Post-Traumatic Embitterment Disorder: The Newest Mental Illness?

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In this economy, nearly everyone has experienced unemployment, bankruptcy, foreclosure, divorce, or some combination thereof. But roughly 1-2% of these people become so stressed out by these losses that "they can barely function other than to ruminate about their circumstances," according to Dr. Michael Linden, the German psychiatrist who described and named Post-Traumatic Embitterment Disorder (PTED).

In his 2003 paper, Dr. Linden noted that PTED is similar to Post-Traumatic Stress Disorder (PTSD), except those with PTSD suffer intense fear and anxiety after experiencing a life-threatening event. Those with PTED were hard-working and mentally healthy people until a triggering event destroyed their core values and shattered their basic beliefs.

"People feel wronged, humiliated and that some injustice has been done to them," reports Dr. Linden.

Dr. Linden first noticed an increase in angry, disillusioned and embittered patients after German reunification. But what is bitterness, and how are those who supposedly suffer from PTED different from people who are justifiably angry about the current state of their lives or their country?

"Embitterment is a violation of basic beliefs," Dr. Linden explains. "It causes a very severe emotional reaction. We are always coping with negative life events. It's the reaction that varies."

According to Dr. Linden, those with PTED suffer from intrusive thoughts and memories long after the triggering event, phobicly avoid places related to the event and are pathologically consumed by an intense desire for revenge.

"The critical part is this [long] lasting and very intensive emotional embitterment, a mixture of depression and helplessness and hopelessness. It's a very nasty emotion."

But Dr. Linden found that PTED patients also suffer from a suite of other emotional complaints: 68.8% 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. This overlap in symptoms is known as comorbidity and serves to confuse diagnosis and treatment of mental disorders.

Further, those with PTED rarely seek out psychological help.

"These people don't have the feeling that they must change, but rather have the idea that the world should change or the oppressor should change, so they don't ask for treatment," Dr. Linden points out. "They are almost treatment resistant. Revenge is not a treatment."

But if they do get help, cognitive-behavioral therapy is the most successful treatment for PTED.

Perhaps resistance to seeking treatment can be remedied if PTED is included as a diagnosable and treatable mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) -- the "bible" of mental health. Originally published in 1952, the first edition of the DSM listed 112 mental health disorders: the most recent edition, the DSM-IV, describes 374 mental health disorders in its forest-consuming 886 pages.

Currently, the DSM is being rewritten and the new version, the DSM-V, is due to be published in 2012, triggering intense debate in the psychological and psychiatric community as to what precisely constitutes a mental health disorder.

Since health insurance companies typically limit their coverage to mental health issues that are formally listed in the DSM, adding PTED to the manual of mental illness could help people get help and encourage research into the disorder.

Dr. Linden suggested that loving, normal individuals who suddenly snap, killing either their family or coworkers and then themselves may actually be suffering from post-traumatic embitterment syndrome. If so, this is certainly reason enough to pursue treatment and further research.


Linden, M. (2003). Posttraumatic Embitterment Disorder Psychotherapy and Psychosomatics, 72 (4), 195-202 DOI: 10.1159/000070783

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... learning the hard way that you ain't all that.

While the poster is intended sarcastically while the post is serious, the juxtaposition raises a question: will this reaction be more common or more severe among those raised to have "high self-esteem" in all circumstances?

By Pierce R. Butler (not verified) on 03 Jun 2009 #permalink

This is fascinating. Thanks, Grrl.

" ... Revenge is not a treatment"

Is this a comment on the impracticality (and undesirable social consequence) of revenge seeking?

Or is it a reiteration of the oft-repeated saw of literature and movies that success at revenge leaves you empty and unsatisfied and fails to heal the hole in your psyche.

If the latter, is there any empirical basis for making the claim?

By Stagyar zil Doggo (not verified) on 03 Jun 2009 #permalink

I don't understand how categorizing a vague emotional response with an acronym is medically useful. Is there some state machine that maps common lifetime experiences to medically acceptable emotional responses that I don't know about?

The bits about people feeling something has been done to them, and that they are treatment-resistant, are telling.

Every now and again I meet someone who thinks nothing is their fault, they didn't do anything wrong, the world is out to get them, blah blah blah. They don't recognize that they are asking the world to change for their convenience, rather than taking responsibility for themselves.

It's extremely common in poor people. This makes it a double-whammy, because in a sense they're right: it's not their fault they were born into such a major disadvantage (and the correlating disadvantages in nutrition and education). The problem is in dwelling on the circumstances, rather than looking for ways out.

Whether this mindset is triggered by something specific (I suspect not, in most such cases), it's clearly a mental disorder of some variety. It's characterized by an insufficient grip on reality, teamed with a persecution complex. If giving this set of traits a particular name can lead to helping more people get past it, then hooray.

What if this sort of this is a reasonable biological adaptation?

It could well be a sort of altruism response. Nobody likes to let the bad guy get away with stuff.

Also, yes, the oppressor should change. It's not okay to be an oppressor.

#3, revenge does little because it doesn't change the thing that's causing you stress. Unless your problem is losing faith in the existence of justice, it's not going to help much.


You said "Every now and again I meet someone who thinks nothing is their fault, they didn't do anything wrong, the world is out to get them, blah blah blah. They don't recognize that they are asking the world to change for their convenience, rather than taking responsibility for themselves."

Dr. Linden's article resonates with me, but before you judge me, or anyone else, consider the possibility that there really IS an occasional bout of gross injustice in the world, and there ARE people who are suffering the type of oppression they self-describe. I have been told that the 50% of my GROSS income that will be going to my ex-wife for the next 19 years is "reparations due her for the millenia of oppression of the Sisterhood by the Patriarchal Conspiracy." Those words were given her by the same people, the same source, that continually crows that "men" (actually ex-husbands or STB ex-husbands) should quit complaining about the rhetoric and tactics directed against them and "take responsibility for themselves."

Before dismissing someone's perception of events, and by implication, denying the existence of a problematic mental state, or at least its origin, but certainly any treatment, consider whether this helps or hinders the situation, the world. Personally, I doubt that mental health treatment would help my condition; relief from the financial and other impositions attendant on my circumstances would be necessary, but I would not presume to deny treatment to someone else, whether or not I can objectively confirm their claims of cause. In fact, my own experiences have made me very sympathetic and active in attacking the causes of many real injustices in the world, and experiencing a sensation of unending humiliating and unjustified defeat IS an injustice, even if there is no objectively identifiable external cause to address.

By OrchidGrowinMan (not verified) on 05 Jun 2009 #permalink

I owned a house in the ghetto that I was going to try and fix up, and uh, suffice to say it didn't go well AT ALL and I lost a lot of money.

Reading the symptoms of this so-called PTED was kind of creepy, because it pretty much describes EXACTLY how I felt (and, to a certain extent) still feel about that experience. I won't go into details because I have to work, but wow... it was creepy. The phobic avoidance of associated places, the blaming of others, the desire for revenge... yeah, I went through all of that, and pretty intensely.

I still experience a reflexive feeling of intense hostility every time I see the logo for the local city government. heh... I long ago admitted it to myself that it was my fault things went the way they did, but I can't help but still feel that visceral response.

Luckily, in my case the PTED -- if you can call it that -- was a relatively localized experience, i.e. it doesn't really affect my day to day life. But the times I do have to go near that neighborhood, or contact the city government for some reason... yeah, pretty much exactly the symptoms described in this article. Scary...

By James Sweet (not verified) on 05 Jun 2009 #permalink


I'm not entirely certain where we're disagreeing, here. (Or rather, you seem to be disagreeing with me somewhere, but I can't quite figure out where. I may be misunderstanding your point.)

My basic point is that shit happens. Life is not fair. It is more unfair for some people than others. THIS SUCKS.

But getting "stuck" in dwelling on the injustice, to the point where a person doesn't take any action, but just stews... Well, that's a problem. That's a life that has stalled. That's potential wasted, resources squandered, and a net increase in human misery.

People often say, "Don't tell me to get over it!" And yet if "it" is keeping that person's life in stall mode, isn't that a problem?

This proposed diagnosis seems to be saying that no, it's not easy to just get over it. And the not getting over it is self-perpetuating. But if we can classify the problem and approach it with situationally tailored tools, that might help.


#3, revenge does little because it doesn't change the thing that's causing you stress. Unless your problem is losing faith in the existence of justice, it's not going to help much.

Yes, as I said, I saw those movies too. Empirical supporting evidence (even indirect) would have been nice.

I also fail to see the distinction you appear to be making. You can obsess over "Justice" just as much as over Revenge.

Jared Diamond, for example describes hunter gatherer bands where the concept of justice did not exist. They only had revenge. Revenge is the atavistic precursor to justice. So its not obvious to me that while Justice is universally good, Revenge (and revenge seeking) is universally bad.

By Stagyar zil Doggo (not verified) on 06 Jun 2009 #permalink

I find that the concept of "getting over it" is one that can be interpretted one of two ways. The interpretation that is communicated to/internalized by the person of interest may determine the path ahead.

1) Just get over it: this is a cold, "its all in your head", "there has been no injustice", "your sense of victimization has no grounds" interpretation. It is also the one that seems most obvious when the phrase is heard. It also is probably the one most likely to increase the sense of injustice within the person affected, thus deepening the despair. Probably a good way to re-inforce someone being stuck ruminating over the issue.

2) "Only you can decide to take the upward path towards moving on". This may be quite more helpful to promote this concept of "getting over it". This means something like this: "While you may or may not have been the cause of your injustices. Further, I would say that you probably played only a very minor role in promoting your own failures. Further, I accept that this has happened to you and should not have. However, it is a tough battle to get out of this pattern and its one that only you can initiate. Until you get to the point where you are willing to work hard to get out of the pattern will you ever be able to avoid being the victim of these external forces." While much more wordy and difficult to iterate quickly, off the cuff....I think it would be much more helpful.

If PTED is a response to the arbitrary blows of life, then it is understandable that it might be untreatable. However, many of the bad things that happen to us in the work place, or perhaps at our children's school - two typical places for the flourishing of injustice - are the direct result of the malice of the inadequate, and this is frequently compounded by the cowardice of those who might be in a position to right the wrong, indeed who have a duty to do so. It is the realisation, that those whom one counted as friends before the event, are in fact entirely self interested and prefer the status quo to standing up against wrongdoing, that does the damage to the psyche.
This syndrome can, in fact, be partially self treated, but the presence of a wise counsellor is enormously useful. The malicious abuse of position, followed by the failure of the abuser's and the abused's colleagues to act, is fundamentally a failure of love. While the abused continues to see himself as entirely the victim, the embitterment will continue, but frequently the malicious abuse is the result of a failure of love on the part of the person who then becomes the victim further down the line. When the sufferer from PTED can see that his abuse is the result of his own failure in love, he is suddenly free of the crippling hatred, the fantasy killing and the imaginary future put downs with which he will take revenge upon his abuser. Christianity understands this well, regarding this self-knowledge is intensely healing, and I should be interested to know how other religious philosophies approach this. The parent who has fiercely criticised the academic standards of a talented child's English teacher, and then finds that the child has been excluded from the school play and its natural role in the play given to another child who is known to be both dim and a bully, will understand the situation perfectly.

By Hugh Hetherington (not verified) on 20 Jun 2009 #permalink

Another step toward pathologizing everyone who isn't smiling, productive, and willing to "go along." Which will give permission to allow some overzealous authority figures to lock these "crazy people" up to "protect society." And will give the mainstream folks a "scientific basis" for ostracizing these poor "sick people."

And, of course, will allow the drug companies to air commercial after commercial to convince people who are unhappy but perfectly ordinary and healthy that they need a little pill. At only $4 per pill, to be taken daily for the rest of their now unnatural lives.

Seriously hard done by earlier in life (and to a smaller extent, still today), owing to a disability, my husband has this. Youbetchabygolly, it's real. Many of the negative and damaging things that happened to him almost certainly did not happen for the reasons he believes, though they still weren't his fault. I can scarcely get through to him for a minute about that. He's unrealistically furious at some people, and strangely very little angry at one particular adult in his life as a child (his stepfather) whose disgusting, psychotic abuse deeply hurt him. He remains mired in bitterness and revenge fantasies (that he will never carry out, he assures me, and I believe him). He won't take positive steps to change things because he believes others owe it to him to do that. Well, yeah, they do, but they never will, so he's going to have to do it himself, which concept I can't convey to him by any means whatsoever. I love him dearly and will never leave him--despite the above, he's really good to me--, but my dearest wish is for him to get through all of this and move forward into health.

I approve of defining this disorder, which appears to me to be a particular dysfunctional pattern fallen into by certain people for certain predictable reasons, because it makes it possible to direct resources into scientific study of the phenomenon and into remediation of its particular symptoms, and from personal experience, I think that badly needs to happen.

What I *don't* believe is that it just defines anyone who has been victimized as pathological merely because they are in pain on account of their victimization (thereby trivializing the victimization). Regardless of what actually happened to a person, how dysfunctional is it to stay miserably stuck in one's victimization forever and never move forward? Now, how disempowering is that, really? What good it it to say well, the anger and anguish is justified due to the nature of the transgressions against the person, so obviously s/he will have to stay in that space forever without informed, professional help in getting up and out? I think this is probably a real psychiatric disorder and belongs in the new DSM.

Lisa, you never got totally shit on as a kid?

I was successfully treated for a long-as-I-could-remember bout of depression.

My therapist thinks a certain amount of anger is a perfectly rational response (the key is in the handling and the perspective), and frankly, thinks it's quite reasonable to have a pretty sizable bit of contempt for eejits. She would think this PTED is bullshit.

Come back to the thread when you've had, oh, 5 straight years of nothing but utter crap from incompetents.

By Katharine (not verified) on 13 Oct 2009 #permalink

I agree with some posts above: ie. do we need a label to pathologize yet another element of natural human feeling? Especially as this one doesn't fit our worldview of positive individualism..

I don't disagree that bitterness can colour a persons world too black, hinder them from doing what they would like (perhaps even taking action against injustice), yet I do think people can seek help for anxiety and depression instead (if the comorbidities are indeed that high) and that this diagnosis invites the pharmaceutical industry: to provide pills against feelings of anti-ness (not always that unhealthy)and the growing number of behavioural genetics proponents: to start unnecessary research upon whether genes account for variance in this 'syndrome' etc. There is enough dispute about the validity of personality disorders, lets not add more dubious diagnoses on the list.

How about on the contrary 'pathological individualism' : a focus on the self and not the political. Some of the criteria could include tendency to discriminate (whether racism, sexism, against the disabled, poor or mentally ill), not take part in anything political: indeed even facing bitterness just to decide: "screw everyone else in my position, I'll just make it to the top on my own". Not seeking unbiased news reports to form objective opinions, a desire to accumulate : whether awards, 'friends' on facebook or new cars and mobile phones.
Yet of course, this is all acceptable in society.

By Linda Kemp (not verified) on 28 Oct 2009 #permalink

i'm surprised that no one has mentioned narcissism and what role it plays in all of this.

When I was about 14 years old, I suffered from severe bullying throughout that whole school year. I managed to surpass that event, but always wondered if I would be traumatized by it. The years went on and I did very well both academically and socially. I'm 20 now. I've been two and a half years with a girlfriend and made some friends of which I'm very proud to have. Lately, i started a very intensive Air Transport Pilot License with a class totally new to me. Initially it all went very well but 4 weeks from today I suffered a panic or anxiety attack which led me to a mild depression, apparently with no reason of being. From that moment on I stoped being able to socialize with my new colleagues and I even feel like I cannot open myself to them because of some irracional fear... This is affecting my professional and social outcome. I though about seeking psychological help as I realized that post trauma for the childhood event may be possible.... But then again why only now, after having 6 years of perfectly normal and happy life? I don't know how to get out of this situation. What can I do?

To be honest, it should be a real disorder, but not just one given easily. Like not like "Oh my mom didn't buy me something I wanted, now Im bitter." Or even if you just lost a competition or something. I would say it should be for something that is more serious. I'm 14 years old, and for my whole life I had to delt with my alcholic father abusing my mother day and night, almost murdering her on several occasions. Weekends were a nightmare for me, because I would always have to worry about my father barging in drunk. My mom told me to never call the police, because she said she would be deported, and I would be left alone. Because of this, my mother always put me down, claiming the reason for why he was abusive was because of me. She degraded me everyday, calling me fat, stupid and everything else. In 6th grade I developed anorexia, however my mother dismissed it, saying I was only doing it for attention. I improved sightly, however since she stopped treatment out of nowhere, and so the thought of gaining weight haunted me for the next few years. However, the same year I was hit by a car. Even in the hospital she yelled at me for my lack of motivation. I was also bullied my whole life, because my grades were 90's, and because I was a quiet, but kind person, who didn't know how to defend herself. So as you can see, I developed depression, for the past few months it has gotten horrible, however my mother believes it's just me being stupid. However, she has let me gone to therapy for the past few weeks. But she thinks I should be happy now, and that I should 'stop being a baby and get over it.' But she's the only person I have had for my entire life, since my extended family is of my dad's side, and my mom has no living family. So I'm terrified of being abandoned, and is extremely paranoid, because I think everyone wants to harm me, since the only people I have ever came across has been horrible to me, for no reason. Obviously, you can see that I'm extremely bitter for having to grow up with noone to rely on, since my own parents don't even care. Honestly though, I can't move on. It's a horrible feeling.

@ Yenny
Repeat what you've said to us to another adult and/or the police. Your parents are harmful to your well-being, and neither are worth protecting.