Frontiers in psychiatry · 2026
Embitterment symptoms and comorbid psychopathology in an anxiety outpatient clinic: frequency, clinical distribution, and psychosocial correlates.
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Arslan Bahar, Ünal Süheyla
Аннотация
OBJECTIVE: Posttraumatic embitterment disorder (PTED) has been proposed as a clinical construct characterized by persistent feelings of injustice, resentment, helpless anger, and intrusive embitterment-related cognitions following negative life experiences perceived as unjust, humiliating, or irreversible. The present study aimed to determine the frequency and clinical distribution of clinically relevant embitterment symptoms and PTED-compatible presentations.
METHODS: This cross-sectional study included 344 participants, consisting of 315 consecutive patients attending an anxiety outpatient clinic at a tertiary psychiatric center and 29 healthy control volunteers. Psychiatric diagnoses were established according to DSM-5 criteria through face-to-face clinical interviews, while PTED-related symptoms were evaluated using the clinical characteristics and standardized symptom criteria proposed by Linden and colleagues. Participants completed the Posttraumatic Embitterment Disorder Self-Rating Scale (PTED Scale), the Brief Symptom Inventory (BSI), the Buss-Perry Aggression Questionnaire (BPS), the Life Problems Screening List, and a structured sociodemographic assessment form.
RESULTS: On the PTED Self-Rating Scale, 178 participants (56.5%) obtained a mean score exceeding the established threshold of 2.5, indicating clinically significant embitterment. Of these, 114 participants (36.2% of the total sample) additionally met the chronicity criterion (symptom duration ≥6 months), consistent with a PTED-compatible profile as proposed by Linden et al. (2004). Embitterment severity was significantly associated with hopelessness, hostility, anger expression, somatization, negative self-perception, interpersonal relationship problems, occupational stress, financial stress, parenting stress, marital stress, childhood abuse, and dysfunctional family structure.
CONCLUSION: The present findings suggest that PTED-compatible symptom patterns may represent a clinically meaningful and underrecognized cognitive-emotional syndrome in psychiatric outpatient settings. Further longitudinal and cross-cultural studies are needed to clarify the diagnostic boundaries, phenomenology, and therapeutic implications of PTED-compatible presentations.
METHODS: This cross-sectional study included 344 participants, consisting of 315 consecutive patients attending an anxiety outpatient clinic at a tertiary psychiatric center and 29 healthy control volunteers. Psychiatric diagnoses were established according to DSM-5 criteria through face-to-face clinical interviews, while PTED-related symptoms were evaluated using the clinical characteristics and standardized symptom criteria proposed by Linden and colleagues. Participants completed the Posttraumatic Embitterment Disorder Self-Rating Scale (PTED Scale), the Brief Symptom Inventory (BSI), the Buss-Perry Aggression Questionnaire (BPS), the Life Problems Screening List, and a structured sociodemographic assessment form.
RESULTS: On the PTED Self-Rating Scale, 178 participants (56.5%) obtained a mean score exceeding the established threshold of 2.5, indicating clinically significant embitterment. Of these, 114 participants (36.2% of the total sample) additionally met the chronicity criterion (symptom duration ≥6 months), consistent with a PTED-compatible profile as proposed by Linden et al. (2004). Embitterment severity was significantly associated with hopelessness, hostility, anger expression, somatization, negative self-perception, interpersonal relationship problems, occupational stress, financial stress, parenting stress, marital stress, childhood abuse, and dysfunctional family structure.
CONCLUSION: The present findings suggest that PTED-compatible symptom patterns may represent a clinically meaningful and underrecognized cognitive-emotional syndrome in psychiatric outpatient settings. Further longitudinal and cross-cultural studies are needed to clarify the diagnostic boundaries, phenomenology, and therapeutic implications of PTED-compatible presentations.