Having money doesn’t solve all your problems. In fact, it may even create more.

Some psychotherapists have found brisk business in catering to members of the super-rich who feel guilty about having amassed fortunes, but also feel isolated by their wealth and unable to talk about their emotional problems. “The Occupy Wall Street movement was a good one and had some important things to say about income inequality, but it singled out the 1% and painted them globally as something negative,” Jamie Traeger-Muney, a wealth psychologist and founder of the Wealth Legacy Group, which advises people on the emotional impact of dealing with wealth, told The Guardian newspaper.

Ultra-wealthy people in particular don’t always know who likes them for who they are rather than what they have. When billionaire media mogul Oprah Winfrey, who just purchased a 10% stake in Weight Watchers US:WTW discovered she had a long-lost sister, Winfrey said her sister never tried to sell her story, which was a rare thing. “Since I have been a person known in the public, there have been few times that I’ve been anywhere and not been sold out,” she said on her television talk show in 2010. “There have been few times where you can bring anybody new into your life and not have that person in some way betray you or use you or take advantage of you.”

“I don’t see guilt in wealthy people,” says Fran Walfish, a psychotherapist based in Beverly Hills, Calif. “We are living in a culture that breeds entitlement.” Walfish treats very wealthy clients, but also worked at Cedars Sinai Hospital in Los Angeles for 15 years treating people from disadvantaged areas. “I do see the isolation and I see a lot of secrecy and a fear that other people are after them for their money,” she says. “A lot of times wealthy people say, ‘Come with me to Hawaii,’ and pick up the tab.” But they fear that someone will take advantage of them, Walfish adds. “This is especially true of wealthy women. Many won’t go out with someone who is not in the same wealth bracket.”

And with great wealth can come a feeling (real or imagined) of greater responsibility and, in many cases, a whole new level of stress. “The F. Scott Fitzgerald quote, ‘The rich are different from you and me’ holds a lot of truth,” says Jonathan Wai, a psychologist at Duke University in Durham, N.C. “Those people really wanted to get rich. That’s why they’re there. A lot of wealth inequality is partly due to human inequality, which could be personal traits like remarkable brain power, or their start in life, or both. For the people at the top, it may be tough to reconcile all that, especially when they look at their wealth and wonder why there is such great disparity.”

Read: 10 things billionaires won’t tell you

Arguably, the ambitions of the super-rich are often not as modest as other people’s ambitions. Microsoft MSFT, -0.17% co-founder Bill Gates has a grand plan to improve our world with his Bill and Melinda Gates Foundation, including eradicating malaria in sub-Saharan Africa. Facebook FB, +0.14% Chief Executive Mark Zuckerberg wants to connect the globe to the Internet, Tesla TSLA, -3.21% CEO Elon Musk wants to put a man on Mars within the next 10 years, and Richard Branson, founder of Virgin America US:VA, wants to be a trailblazer in commercial space travel. “The decisions these people make are going to influence all of us, for better or worse,” Wai says.

Research is divided on whether money can actually buy you (a certain degree) of happiness. Life satisfaction does increase with household wealth, according to a study by the Office of National Statistics, a government agency. That could be related to the ability to take vacation, afford better schools for your children, access health insurance and be free of the financial stress that plagues so many cash-strapped people in the aftermath of the recession. But another recent study by a Nobel Prize-winning economist and psychologist suggests happiness plateaus after $75,000 a year.

Still, the 1% — broadly defined as those who have $500,000 a year in cash income, according to the Tax Policy Center — are often ridiculed for complaining, Wai adds. In 2013, Winfrey alleged that a shop clerk refused to show her a $38,000 crocodile bag because of her skin color. (The clerk said it wasn’t true.) On social media, some people said Winfrey should not complain — not because of the alleged racism — but because she has the money to buy such an expensive handbag. Many commentators on “The Guardian” article made fun of the wealth and one wrote: “Donate your wealth to charity until you are comfortable with what is left.”

But even though it may be more socially acceptable to be broke than to brag about how much you have saved for retirement, Walfish says the 1% also have the same problems as everyone else. “The only big difference is that wealthy people don’t have to deal with the worry of making ends meet and supporting their family,” Walfish says. “That crosses off the list one big source of stress.” Almost everything else —except for the fear that people love their money more than they love them — is the same. Those problems include communication skills in relationships (even if they are brilliant deal-makers at work), child-rearing practices, coping with in-laws and sex.

“Often, stratospherically wealthy people put family and relationships second to financial success on the priority list,” she says. “Something has to give when you have that much money.”

Also see: 10 things psychologists won’t tell you