The importance of understanding Posttraumatic Embitterment Disorder

Why is embitterment becoming increasingly recognized as a problematic phenomenon?

Embitterment, like anxiety, is a reactive emotion. But instead of a reaction to threats, it is caused by a sense of injustice, humiliation, and breach of trust. Everyone knows the feelings of anger and resentment that encompass embitterment. But when it is more intense and lasts for long periods of time it can become a crippling disorder. This disorder was first described more than a century ago and explained in great detail by Emil Kraepelin, the founding father of the classification of mental disorders. However, embitterment is often not recognized in clinical practice, because it can be mistaken as normal when there is a cause, and this further obscures the fact that the emotional status is the core pathological phenomenon, similar to pathological anxiety. The states of embitterment are accompanied by a large variety of other symptoms such as impaired mood, phobic avoidance, psychosomatic distress, and these secondary symptoms mislead us and point towards other diagnoses. Empirical studies have shown that pathological states of embitterment (e.g., posttraumatic embitterment disorder or PTED) are frequent, with a prevalence rate of about 2% to 5% in the general population.

How does PTED differ from PTSD and why is it difficult for psychiatrists, therapists, and other professionals to manage?

PTSD (posttraumatic stress disorder) is caused by a horrific life-threatening experience that elicits strong anxiety, which then prevails and reemerges because of memories and intrusions. PTED (posttraumatic embitterment disorder) is caused by events which challenge the psychological integrity of a person, such as experiences of injustice, humiliation, and breach of trust.

Embitterment is a nagging emotion, associated with feelings of aggression to the perpetrator, a sense of helplessness, cynicism, and/or a retreat from social contacts. Patients then react in this manner towards their therapists. All therapists know these patients – and typically do not like them.

What is wisdom therapy and why is this the right approach for treatment?

For more than 50 years basic research in psychology on wisdom therapy has been conducted, showing that wisdom can be a resilience factor which everyone needs for coping with difficult, ambivalent, irrevocable negative life events. As embittered patients are locked in and feel stuck – almost helpless in such situations – fostering wisdom competencies is a proven approach to help overcome what has happened and to look to the future.

How do your two new books help psychiatrists, therapists, and other professionals?

The books on embitterment and wisdom therapy explain the details and the state of research on embitterment. One book is primarily written for mental health professionals – psychologists or psychiatrists who want to help their clients. The other is written for those who suffer PTED, who may be clients who have had the book recommended by their mental health provider or may simply be people who want to find out more about PTED. Together they enable clinicians and patients to recognize and understand this often overlooked emotion. Both books provide details on wisdom psychology, how wisdom can be operationalized, and strategies of wisdom problem solving and wisdom psychotherapy.

Any final comments?

Many patients who turn out to be treatment resistant may actually be suffering from embitterment. Therefore, this emotion should be regularly assessed and considered by clinicians.

Embitterment can also be a dangerous emotion, as patients regularly harbor aggressive fantasies, where patients act out or take some type of drastic action. Clinicians need to understand and consider embitterment with these patients in order to prevent disaster.