Spectrum of Embitterment Manifestations

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Objective: Embitterment is seen in reaction to injustice, vilification, or humiliation. Similar to anxiety, it is known to everybody, but it can also occur in the context of mental disorders and even become an illness in itself. The goal of the present study is to describe the spectrum of the types, rate, intensity, and clinical context of embitterment manifestations. Method: The posttraumatic embitterment disorder (PTED) self-rating scale was used to screen for reactive embitterment in 1,479 psychosomatic inpatients. Of these, 489 patients showed increased scores and were interviewed with a standardized diagnostic interview investigating embitterment and the life events that elicit it. Results: Feelings of embitterment, irrespective of intensity, were known to 86.5% of the sample and associated with impairment in daily life. Four different types of patients could be identified: (a) nonreactive embitterment or embitterment-prone personality (i.e., increased embitterment without reports about specific negative life events), (b) complex embitterment (i.e., increased embitterment in the context of multiple negative life events), (c) PTED in reaction to a single traumatic event, and (d) secondary embitterment (i.e., increased embitterment in the context of other mental disorders). Conclusions: Embitterment is part of the normal spectrum of emotions, but it is also relevant in mental disorders. Increased embitterment can be part of other mental illnesses, such as personality disorders, but it also constitutes a state of illness in itself in the form of embitterment-prone personality, PTED, or complex PTED.

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