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You’ve probably heard of Post-Traumatic Stress Disorder (PTSD), but have you ever heard of Post-Traumatic Embitterment Disorder (PTED)? In 2003, a German psychiatrist, Michael Linden, proposed the idea of a mental disorder called Post-Traumatic Embitterment Disorder. This new diagnosis was based on cases of PTSD where the individuals affected have never experienced life-threatening traumatic events like car accidents, sexual assault, and war; the defining difference from PTSD is that PTSD is diagnosed, most importantly, based on someone’s experience with life-threatening events.
Post-Traumatic Embitterment Disorder is classified as an adjustment disorder. PTED is a reaction to negative life situations such as injustice and other circumstances that may be detrimental to one’s beliefs or identity, manifesting itself in the form of bitterness, mood disorders, somatic disturbances, withdrawal from social situations, and even suicidal tendencies. Someone with PTED has most likely gone through at least one or two defining negative life events. Furthermore, someone with PTED is likely to experience dysfunction in various areas of their lives, including professionally, personally, and interpersonally. Those with PTED also have the tendency to make sure that everyone around them understands just how badly they were treated.
One main difference between PTED and PTSD is the nature of the events which caused the disorder. For PTED, the negative event must not be life-threatening; conversely, the traumatic event which led to the formation of PTSD must be a life-threatening one. However, the defining difference between the two actually lies in the psychological processes underlying the traumatic events. For someone with PTED, a negative event that most people regard as a normal part of life seems to greatly violate their fundamental belief system and identity, hence causing them to develop bitterness. On the other hand, someone with PTSD will develop anxiety and panic after experiencing a traumatic event that is life-threatening and extraordinary by any standard.
Embitterment is an emotion in which someone feels as if they failed, or more generally, a feeling of disappointment, shame, or embarrassment. It’s normal to feel this way after a negative experience, but if the emotions linger on for a long period of time, it’s a sign that something is amiss. Embitterment persists even after one attempts to manage their emotions to the best of their abilities; this is what someone with PTED experiences.
Furthermore, a negative life event often leads to depression; because of this, it’s crucial to note the differences between embitterment and depression. Embitterment is a full and explosive emotion while depression is a melancholic and anhedonic feeling.
The feeling of bitterness that one feels as a part of their PTED could easily take over their entire personality, which often leads to other symptoms like negativity, hopelessness, refusal to get help, dysphoria, self-blame, loss of appetite, appearance of depressive symptoms, sleep disorders, and loss of spirit. When embitterment becomes too heavy to bear, it often inspires thoughts of revenge, aggression, or even suicide. Unwanted thoughts often also permeate the thoughts of those with PTED in the most unexpected times, often in a sudden manner and without warning; this phenomenon is called intrusive thoughts.
According to multiple studies, PTED is a fairly common mental disorder. In 2007, a study conducted by Michael Linden involving 48 subjects with PTED found that 72% of them suffered from a negative event related to work, 12.5% related to family or other relationships, 8.3% related to the death of a loved one, and 6.3% related to an illness. 97.9% of individuals with PTED expressed their experience with persistent negative feelings and 91.7% have experienced anxiety since the onset of the event that triggered their PTED in the first place; 100% felt that they’d been subjected to unfairness or injustice, 97.9% experienced bitterness, and 91.7% reported feelings of anger. Unsurprisingly, 77.1% of individuals with PTED tend to avoid places and people that remind them of the negative event they experienced. Interestingly, a number of characteristics of melancholic depression also present themselves in those who suffer from PTED; for example, 83.3% of studied individuals reported that they lost interest in activities that they previously enjoyed, 83.3% feel increased inhibition, and 79.2% reported waking up extremely early in the morning.
Unfortunately, there is currently no conclusive study on what kind of therapy is most proper for PTED; this is partly due to the fact that PTED is not currently fully accepted by the medical field as a mental disorder. However, a form of therapy involving wisdom psychology has proven to be a promising tool in curing PTED by emphasizing moderation in between extremes, exercising good judgement, and balancing emotions.
Linden M. Posttraumatic embitterment disorder. Psychother Psychosom. Jul-Aug 2003;72(4):195-202.
Linden M, Arnold CP. Embitterment and Posttraumatic Embitterment Disorder (PTED): An Old, Frequent, and Still Under Recognized Problem. Psychother Psychosom 2021;90:73–80.
Linden M, Baumann K, Rotter M, Schippan B. The Psychopathology of Posttraumatic Embitterment Disorders. Psychopathology 2007;40:159–165.
Linden M. Querulant delusion and post-traumatic embitterment disorder. Int Rev Psychiatry. Aug-Sep 2020;32(5-6):396-402.
Linden M, Baumann K, Lieberei B, Lorenz C, Rotter M. Treatment of posttraumatic embitterment disorder with cognitive behaviour therapy based on wisdom psychology and hedonia strategies.Psychother Psychosom. 2011;80(4):199-205.
