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Objectives: The aim was to examine guilt and embitterment in mothers and fathers of children with burns and its associations with depression and burn severity. Methods: Parents (N=61, mothers n=41, fathers n=20) completed self-report questionnaires on guilt and embitterment, 0.8-5.6 years after their child's burn. Burn severity and sociodemographic variables were obtained from medical records and symptoms of depression were assessed with the Montgomery-Asberg Depression Rating Scale (MADRS). Results: The parents reported low levels of guilt, embitterment and depression. Burn-specific and general guilt were higher in mothers than fathers, but there were no differences in embitterment or symptoms of depression. General guilt was associated with depression, whereas burn-specific guilt and embitterment were not. Conclusions: Parents with general guilt may suffer from symptoms of depression. An implication is that clinicians should address guilt feelings among parents in order to alleviate distress and to identify any need for further counseling.

In clinical practice and in the context of work and disability pension examinations, clinical and vocational professionals regularly encounter patients with a rheumatic disease who are embittered. These patients view themselves as victims of external factors, experience a sense of resentment and injustice, show low motivation to improve their situation and have a misanthropic stance. The aim of this thesis was to improve insight into the phenomenon of embitterment in patients with a rheumatic disease. Using the cognitive appraisal theory of emotion as a framework, we hypothesized that appraisals that constitute embitterment will give rise to three emotions: (1) the undermining and flouting of one’s values and norms will be shown in the self-conscious affects of shame and guilt, (2) other-responsibility will be shown in anger and hostility, and (3) uncontrollability will be manifested in sadness. As hypothesized, embitterment was particularly associated to shame and guilt, hostility, and sadness. The question why some individuals are more prone than others to embitterment may partly be answered in terms of personality vulnerability factors. It was observed that the co-occurrence of high neuroticism (i.e., the tendency to react with negative emotions) and low agreeableness (i.e., the tendency to value getting along with others) was associated with embitterment. This might reflect that individuals with high neuroticism who lack agreeableness are impaired in the pro-social attenuation of hostile cognitive-emotional states in response to invalidation. This may clear the way for embitterment. An insecure attachment orientation may also be a vulnerability factor. Individuals may manage their attachment insecurity in two ways. Anxiously attached individuals hyperactivate their attachment system to avoid lack of acceptance and support, whereas avoidantly attached individuals deactivate their attachment system to avoid dependency and getting hurt. Especially the anxious attac

Hostility and anger have long been shown to be predictive of negative psychological, interpersonal and physical outcomes. Much of the literature, has focused on hostility as a state rather than a personality trait and has not attempted to explicate the link between embittered personality and depression. To achieve these goals, a newly created measure called the Resentful Embittered Personality Scale (REPS) was evaluated in detail. First, the literature examining the construct of embitterment and hostility was reviewed, its links with depression was explained, and unpublished pilot data were reviewed. Next, the psychometric properties, convergent and divergent validity, and reliability of the REPS were evaluated in the first study by exploring correlations with the NEO-FFI and other specific personality constructs and measures of hostility and distress. The second study evaluated the REPS with the larger measure of general personality, the NEO-PI-R, to further understand the nuances of these relationships between the REPS and the specific facets from the Big Five measure of personality. The focus of the third study was to examine the REPS with respect to both well-being and distress along with measures of stress. Finally, the fourth study examined the predictive validity of the REPS with respect to dyadic adjustment and depression six months later, after the birth of their first child. Results showed that the REPS was a valid and reliable measure and that the construct’s associations with certain factors of the NEO-PI R suggested that it reflected a highly ego-defensive and interpersonally sensitive personality style that likely functioned to set up a self-fulfilling prophecy of expected and elicited interpersonally conflictual exchanges. Multiple hierarchical regression analyses found that the REPS predicted both main and interactive effects of psychological distress and well-being over and above other personality and stress measures. Finally, embittered personality