Post-Traumatic Embitterment Disorder (PTED)

Post-Traumatic Embitterment Disorder (PTED)


Post-traumatic Embitterment Disorder (PTED) is a widely seen type of pathological reaction to adverse life events, and is characterized by a distinct psychological process (experiences of injustice and violation of basic beliefs) and by a highly specific psychopathological profile (embitterment and intrusions). PTED is seen in times of societal changes which force people to cope with reorganizations of their lives and prospects. The symptoms of PTED can be very severe, chronic, life-threatening (because of suicidal and/or homicidal fantasies), and hard to treat, and often result in disability in almost all areas of life. The newly developed concept is proposed by Dr. Micheal Linden in 2003 as a mental illness; PTED can be discriminated from PTSD, depression, anxiety disorders, and other adjustment and reactive disorders. The disorder is modeled after post-traumatic stress disorder because it too is a response to a trauma that endures. People with PTSD are left fearful and anxious. Embittered people are left seething for revenge.

People who feel they have been wronged by someone and are so bitter they can barely function other than to ruminate about their circumstances. Embitterment is an emotion that is probably known to everybody. The data of Linden at al. (2009) suggests that 1/3 of the general population remember feelings of embitterment and 1/4 do so in a more intense way (mean total score ≥ 1). However, only 2–3% were found to suffer from reactive embitterment of clinically relevant intensity. In this respect, embitterment must be understood as a dimensional phenomenon similar to anxiety or depressed mood.

Despite partial overlaps in symptomatology, PTED can be differentiated from other affective disorders, post-traumatic stress disorder, or anxiety disorders. In contrast to adjustment disorder the symptomatology of PTED does not show the tendency of spontaneous remission. In contrast to depression, affect modulation is unimpaired in PTED. In depression, the specific causal connection between the trigger event and symptomatology can not be found, unlike in PTED. While in posttraumatic stress disorder (PTSD) anxiety is the predominant emotion, in PTED it is embitterment. In PTSD there must be a critical event that has to be exceptional, life-threatening and, most important, is
invariably leading to acute panic and extreme anxiety. In PTED there is always an acute event that can be called normal as it can happen to many persons in a life course. Still it is also an exceptional event as it is not an everyday event.


Core criteria of PTED are:

(1) a single exceptional negative life event precipitates the onset of the illness;

(2) the present negative state developed in the direct context of this event;

(3) the emotional response is embitterment and feelings of injustice;

(4) repeated intrusive memories of the event;

(5) emotional modulation is unimpaired, patients can even smile when engaged in thoughts of revenge, and

(6) no obvious other mental disorder that can explain the reaction.

Additional symptoms are

  • feelings of helplessness
  • self-blame
  • rejection of help
  • suicidal ideation
  • dysphoria
  • aggression
  • down-heartedness
  • seemingly melancholic depression
  • unspecific somatic complaints
  • loss of appetite
  • sleep disturbances
  • pain
  • phobic symptoms in respect to the place or to persons related to the event
  • reduced drive

Diagnosis of PTED

Diagnostic criteria for posttraumatic embitterment disorder (PTED)
(A) Development of clinically significant emotional or behavioral symptoms following a single exceptional, though normal negative life event.
(B) The traumatic event is experienced in the following ways:
(1) the person knows about the event and sees it as the cause of illness;
(2) the event is perceived as unjust, as an insult, and as a humiliation;
(3) the person’s response to the event involves feelings of embitterment, rage, and helplessness;
(4) the person reacts with emotional arousal when reminded of the event.
(C) Characteristic symptoms resulting from the event are repeated intrusive memories and a persistent negative change in mental well-being.
(D) No obvious mental disorder was present prior to the event that could explain the abnormal reaction.
(E) Performance in daily activities and roles is impaired.
(F) Symptoms persist for more than six months


The main cause of PTED is a single traumatic event that has brought change in person’s life. The event is experienced as traumatic due to a violation of basic beliefs. Traumatic events of this type include, but are not limited to, conflict at the workplace, unemployment, the death of a relative, divorce, severe illness, or experience of loss or separation. The illness develops in the direct context of the event. The person must not have had any obvious mental disorder prior to the event that could explain the abnormal reaction. A profound sense of injustice takes over person and therefore making them embitter and full of revenge.

The essential feature of post-traumatic embitterment disorder (PTED) is the development of clinically significant emotional or behavioral symptoms following a single exceptional, though normal negative life event. The person knows about the event and perceives it as the cause of illness. The event is experienced as unjust, as an insult, and as a humiliation. The person’s response to the event must involve feelings of embitterment, rage, and helplessness. The person reacts with emotional arousal when reminded of the event.

Since, the PTED is a proposed disorder and much research is needed in seeing the brain imagery and effect of different neurotransmitters on the brain.


Dr. Linden found that PTED patients also suffer from a suite of other emotional complaints: 68.8% of the patients fulfilled the criteria for adjustment disorders; 52.1% for major depression; 41.7% for dysthymia; and 35.4% for generalized anxiety disorders.


Pharmacology Treatment

Clomipramine (brand name Anafranil) is used extensively for treatment of PTED. However there is no research yet been done on the effect of the drugs on the treatment.

The other drugs used are SSRIs including Fluoxetine, Paroxetine, Escitalopram, Sertraline, Citalopram, and Fluvoxamine.

Wisdom Therapy

A promising new treatment approach is wisdom therapy, which is a form of cognitive therapy based on recent developments in the field of wisdom psychology. Treatment involves presenting the patient with case vignettes of unsolvable life problems and teaching patients to attain a change of perspective, distance from oneself, empathy with the aggressor, acceptance of unwanted emotions, emotional serenity, contextualism, value relativism, relativism of aspirations, and long-term perspectives.

Wisdom Therapy is a comprehensive, practical, scientifically established approach that can help you address the life challenges and conflicts you’re facing. The wisdom we gain throughout our life includes improved coping methods, communication and social skills, humility, empathy and compassion for others, emotional intelligence, specific thought patterns, mindfulness, and a practice of appreciation and gratitude.

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