POST TRAUMATIC EMBITTERMENT DISORDER.pdf

Psychiatry topic for nursing post-conference discussion.

2. DEFINITION
2024 POST TRAUMATIC EMBITTERMENT DISORDER 2
Prof. Michael Linden, PhD .
Psychiatrist and cognitive behavior
therapist.
Director of the Psychosomatic Medicine
Research Group at the Charité University
and Medical Director of the Institute for
Behavior Therapy (Berlin)
It is an extreme reaction to a negative
life event that the person considers
unfair and that leads to growing
feelings of resentment, anger, and
bitterness and causes impairment in
ADL. (Linden, 2020)
EPIDEMIOLOGY
•2-3% ➔ reactive bitterness(Linden, 2022)
•40% in South Korea (Shin et al., 2024)
•underdiagnosed.

3. 2024
POST-TRAUMATIC EMBITTERMENT DISORDER
3
INJUSTICE
HUMILIATION
SEVERELY
DISAPPOINTED
BREACH OF
TRUST
VIOLATION OF
BASIC VALUES/
RIGHTS
N
E
G
A
T
I
V
ELIFEE V
E
N
T
EMBITTERMENT
TRIGGERING
FEELINGS &
THOUGHTS
De Sousa & D’Souza, (2020)
DEFEAT
REVENGE

4. DIAGNOSTIC CRITERIA
2024 POST TRAUMATIC EMBITTERMENT DISORDER 4
A.- Significant emotional/behavioral symptoms after normal
negative life event.
B.- Traumatic event experienced as:
1)seen as the cause of illness
2)perceived as unjust or humiliation
3)feelings of embitterment, rage, and helplessness
4)emotional arousal when reminded
C.- Intrusive memories & negative change in mental well-
being.
D.- No previous mental disorder
E.- Impairment in ADL
F.- Persistent (>6 months)
(Linden, 2022)

5. PTED
Self-Rating
Scale
2024 POST TRAUMATIC EMBITTERMENT DISORDER 5

6. 2024 POST TRAUMATIC EMBITTERMENT DISORDER 6
STANDARDIZED DIAGNOSTIC INTERVIEW
(LINDEN ET AL.,2008).
94% sensitivity and 92% specificity.

7. 2024 POST TRAUMATIC EMBITTERMENT DISORDER 7
DIFFERENTIAL DIAGNOSIS
PTED PTSD
•Trigger by a negative life event
•Embitterment, resentment
•Trigger by life-threatening event
•Extreme fear, panic, anger
PTED MDD
•When distracted mood is preserved.
•Onset related to negative event
•Anhedonia
•No connection with a single event.
PTED PHOBIAS
•Behavior related to a negative event
•Embitterment, rumination
•Avoidant behavior
•Fear when exposed to object of fear
PTED PERSONALITY DISORDER
•Connection with singular event.
•Clear onset
•No connection with singular event
•Life-long development

8. TREATMENT
2024 POST TRAUMATIC EMBITTERMENT DISORDER 8
•Cognitive-behavioral therapy (CBT)➔ coping skills
•Supportive counseling➔emphasizing empathy and validation
•Pharmacotherapy ➔ selective serotonin reuptake inhibitors (SSRIs)
•Compassion-focused therapy (CFT):
✓to enhance compassion for oneself and others
✓to counteract negative self-judgment.
•Wisdom Competence Therapy (De Sousa & D’Souza, 2020), (Linden, 2022)
•Mindfulness meditation:
✓reduce embitterment symptoms
✓improve psychological well-being
•Virtual reality therapy:
✓Simulate lifelike scenarios to confront and process
traumatic events
✓overcome feelings of embitterment and desensitize
individuals.

9. 2024 POST TRAUMATIC EMBITTERMENT DISORDER 9
PTED

10. 2024 10
PREVENTIVE MEASURES AND EARLY INTERVENTION
STRATEGIES.
Educating people about risk factors and coping skills to deal
with life adversities could prevent embitterment from
escalating to debilitating levels.
(Yoo & Kim, 2021).

11. 2024 POST TRAUMATIC EMBITTERMENT DISORDER 11
REFERENCES
AvinashDe Sousa, & D’Souza, R. (2020). Embitterment: The Nature of the Construct and Critical Issues in the Light of COVID-19. Healthcare, 8(3), 304–
304. https://doi.org/10.3390/healthcare8030304
Linden, M. (2022). Embitterment, Posttraumatic Embitterment Disorder, and Wisdom Therapy. Hogrefe Publishing GmbH.
Lindén, M., & Arnold, C. P. (2020). Embitterment and Posttraumatic Embitterment Disorder (PTED): An Old, Frequent, and Still Underrecognized
Problem. Psychotherapy and Psychosomatics, 90(2), 73–80. https://doi.org/10.1159/000511468
Lindén, M., Baumann, K., Lieberei, B., & Rotter, M. (2009). The post‐traumatic embitterment disorder Self‐Rating Scale (PTED Scale). Clinical
Psychology & Psychotherapy, 16(2), 139–147. https://doi.org/10.1002/cpp.610
Lindén, M., Baumann, K., Rotter, M., & Schippan, B. (2007). Posttraumatic Embitterment Disorder in Comparison to Other Mental Disorders.
Psychotherapy and Psychosomatics, 77(1), 50–56. https://doi.org/10.1159/000110060
Linden, M., Baumann, K., Rotter, M., & Schippan, B. (2008). Diagnostic criteria and the standardized diagnostic interview for posttraumatic
embitterment disorder (PTED).International journal of psychiatry in clinical practice,12(2), 93–96.
https://doi.org/10.1080/13651500701580478
Shin, J., Lee, Y., Cho, S., Sung, J., Kim, S., & Lee, S. (2024). Implication of findings from a two-wave survey on embitterment in South Korea for strategies
to promote mental health of the general public. Apa.org. https://psycnet.apa.org/record/2018-00130-001
Yoo, S., Lee, J. H., & Kim, S. (2021). Coping and rumination as mediators in the development of reactive embitterment in the general population.
Psychological Trauma: Theory, Research, Practice, and Policy, 13(5), 565–574. https://doi.org/10.1037/tra0000967