When does bitterness become a disorder?

The damage done to strangers, lovers and family members by sociopaths includes physical, emotional, psychological, social and financial harm. Over the years I have encountered many people whose lives have been damaged in this way.

The victimization alone is very sad, but people suffer not only from the actual damage but from their psychological and emotional reactions to it. It is one thing to lose a large sum of money or time that you can’t ever get back. The losses happened and are permanently in the past. It is another thing for a person’s present to be occupied by that loss.

The Aftermath is often more extensive than the victimization itself

It is my observation that for many victims this aftermath lasts a long time and includes considerable dysfunction and this dysfunction causes additional damage. Many have used the label “PTSD” for these psychological, emotional and physical reactions to victimization. Although I agree that diagnosis may fit some, I have never been entirely comfortable with it applied to this context. The reason is that PTSD technically applies to only to situations that are “life-threatening.” PTSD is an anxiety disorder as opposed to an “adjustment disorder” and some symptoms that victims have are not based in “anxiety.”

Psychologist and Professor, Dr Michael Linden, of the Research Group Psychosomatic Rehabilitation, Berlin, Germany has proposed a new disorder be added to the DSM. This disorder, termed Post-Traumatic Embitterment Disorder or PTED describes the reactions I have seen in many people victimized by sociopaths.

I thought seriously about this blog for two weeks before posting it because suggesting there is such a thing as PTED is far from politically correct and sincerely, I would not want anyone to get the idea that I blame victims for their aftermath symptoms. On the other hand, I hope that those who have the symptoms Dr. Linden identifies will consider addressing them. I am also not in favor of the medicalization of common psychological reactions and so am not rushing to advocate PTED be declared an official diagnosis.

What is PTED?

Just as PTSD is thought to result from the threat of loss of life, PTED results from a different kind of threat. Dr. Linden states regarding PTED, “The core pathogenic mechanism is not the provocation of anxiety, but a violation of basic beliefs. This threat to deeply held beliefs, acts upon the patient as a powerful psychological shock, which triggers a prolonged feeling of embitterment and injustice.”

For victims of sociopath’s the sociopath’s behavior violates core beliefs about human nature and sense of safety. That theme is discussed over and over on this website.

Diagnostic and associated features

The essential feature of posttraumatic embitterment disorder is the development of clinically significant emotional or behavioral symptoms following a single exceptional, though normal negative life event. The person knows about the event and perceives it as the cause of illness. The event is experienced as unjust, as an insult, and as a humiliation. The person’s response to the event must involve feelings of embitterment, rage, and helplessness. The person reacts with emotional arousal when reminded of the event. The characteristic symptoms resulting from the event are repeated intrusive memories and a persistent negative change in mental well-being. Affect modulation is unimpaired and normal affect can be observed if the person is distracted”¦

Besides prolonged embitterment individuals may display negative mood, irritability, restlessness, and resignation. Individuals may blame themselves for the event, for not having prevented it, or for not being able to cope with it. Patients may show a variety of unspecific somatic complaints, such as loss of appetite, sleep disturbance, pain.

PTED is said to be a disabling condition and is very difficult to treat.

Additional comments

Although I read two of Dr. Linden’s papers (see below) I was disappointed that he failed to define what it means to be bitter. How does bitterness differ from other reactions like anxiety or grief? Bitter is not an emotion it is a taste. Is he suggesting that victims have an actual bitter taste in their mouths? In studying dictionary definitions I can offer that bitterness is unique in that there is an anger/hostility component- synonym resentful, hostile feeling.

Provided he can more precisely define bitterness, I think Dr. Linden may be communicating something useful here. That is the idea that we have to mobilize our resources to move beyond events that threaten us. Events that threatened core beliefs may be very traumatic for people. It is important for victims to examine their core beliefs in recovering from a relationship with a sociopath.

I am interested in your reactions to this proposed diagnosis.

References

Linden, Michael, Kai Baumann, Barbara Lieberei, and Max Rotter. 2009. “The Post-Traumatic Embitterment Disorder Self-Rating Scale (PTED Scale).” Clinical Psychology & Psychotherapy 16, no. 2: 139-147.

Linden, Michael, Kai Baumann, Max Rotter, and Barbara Schippan. 2008. “Diagnostic criteria and the standardized diagnostic interview for posttraumatic embitterment disorder (PTED).” International Journal of Psychiatry in Clinical Practice 12, no. 2: 93-96.