tags: Post-Traumatic Embitterment Disorder, Post-Traumatic Stress Disorder, Adaptation disorder, stress reaction, Adjustment disorder, Negative life events, psychology, behavior, psychiatry, peer-reviewed paper

[larger view]





In this economy, nearly everyone has experienced unemployment, bankruptcy, foreclosure, divorce, or some combination thereof. But roughly 1-2% of these people become so stressed out by these losses that "they can barely function other than to ruminate about their circumstances," according to Dr. Michael Linden, the German psychiatrist who described and named Post-Traumatic Embitterment Disorder (PTED).

In his 2003 paper, Dr. Linden noted that PTED is similar to Post-Traumatic Stress Disorder (PTSD), except those with PTSD suffer intense fear and anxiety after experiencing a life-threatening event. Those with PTED were hard-working and mentally healthy people until a triggering event destroyed their core values and shattered their basic beliefs.

"People feel wronged, humiliated and that some injustice has been done to them," reports Dr. Linden.

Dr. Linden first noticed an increase in angry, disillusioned and embittered patients after German reunification. But what is bitterness, and how are those who supposedly suffer from PTED different from people who are justifiably angry about the current state of their lives or their country?

"Embitterment is a violation of basic beliefs," Dr. Linden explains. "It causes a very severe emotional reaction. We are always coping with negative life events. It's the reaction that varies."

According to Dr. Linden, those with PTED suffer from intrusive thoughts and memories long after the triggering event, phobicly avoid places related to the event and are pathologically consumed by an intense desire for revenge.

"The critical part is this [long] lasting and very intensive emotional embitterment, a mixture of depression and helplessness and hopelessness. It's a very nasty emotion."

But 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. This overlap in symptoms is known as comorbidity and serves to confuse diagnosis and treatment of mental disorders.

Further, those with PTED rarely seek out psychological help.

"These people don't have the feeling that they must change, but rather have the idea that the world should change or the oppressor should change, so they don't ask for treatment," Dr. Linden points out. "They are almost treatment resistant. Revenge is not a treatment."

But if they do get help, cognitive-behavioral therapy is the most successful treatment for PTED.

Perhaps resistance to seeking treatment can be remedied if PTED is included as a diagnosable and treatable mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) -- the "bible" of mental health. Originally published in 1952, the first edition of the DSM listed 112 mental health disorders: the most recent edition, the DSM-IV, describes 374 mental health disorders in its forest-consuming 886 pages.

Currently, the DSM is being rewritten and the new version, the DSM-V, is due to be published in 2012, triggering intense debate in the psychological and psychiatric community as to what precisely constitutes a mental health disorder.

Since health insurance companies typically limit their coverage to mental health issues that are formally listed in the DSM, adding PTED to the manual of mental illness could help people get help and encourage research into the disorder.

Dr. Linden suggested that loving, normal individuals who suddenly snap, killing either their family or coworkers and then themselves may actually be suffering from post-traumatic embitterment syndrome. If so, this is certainly reason enough to pursue treatment and further research.

Sources:

Linden, M. (2003). Posttraumatic Embitterment Disorder Psychotherapy and Psychosomatics, 72 (4), 195-202 DOI: 10.1159/000070783