Does PTED (Post Traumatic Embitterment Disorder) need its own categorisation?

Emil Kraepelin, described "querulant delusion" in his textbook Psychiatry. This disorder is a reaction to injustice which can be caused by events such as legal disputes and conflicts with neighbours, family members, or government. Individuals are obsessed with the wish to restore justice and/or to take revenge. Kraepelin calls it a "psychosis," specifically a psychosis that stems from a single event and not one originating from a biological source such as schizophrenia. The DSM5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) would categorise this condition under adjustment disorder. There is no mention of the term or emotion "embitterment" in the ICD-10 (International Classification of Diseases, 10th revision) or DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition), however it is increasingly being studied internationally alongside other stress-related disorders like PTSD and prolonged grief, which is now categorised in the DSM5.

Symptoms of PTED

Injustice is experienced as an act of aggression and downgrading, resulting in counter aggression from the victim. These victims of injustice strive to restore justice and their self-worth, if necessary, by taking revenge. If this is accompanied with feelings like "there is no way out," degradation, and helplessness, embitterment is the natural response. When the individual feels trapped they will fight to get even but may also seek revenge without a positive goal and even accept their own self-destruction. This feeling becomes obsessive quality and can take over the whole personality, resulting in many additional symptoms, such as severe anxiety.

Does PTED need its own categorisation?

According to Michael Lindon post traumatic embitterment disorder describes a subtype of adjustment disorders, characterised by prolonged embitterment, severe additional psychopathological symptoms and great impairment in most areas of life in reaction to a severe negative but not a life threatening life event.

Possible Differential Diagnosis

Post traumatic Stress Disorder (PTSD):
triggered by one singular or several potentially life-threatening, uncommon events causing extreme fear and panic (e. g. road accidents, robberies, war)
cardinal emotion is recurring or persisting fear; embitterment does not occur
Major depressive disorder:
very common misdiagnosis due to several symptomatic similarities (e. g. depressed mood, suicidal ideation ,absent-mindedness)
Adjustment disorder:
normally subsides within six months after the triggering event
can be caused by a number of events, not necessarily by insults, betrayal, humiliation or injustice
Phobia:
Avoidance behaviour caused by fear, not by embitterment
Personality disorders:
Lifelong development, no immediate connection to a singular event


The Treatment of Embitterment / Adjustment Disorder
Regardless of whether there needs to be a separate classification for embitterment therapists know embittered patients. It is a challenge to treat such patients as they often reject the help of others. There are indicators which suggest that many embittered patients are treatment-resistant to general psychotherapeutic approaches, however in the UK Cognitive-Behavioural Therapy (CBT) would be the approach advised by clinicians. This therapy identifies the thoughts and behaviours that tend to lead to stress, anxiety, anger, depression and conflicts. For more information click on the link below:


References:
Kraepelin E, editor. Psychiatrie: Ein Lehrbuch für Studierende und Ärzte. Klinische Psychiatrie III, ed 4. Leipzig: Johann Ambrosius Barth; 1915. pp. 1533-46.
Linden M. Querulant delusion and post-traumatic embitterment disorder. Int Rev Psychiatry. 2020;32:396-402.


Linden, Michael; Arnold, Christopher Patrick (23 November 2020). "Embitterment and Posttraumatic Embitterment Disorder (PTED): An Old, Frequent, and Still Underrecognized Problem". Psychotherapy and Psychosomatics. 90 (2): 73-80. doi:10.1159/000511468. PMID 33227789. S2CID 227156350.


https://en.wikipedia.org/wiki/Posttraumatic_embitterment_disorder