Background: Adjustment and reactive disorders are a heterogeneous group of mental disorders. Diagnostic criteria are vague and scientific research is limited despite the fact that these disorders play a major role in clinical practice. Methods: The ‘posttraumatic embitterment disorder’ (PTED) is introduced as a new concept for a subgroup of adjustment disorders. A case vignette and diagnostic criteria are presented. Results: Core criteria of PTED are: (1) a single exceptional negative life event precipitates the onset of the illness; (2) the present negative state developped 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, pain, phobic symptoms in respect to the place or to persons related to the event, reduced drive. Duration is longer than 3 months. Performance in daily activities and roles is impaired. Conclusions: PTED is a frequent disorder. The diagnosis of PTED can lead to specific therapeutic interventions. PTED can be discriminated from PTSD, depression, anxiety disorders, and other adjustment disorders.

Van der Kolk BA, Herron N, Hostetler A: The history of trauma in psychiatry. Psychiatr Clin North Am 1994;17:583–600.
Van der Kolk BA, McFarlane AC, Weisaeth L (eds): Traumatic Stress. New York, Guilford, 1996.
Paykel ES: Stress and affective disorders in humans. Semin Clin Neuropsychiatry 2001;6:4–11.
Janet P: L’amnésie et la dissociation des souvenirs par l’émotion. J Psychol 1904;1:417–453.
Kraepelin E: Psychiatrie. Leipzig, Barth, 1908.
Schneider K: Klinische Psychopathologie. Stuttgart, Thieme, 1932.
Jaspers K: Allgemeine Psychopathologie. Berlin, Springer, 1946.
Spurrell MT, McFarlane AC: Life-events and psychiatric symptoms in a general psychiatry clinic: The role of intrusion and avoidance. Br J Med Psychol 1995;68:333–340.
O’Brien LS (ed): Traumatic events and mental health. Cambridge, Cambridge University Press, 1998.
WHO: International Statistical Classification of Diseases and Related Health Problems, revision 10. Geneva, WHO, 1992.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
Fischer G, Riedesser P (Hrsg): Lehrbuch der Psychotraumatologie. München, Reinhardt, 1999.
Maerker A (Hrsg): Therapie der posttraumatischen Belastungsstörungen. Berlin, Springer, 1997.
Blanchard EB, Hickling EJ, Buckley TC, Taylor AE, Vollmer A, Loos WR: Psychophysiology of posttraumatic stress disorder related to motor vehicle accidents: Replication and extension. J Consult Clin Psychol 1996;64:742–751.
Fullerton CS, McCarroll JE, Ursano RJ, Wright KM: Psychological response of rescue workers: Firefighters and trauma. Am J Orthopsychiatry 1992;62:371–378.
Kulka RA, Schlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, Weiss DS: Trauma and the Vietnam War Generation. Report of Findings from the National Vietnam Veterans Readjustment Study. New York, Brunner, 1990.
Amiel-Lebigre F, Kovess V, Labarte S, Chevalier A: Symptom distress and frequency of life events. Soc Psychiatry Psychiatr Epidemiol 1995;33:263–268.
Simon GE: Long-term prognosis of depression in primary care. Bull World Health Organ 2000;78:439–445.
Regier DA, Boyd JH, Burke JD, Rae DS, Myers JK, Kramer M, Robins LN, et al: One-month prevalence of mental disorders in the United States. Based on five epidemiologic catchment area sites. Arch Gen Psychiatry 1988;45:977–986.
Mezzich JE, Fabrega H, Coffmann GA, Haley R: DSM-III disorders in a large sample of psychiatric patients: Frequencies and specificity of diagnoses. Am J Psychiatry 1989;146:212–219.
Andreasen NC, Wasek P: Adjustment disorders in adolescents. Arch Gen Psychiatry 1980;37:1166–1170.
Fabrega H, Mezzich JE, Mezzich AC: Adjustment disorder as a marginal or transitional illness category in DSM-III. Arch Gen Psychiatry 1987;44:567–572.
Snyder S, Strain JJ, Wolf D: Differentiating major depression from adjustment disorder with depressed mood in the medical setting. Gen Hosp Psychiatry 1990;12:159–165.
Schatzberg AF: Anxiety and adjustment disorder: A treatment approach. J Clin Psychiatry 1990;51:20–24.
Bronisch T, Hecht H: Validity of adjustment disorder, comparison with major depression. J Affect Disord 1989;17:229–236.
Bronisch T: Adjustment reactions: A long-term prospective and retrospective follow-up of former patients in a crisis intervention ward. Acta Psychiatr Scand 1991;84:86–93.
Pollock D: Structured ambiguity and the definition of psychiatric illness: Adjustment disorder among medical inpatients. Soc Sci Med 1992;35:25–35.
Despland JN, Monod L, Ferrero F: Clinical relevance of adjustment disorder in DSM-III-R and DSM-IV. Compr Psychiatry 1995;36:454–460.
Greenberg WM, Rosenfeld DN, Ortega EA: Adjustment disorder as an admission diagnosis. Am J Psychiatry 1995;152:459–461.
Jones R, Yates WR, Williams S, Zhou M, Hardman L: Outcome for adjustment disorder with depressed mood: Comparison with other mood disorders. J Affect Disord 1999;55:55–61.
Dehlinger E, Ortmann K: Zufriedenheit mit dem Gesundheitsstatus in der Bundesrepublik Deutschland und der ehemaligen Deutschen Demokratischen Republik. Ein Vergleich. Gesundheitswesen 1992;54:88–94.
Achberger M, Linden M, Benkert O: Psychological distress and psychiatric disorders in primary health care patients in East and West Germany 1 year after the fall of the Berlin wall. Soc Psychiatry Psychiatr Epidemiol 1999;34:195–201.
Wittchen HU, Müller N, Pfister H, Winter S, Schmidtkunz B: Affektive, Somatisierungs- und Angsterkrankungen in Deutschland. Gesundheitswesen 1999;61:216–222.
Hillen T, Schaub R, Hiestermann A, Kirschner W, Robra BP: Self rating of health is associated with stressful life events, social support and residency in East and West Berlin shortly after the fall of the wall. J Epidemiol Community Health 2000;54:575–580.
Rush AJ, Weissenburger JE: Melancholic symptom features and DSM-IV. Am J Psychiatry 1995;152:1242–1243.
Alexander J: The psychology of bitterness. Int J Psychoanal 1966;41:514–520.
Baures MM: Letting go bitterness and hate. J Humanist Psychol 1996;36:75–90.
Bobon D, Baumann U, Angst J, Helmchen H, Hippius H (eds): AMDP-System in Pharmacopsychiatry. Basel, Karger, 1983.
AMDP (Hrsg): Das AMDP-System. Manual zur Dokumentation psychiatrischer Befunde. Göttingen, Hogrefe, 1995.
Pirhacova I: Perceived social injustice and negative affective states. Studia Psychol 1997;39:133–136.
Zemperl J, Frese M: Arbeitslose: Selbstverwaltung überwindet die Lethargie. Psychol Heute 1997;24:36–41.
McFarlane AC: Avoidance and intrusion in posttraumatic stress disorder. J Nerv Ment Dis 1992;180:439–445.
McKenzie N, Marks I, Liness S: Family and past history of mental illness as predisposing factors in post-traumatic stress disorder. Psychother Psychosom 2001;70:163–165.
Fava GA, Sonino N: Psychosomatic medicine: Emerging trends and perspectives. Psychother Psychosom 2000;69:184–197.
Fava GA, Mangelli L, Ruini C: Assessment of psychological distress in the setting of medical disease. Psychother Psychosom 2001;70:171–175.
Madianos MG, Papaghelis M, Ioannovich J, Dafni R: Psychiatric disorders in burn patients: A follow-up study. Psychother Psychosom 2001;70:30–37.
Kjaer Fuglsang A, Moergeli H, Hepp-Beg S, Schnyder U: Who develops acute stress disorder after accident injuries? Psychother Psychosom 2002;71:214–222.
Timko C, Janoff-Bulman R: Attributions, vulnerability, and psychological adjustment: The case of breast cancer. Health Psychol 1985;4:521–544.
Basoglu M, Mineka S, Paker M, Aker T, Livanou M, Gok S: Psychological preparedness for trauma as a protective factor in survivors of torture. Psychol Med 1997;27:1421–1433.
Staudinger UM, Freund AM, Linden M, Maas I: Self, personality, and life regulation: Facets of psychological resilience in old age; in Baltes PB, Mayer KU (eds): The Berlin Aging Study. Aging from 70 to 100. Cambridge, Cambridge University Press, 1999, pp 302–328.
Schnyder U, Buchi S, Sensky T, Klaghofer R: Antonovsky’s sense of coherence: Trait or state? Psychother Psychosom 2000;69:296–302.
Janoff-Bulman R: Characterological versus behavioral self-blame: Inquiries into depression and rape. J Pers Soc Psychol 1979;37:1798–1809.
Frazier PA: Victim attributions and post-rape trauma. J Pers Soc Psychol 1990;59:298–304.
Shaver KG, Drown D: On causality, responsibility, and self-blame: A theoretical note. J Pers Soc Psychol 1986;50:697–702.
Livanou M, Basoglu M, Marks I, De SP, Noshirvani H, Lovell K, Thrasher S: Beliefs, sense of control and treatment outcome in posttraumatic stress disorder. Psychol Med 2002;32:157–165.
Magwaza AS: Assumptive world of traumatized South African adults. J Soc Psychol 1999;139:622–630.
Beck AT, Rush AJ, Shaw B, Emery G: Cognitive Therapy of Depression. New York, Guilford, 1979.
Schützwohl M, Maerker A: Ärgererleben und Ärgerausdrucksverhalten nach Traumatisierung. Ausmass und Beziehung zu posttraumatischen Belastungsreaktionen nach politischer Inhaftierung in der DDR. Z Klin Psychol Psychother 2000;29:187–194.
Ehlers A, Clark DM, Dunmore EB, Jaycox L, Meadows E, Foa EB: Predicting the response to exposure treatment in PTSD: The role of mental defeat and alienation. J Trauma Stress 1998;11:457–471.
Ehlers A, Maerker A, Boos A: Posttraumatic stress disorder following political imprisonment: The role of mental defeat, alienation, and perceived permanent change. J Abnorm Psychol 2000;109:45–55.
Erikson EH: Identität und Lebenszyklus. Frankfurt, Suhrkamp, 1976.
Baltes PB, Smith J: Weisheit und Weisheitsentwicklung: Prolegomena zu einer psychologischen Weisheitstheorie. Z Entwicklungspsychol Pädagog Psychol 1990;22:95–135.
Staudinger UM, Baltes PB: Weisheit als Gegenstand psychologischer Forschung. Psychol Rundsch 1996;47:1–21.
Staudinger UM, Lopez D, Baltes PB: The psychometric location of wisdom-related performance: Intelligence, personality, and more? Pers Soc Psychol Bull 1997;23:1200–1214.
Strain JJ, Newcorn J, Wolf D, Fulop G, Davis W: Considering changes in adjustment disorder. Hosp Community Psychiatry 1993;44:13–15.
Strain JJ, Smith GC, Hammer JS, McKenzie DP, Blumenfield M, Muskin P, Newstadt G, Wallack J, Wilner A, Schleifer SS: Adjustment disorder. A multisite study of its utilization and interventions in the consultation-liaison psychiatry setting. Gen Hosp Psychiatry 1998;20:139–149.
Follette VM, Ruzek JI, Abueg FR: Cognitive-Behavioral Therapies for Trauma. New York, Guilford, 1998.
Frankl VE: Logotherapie und Existenzanalyse. Weinheim, Psychologische Verlags Union, 1998.
Tausch R: Vergeben, ein bedeutsamer seelischer Vorgang. Z Sozialpsychol Gruppendyn Wirtschaft Ges 1992;17:3–29.
Böhmig-Krumhaar SA: Leistungspotentiale wert-relativierenden Denkens: Die Rolle wissensaktivierender Gedächtnisstrategie. Berlin, Max-Planck-Institut für Bildungsforschung Studien und Berichte, 1998, vol 65.
Maerker A, Böhmig-Krumhaar SA, Staudinger M: Existentielle Konfrontation als Zugang zu weisheitsbezogenem Wissen und Urteilen. Z Entwicklungspsychol Pädagog Psychol 1998;30:2–12.
Stickgold R: EMDR: A putative neurobiological mechanism of action. J Clin Psychol 2002;58:61–75.
Gottschalk LA, Fronczek J, Abel L, Buchsbaum MS, Fallon JH: The cerebral neurobiology of anxiety, anxiety displacement, and anxiety denial. Psychother Psychosom 2001;70:17–24.
Susemihl F (ed): Aristotelis Ethica Nicomachea. Leipzig, Apelt, 1912.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.