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.
