Other’ suggesting this list
covered all the dominant obsessive, unwanted and strange thoughts.
While the ordering of prevalence was similar for all age groups, in all cases, the prevalence was several
times higher among the 18-24 age group (Figures 2 and 3). In percentage terms the largest increase
was with respect to obsessions with relationships which increased from 4.8% of adults 45-64 to 20.0%of the 18-24 age group, an approximately four-fold difference between 18-24 year olds and their parents’generation. Celebrity obsessions, although the lowest prevalence overall, were almost 12-fold higher inthe 18-24 age group compared to those 45-64.

Figure 2: Prevalence of different types of severely

Figure 3: Fold difference in prevalence of types of severely

debilitating obsessive, strange and unwanted thoughts

debilitating obsessive, strange and unwanted thoughts between
the 18-24 age group compared to those between ages 45 and 64

Your relationship with someone

25%

Something negative from the past
Possible disasters in the future% of Respondents

20%

Order of things in your environment

Social media comments

Social media comments

A macro issue or current event
A celebrity

10%

Your relationship with someone
Possible disasters in the future

Hygiene, cleanliness15%

A celebrity

Something negative from the past
A macro issue or current event

5%

Hygiene, cleanliness
Order of things in your environment

0%
18-24

25-34

35-44

45-54

Age Group

55-64

65-74

75-84

0

2

4

6

8

10

12

Fold-difference(18-24 vs 45-64)

Guilt and Blame
Guilt and self-blame are socially and morally important emotions that people feel when they think they've
caused harm or breached their moral code16. Like obsessive thoughts they are a common experience,
reported at varying levels by 82% of those in the 2020-2021 Mental Health Million data, but typically are
not debilitating. However, debilitating feelings of this nature such as guilt over something that is not your5

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fault (for example, parents’ divorce or familial conflict), or survivors guilt have been associated with anumber of mental health disorders including depression and post-traumatic stress disorder (PTSD) 6,17,18.
As with obsessive thoughts, we asked those individuals who reported a severe impact of Guilt & [Self]
Blame on their ability to function (selection of 8 or 9 on a 9-point life impact scale) to describe thedominant source of these feelings by selecting from the list of options shown below. Respondents could
choose up to 2 options that dominated their feelings of guilt and blame.

Across all age groups the most prevalent source of guilt was disappointing people or letting them down
(13.1%). This was followed by feeling guilt about the way they treated someone, or for what they did tosomeone in the past (10.7%), blaming themselves for things that aren’t their fault (8.6%), conflict between
personal values and choices they made (8.5%) and feeling guilty about thoughts or desires that they
believe they should not have (6.8%). Lowest in prevalence was guilt over their race or gender (1.3%).
Across all age groups only 0.2% selected the option ‘Other’ suggesting this list covered all the dominantsources of guilt and self-blame.
As in the case of obsessive thoughts, these sources of guilt and self-blame were more prevalent in young
adults (Figures 4 and 5). For example, 26.1% of young adults reported feeling guilt over disappointing
people or letting people down compared to 7.9% of the 45-64 age group, while 20.7% of young adults
reported guilt relating to the way they treated someone, or for what they did to someone in the past,compared to 6.4% of older adults. Although the overall prevalence of guilt over one’s race or gender
was low, it was 10-fold higher in younger adults compared to the older generation. Feeling guilt about
thoughts or desires that they felt they should not have was five-fold higher in young adults compared tothe older generation.

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Figure 4: Prevalence of different types of

Figure 5: Fold difference in prevalence of types of debilitating guilt and (self blame)

severely debilitating guilt and (self) blame

between the 18-24 age group compared to those between ages 45 and 64

40%

Disappointing or letting people down
Something I did in the past

35%

Things that aren't my fault
Conflict between personal values and choices

30%

Thoughts or desires that I believe I should not have

% of Respondents

Inability to forgive

Thoughts or desires that
believe I should not have
Surviving a trauma
or disasterThings that aren't my fault

Surviving a trauma or disaster25%

My race or gender

My race of gender

Conflict between personalvalues and choices

20%

Disappointing or letting
people down

15%

Something I did in the past

10%

Inability to forgive
5%

0

2

4

6

8

10

0%
18-24

25-34

35-44

45-54

55-64

65-74

75-84

Age Group

Fold-difference(18-24 vs 45-64)

What do we make of this?
Adolescence and early adulthood is a time of immense social change, where concern over social
evaluation rises, and self-consciousness peaks19-21. Elevated levels of socially-conscious thoughts andfeelings are therefore likely to be a normal feature of this development as individuals learn to navigate
the social world and their place in it. However, the magnitude of the prevalence of debilitating obsessive
thoughts and guilt and blame, and the multi-fold difference compared to their parents’ generation, is
far beyond what is acceptable for a healthy society. Moreover, obsessive thoughts and feelings of guilt
and blame that fit with classically defined manifestations6, such as cleanliness and order within OCD, or
survivor guilt within PTSD, represent a relatively small proportion. Instead, they are more broad and varied
themes of distress. How do we understand this alarming phenomenon?

A dominant theme of distorted self and social relationships.
The dominant types of debilitating obsessive thoughts and guilt and self-blame are heavily related topeople’s self and social perspectives. For instance, both the dominant factors causing distress in young
adults, “Relationship with one or more people that you know” in the case of obsessive thoughts and“Disappointing people or letting them down” in the case of guilt and blame, relate to interpersonal factors.
Another factor is guilt over the inability to forgive, even for small things. This is likely a consequence of
how social relationships form and evolve within this generation, something that has radically changed

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compared to their parents’ generation, and compared to 12 years ago1,2, when age-patterns of mental
wellbeing were starkly different.
Growing up in a fully internet-connected world means many relationships of today’s 18-24 year olds playout online and over social media, rather than in person, something that has been further exacerbated by
the Covid-19 pandemic. The diminished number of hours of in-person socializing, by some estimatesas much as five-fold relative to their parents’ generation, is likely to bring with it a diminished capability
for navigating social situations including appropriately interpreting the behavior of others, resolving
conflict, and regulating social expectations22. The shift to online interaction also represents a distortionof the natural mechanisms of reciprocal human bonding. We are physiologically designed to bond bymechanisms that involve eye contact, mirroring of body language, physical touch and olfactory cues,
the absence of which can result in distorted and/or unstable bonding. The dramatic 12-fold increasein celebrity obsessions is one such manifestation of this shift. For example, being able to know about
people you don’t physically know, leads to a distortion of people’s perceived connection with others,
where they feel they are bonded with them simply because they follow them and know intimate details
about their lives.
The negative consequences of changes in the way people interact socially are also strongly visible inother data from the Mental Health Million Project. For instance, the dimension of Social Self, a composite
measure of how we view ourselves and our ability to form strong, stable relationships with others, is in
rapid decline among younger generations3.

A reflection of changing social narratives and expectation
The social narratives and expectations of each generation are also likely to play a role in the outcomes
highlighted here. We previously noted in our 2021 Mental State of the World report that the cultural ethosof performance orientation23, the degree to which a culture values and rewards people predominantly forwork performance, is negatively correlated with mental wellbeing3. The growing societal emphasis on
performance and achievement is often also associated with growing parental and social expectations interms of academic and professional accomplishment. This could be another contributing factor behindthe large prevalence of young people feeling guilt about disappointing people or letting them down.
Socio-cultural narratives are also likely to have an impact on how young people develop their sense of
self. For example, the 10-fold increase in guilt over gender and race may reflect the dominant focus
on race and gender narratives in popular discourse, contributing to internal conflicts relating to race.
Similarly, a greater awareness of the world’s problems can highlight conflict between personal values andchoices (e.g. driving a car despite its climate impact).

8A persistence of the past
After obsessive thoughts around relationships, the next most prevalent debilitating obsessive thoughts
relate to “Something negative or bad that happened in the past”, while the second most prevalent sourceof guilt and blame was “feeling guilty about the way I treated someone, or for what I did to someone in
the past”. The increasing prevalence of dwelling on the past may arise from many factors. For example,
it may be exacerbated by the diminished or distorted social framework where a strong support networkthat can help to buffer distress arising from past experiences is increasingly absent24. It may also be
exacerbated by the permanent record of life created by the Internet where the past is not easily erased
or forgotten, where it’s easy to relive one’s autobiographical history in minute detail on social media
timelines, and where the negative tends to be amplified.

A negative information bias
After negative things in the past, the next and third most prevalent debilitating type of obsessive thoughts
are about “negative things or disasters that could happen in the future”. The negative bias of online news
and information on the Internet, leading to behaviors such as doom-scrolling, may encourage increased
levels of rumination and catastrophizing – negative emotional regulation strategies that are associatedwith feelings of depression and anxiety25. Higher levels of guilt relating to having “thoughts or desires that
I believe I should not have” may also relate to easier access to negative and inappropriate content (e.g.
porn, violence) at much younger ages through the Internet.

In summary
This research highlights the alarming prevalence of obsessive thoughts and guilt and self-blame thatare debilitating today’s young adults, and reveals a complex and multi-faceted nature that is distinct

from those that have been considered in traditional mental health paradigms. In the aggregate, these
symptoms appear to reflect the changing socio-cultural environment that today’s young adults inhabit
where there is diminished in-person social interaction, a distortion of social bonding within virtualenvironments, and a dominance of negative information. The ongoing nature of the Mental healthMillion project provides scope for further exploring causal factors in order to develop interventions andpreventative strategies and track their impact.

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