Posttraumatic Embitterment Disorder and Meditation

Post traumatic Embitterment Disorder (PTED) is a newly described reactive disorder. It is a special form of maladjustment reaction proposed by the German Psychiatrist Dr. Michael Linden of the University of Berlin in 2003.  PTED was introduced as a new concept for a subgroup of Adjustment Disorders. It can also be described as an Adaptation disorder.

Embitterment is a persistent feeling of being let down or insulted, or feeling revengeful but helpless. The feeling of bitterness is always associated with a burning sense of unfairness or injustice, a protesting feeling of having been wronged without cause. It signifies an aggressive protest against a felt and perceived injustice, and is a goad to desperate, sometimes reckless, efforts to gain redress.

Dr.  Linden recognized embitterment as a unique human emotional experience. Feeling embittered is a prolonged emotional state of hate and anger caused by the belief that one has been treated unfairly. Dr.  Linden states that similar to anxiety or depression, embitterment must be understood as a dimensional phenomenon, which becomes pathological when reaching greater intensities, when it is associated with additional symptoms, and when daily role performance is impaired.

Dr. Linden states that PTSD is caused by a physical threat to one’s life; in PTED it is hypothesized to come from a threat to one’s basic belief system. PTED is thus, like PTSD, not characterized by a particular type of stressful events, but by a distinct psychological process (experiences of injustice and humiliation) and by a highly specific psychopathological profile (embitterment). Elevated rates of PTED may occur in times of major social changes that force people to reorganize their personal biographies.

The PTED patients are suffering from severe, multiform, and disabling symptoms. 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.

Core criteria of Post traumatic Embitterment Disorder are: (1) a single exceptional negative life event precipitates the onset of the illness; (2) the present negative state developed 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, reduced drive pain, phobic symptoms in respect to the place or to persons related to the event.

Posttraumatic Embitterment Disorder may occur in times of major social changes that force people to reorganize their personal biographies. According to Professor Harald Ege Post-Traumatic Embitterment Disorder is the most appropriate psychological diagnosis for victims of workplace conflicts, particularly bullying.

Dr Linden proposes “wisdom therapy” as an approach to treat PTED. Wisdom therapy is a form of cognitive therapy based on recent developments in the field of wisdom psychology.

Does Meditation therapy help in Posttraumatic embitterment disorder? According to Prof. Dr. Michael Linden (Personal Communication, 2019) if meditation helps to distance oneself from what happened, or to induce thoughts of forgiveness and consolation with what happened, it will be helpful. 

Mood impairments, somatoform complaints, withdrawal from social contacts, aggressive violent thoughts are common in Posttraumatic embitterment disorder. In addition self blame self criticism, free floating anger, bitterness, wrath, malice, and unforgiveness affect their functionality.  These conditions impact mental and moral well-being.

Dunn & Sensky (2018) indicate that rumination which is linked with chronic embitterment impairs executive functions and problem-solving. Rumination is a maladaptive pattern of thought (Sluder, 2013). Mindfulness allows individuals to disengage from rumination by directing attention to the present moment (Segal et al. 2002 Deyo et al., 2009).

Mindfulness is associated with interpersonal forgiveness (Karremans et al., 2019). Mindfulness enhances forgiveness (Oman et al., 2008). Meditation helps to reduce violent thoughts. In addition meditations such as loving-kindness meditation increase social connectedness (Hutcherson et al., 2008). Furthermore     mindfulness-based therapies are effective in somatoform conditions (Lakhan & Schofield, 2013). Moreover Spiritual meditation which is based on mindful practice helps to reduce negative feelings in PTED and increase spiritual confidence. 

Ruwan M Jayatunge M.D.