Posttraumatic embitterment disorder

Abstract

Background: Adjustment and reactive disorders are a heterogeneous group of mental disorders. Diagnostic criteria are vague and scientific research is limited despite the fact that these disorders play a major role in clinical practice.

Methods: The 'posttraumatic embitterment disorder' (PTED) is introduced as a new concept for a subgroup of adjustment disorders. A case vignette and diagnostic criteria are presented.

Results: Core criteria of PTED are: (1) a single exceptional negative life event precipitates the onset of the illness; (2) the present negative state developped 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. Duration is longer than 3 months. Performance in daily activities and roles is impaired.

Conclusions: PTED is a frequent disorder. The diagnosis of PTED can lead to specific therapeutic interventions. PTED can be discriminated from PTSD, depression, anxiety disorders, and other adjustment disorders.