The psychopathology of posttraumatic embitterment disorders

The posttraumatic embitterment disorder (PTED) was introduced as a new subgroup of adjustment disorders. The trigger event in PTED is an exceptional, though normal negative life event that is experienced as a violation of basic beliefs and values. The predominant emotion in PTED is embitterment. This study presents first data on the psychopathological profile of PTED.

48 inpatients were diagnosed by clinical judgment as suffering from PTED. Patients were then interviewed with the standardized Mini International Neuropsychiatric Interview (MINI) and an additional interview section on the diagnostic criteria for PTED. Patients also filled in the Symptom Checklist-90-Revision (SCL-90-R), and the Impact of Event Scale (IES-R).

According to the MINI68.8% 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. 100% of patients reported that they were suffering from intrusive thoughts about the event. 97.9% of the patients complained about persistent negative mood, 91.7% about restlessness, 83.3% inhibition of drive and loss of interest, 77.1% phobic avoidance of places related to the event, and 75% resignation, but 91.7% reported normal mood when distracted. The SCL-90-R indicated a high load of general psychopathological complaints with an average positive symptom total score of 52.26. Characteristic were feelings of injustice (100%), embitterment (97.7%), and rage (91.7%). The IES-R scale indicated a high prevalence of posttraumatic stress, with an average total score of 3.23. The average duration of illness was 31.7 months.

The PTED patients are suffering from severe, multiform, and disabling symptoms. Their clinical features pose difficult diagnostic problems. The predominant complaints about feelings of injustice, embitterment, and rage and the results of the IES speak for the importance of the critical event for the development and understanding of such disorders.