ArticleFrontiers in psychiatry2026
Embitterment symptoms and comorbid psychopathology in an anxiety outpatient clinic: frequency, clinical distribution, and psychosocial correlates.
Article in Frontiers in psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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.
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