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The editorial explores innovative approaches to addressing burnout in medical workers, focusing on the benefits of Well-Being Therapy (WBT) for those experiencing overwhelming stress, particularly during the COVID-19 pandemic in China. WBT targets allostatic load and psychological well-being, offering personalized treatment to reduce burnout. The text underscores the importance of individualized interventions and comprehensive assessments to differentiate between primary and secondary occupational challenges, suggesting that WBT may enhance work performance and alleviate demoralization in medical professionals. Additionally, the editorial discusses various studies on depression treatment, benzodiazepine use in elderly patients, and challenges in medication management in mental health care, aiming to provide insights into effective treatment strategies and potential risks associated with medication use in diverse patient populations. [Extracted from the article]

This study aimed to explore how dark personality traits influence the interplay between embitterment and jealousy. We first assessed the appropriateness of the scales used to assess jealousy, personality, and embitterment for our study population, examining their performance across different relationship statuses and ensuring their reliability. Then, through correlation, regression, and moderation analyses, we investigated the relationships among these measures. Our results revealed that Machiavellianism and narcissism act as moderators in the embitterment–jealousy relationship. Specifically, Machiavellianism moderated associations between overall embitterment and its psychological state and behavioral jealousy, while narcissism moderated connections between total embitterment and its psychological state, behavioral jealousy, cognitive jealousy, and overall jealousy. Furthermore, the combined influence of a longer relationship duration and higher levels of embitterment and Machiavellianism contributed to total jealousy scores. These findings deepen our comprehension of jealousy’s intricacies and the underlying factors at play.

This study examined the moderated mediation effect of heightened vigilance and Korean culture acceptance attitude on the relationship between microaggressions and embitterment in multicultural young adults aged 25 to 34 in South Korea. A total of 329 multicultural young adults aged 25 to 34 living in South Korea were surveyed. All participants had acquired Korean nationality, even if one of their parents was a non-Korean. First, a significant correlation was found between microaggressions and heightened vigilance, embitterment, and Korean culture acceptance attitude. Second, heightened vigilance partially mediated the relationship between microaggressions and embitterment. Third, Korean culture acceptance attitude moderated the relationship between heightened vigilance and embitterment. Fourth, heightened vigilance and Korean culture acceptance attitude had a moderated mediation effect on the relationship between microaggressions and embitterment. The present study is meaningful in that it examined the mechanisms of discrimination and psychological maladjustment among multicultural young adults and explored the factors that can be overcome in the context of the increasing immigrant population in Korea. [ABSTRACT FROM AUTHOR]

Discontent is an important feature of 'left-behind places', often reflected by a high percentage of voting for populist parties. Drawing on insights from psychology, we extend previous analyses by focusing on collective embitterment as the central underlying emotional state in a region. Arguing that such negative emotions do not arise 'out of the blue', we develop a four-phase model of regional embitterment that accounts for the emotional characterisation of and the level of embitterment among the population, as well as the role of policy interventions. Based on a case study in East Thuringia, we conclude that emotions should be given more attention in future studies. [ABSTRACT FROM AUTHOR]

Objective: "Disorders specifically associated with stress" are receiving increasing attention in clinical practice, research, and modern classification systems of mental disorders. This includes not only reactions to "extremely threatening or horrific events" as it is characteristic for "post-traumatic stress disorders" but also a variety of day-to-day experiences. Examples are experiences of injustice, humiliation, or breach of trust which can have dire psychological consequences such as feelings of embitterment, a strong and crippling emotion. This study investigated the frequency of feelings of injustice and concomitant embitterment across different areas of daily life of psychosomatic patients. Methods: In an observational archival study, 200 inpatients of a department of behavioral medicine filled in the "Differential Life Burden Scale, DLB-Scale" and the "Post-Traumatic Embitterment Scale, PTED-Scale" which asks for experiences of injustice and embitterment. Results: More than half of all patients (58.5%) reported about very or extremely unjust and unfair life events and 51.5% additionally about feelings of embitterment. This was primarily associated with complaints about problems in the family and the workplace and was accompanied by an impairment of well-being. Conclusions: The findings indicate that experiences of injustice and embitterment are frequently seen in psychosomatic inpatients and should get special attention. [ABSTRACT FROM AUTHOR]

Objective: To explore the mediating role of embitterment in the association of mental toughness and psychosocial reactions in COVID-19 sufferers. Methodology: The cross-sectional study was conducted at three government and private universities of Islamabad Pakistan chosen through random selection and comprised a purposive sample of 202 young adults of BS degree, between ages limit 18-25. The overall mean age was 20.4 years with a standard deviation of 1.47. Boys constituted 49% and girls constituted 51% of the total sample. Study sample included 17% participants that had been infected with COVID-19, 52% whose family member had been infected and 15% had experienced the death of a family member due to COVID-19, 12% fell into 2 of the categories while 4% experienced all three circumstances. Results: Results show that male participants scored higher on psycho-social reactions as compared to females. Findings revealed a significant positive relationship of embitterment with psychosocial reactions (β = .49, SE=.06, p < .001). Embitterment also has a negative relationship with mental toughness (β = - .42, SE= .06, p <.001). Conclusion: COVID-19 sufferers faced psychological challenges along with health issues which led to extreme psychosocial reactions and feelings of embitterment, whereas mental toughness functioned as a protective factor. [ABSTRACT FROM AUTHOR]

There are indications for a raise in embitterment during the COVID-19 pandemic. As embitterment is related to felt social exclusion, pessimism, and a proneness toward COVID-19-related conspiracy beliefs, embitterment may be a key factor to consider in the current pandemic. However, perceived social support (PSS), which is associated with hope during the COVID-19 pandemic could serve as an important resilience factor for bitterness. We therefore investigated the effects of PSS on embitterment in aftermath of the second wave of the COVID-19 pandemic. 52 individuals participated in our follow-up online study in October 2020 (T1) and May 2021 (T2). Embitterment (measured with the Berne Embitterment Inventory) and PSS were repeatedly assessed at T1 and T2. A double moderation analysis was conducted, using the PROCESS macro to examine the effects of embitterment, PSS, and age on embitterment 6 months later. The results suggest that the prediction of embitterment at T2 by embitterment at T1 was altered by changes in PSS. Here, in particular participants with high embitterment at T1 and a gain in PSS had higher embitterment scores at T2, whereas participants with low embitterment were found to have lower embitterment scores. This interaction effect was further influenced by the age of the participants, where the effects were more pronounced among middle-aged participants than younger participants. As embittered individuals seem to grow in bitterness with a gain in PSS, support is found for the notion that embittered individuals seeking allies supporting their mindset. [ABSTRACT FROM AUTHOR]

Abstract Objective Embitterment is a persistent emotion that is known to everybody in reaction to injustice and being let down, associated with feelings of helplessness and hopelessness. People with psychiatric disorders can develop bitterness, which is to be understood as a form of reactive embitterment to the illness. The aim of this explorative study was to investigate the occurrence of embitterment in obsessive–compulsive patients compared to healthy volunteers and in the context of their metacognitions and other biographical and clinical characteristics. Method Following a semi-structured diagnostic interview, a number of measures were administered to 31 patients with obsessive–compulsive disorder (OCD) [ICD-10 F42.X: mean age 35.2 (SD = 10.7) years] and 31 healthy volunteers [mean age 39.1 (SD = 15.0) years]. These measures included the Post-Traumatic Embitterment Disorder questionaire (PTEDq) for measuring embitterment, the Yale-Brown Obsessive–Compulsive Scale, the Metacognition Questionnaire and other psychometric questionnaires such as the Beck Depression Inventory and the State-Trait Anxiety Inventory. Results Patients with OCD scored more than three times higher (mean = 2.0, SD = 1.1) than the healthy participants in the PTEDq (mean = 0.6, SD = 0.8; p

Background Although vegetarian and vegan dietary can positively contribute to animal welfare, the environment and health, they also entail social costs for the people following them. These costs may be an increased risk of stigmatization and, presumably, feelings of embitterment.Methods In this study, we investigated for the first time the association between feelings of embitterment and dietary identity centrality and motivation. Dietary motivation, dietary pattern centrality for identity (DIQ-D), and embitterment (PTED scale) were assessed in and compared between people with vegan (n = 489), vegetarian (n = 339) and omnivorous (n = 319) dietary pattern.Results The vegan group reported higher embitterment and discrimination perception than the vegetarian and omnivorous groups. High (vegan) dietary centrality, eating disorder, moral motivation, discrimination perception was associated with embitterment.Conclusions The association between vegan dietary centrality and moral motivation with embitterment is relevant for actions in dietary education and counseling in clinical and public health settings. When dietary pattern becomes relevant for identity building this may come along with problems when it makes the person prone for discrimination perception.

Introduction: Embitterment may occur after stressful but normal life events, such as job loss, divorce, or unjust events. Embitterment is a normal affect, but it may become clinically relevant in case it becomes very strong and long-lasting, and impairs daily functioning. Objective: Until now, no epidemiological data on the frequency of high embitterment in the general population have been available. Methods: A national representative survey of 2,531 people was carried out in Germany in 2019. The participants gave ratings for their embitterment due to perceived events (Posttraumatic Embitterment Scale), their psychological capacity profile (Mini-ICF-APP-S), sick leave duration, and sociodemographics. Results: About 11.7% of the investigated representative population report moderate embitterment, and another 3.8% high embitterment. Embitterment was only low correlated with other psychopathology, here work anxiety (r = 0.281**). There are no differences between embittered and nonembittered in respect to age, sex, household members, and professional distribution. Those with the highest embitterment have been unemployed more often and have lower income. At least 7.2% of those with high embitterment have a severe psychological capacity impairment and are in need of support by thirds to fulfill daily duties. In 55% of the 802 who reported a stressful event, injustice by an important person has been reported. Injustice by an institution (14%) or societal injustice (12%) was least often reported as a relevant stressful event. Conclusion: Physicians, therapists, and public health must be aware of embitterment as a specific mental health problem which occurs frequently and may become chronic with work and life participation problems. [ABSTRACT FROM AUTHOR]

Objective: Embitterment is a persistent emotion that is known to everybody in reaction to injustice and being let down, associated with feelings of helplessness and hopelessness. People with psychiatric disorders can develop bitterness, which is to be understood as a form of reactive embitterment to the illness. The aim of this explorative study was to investigate the occurrence of embitterment in obsessive–compulsive patients compared to healthy volunteers and in the context of their metacognitions and other biographical and clinical characteristics. Method: Following a semi-structured diagnostic interview, a number of measures were administered to 31 patients with obsessive–compulsive disorder (OCD) [ICD-10 F42.X: mean age 35.2 (SD = 10.7) years] and 31 healthy volunteers [mean age 39.1 (SD = 15.0) years]. These measures included the Post-Traumatic Embitterment Disorder questionaire (PTEDq) for measuring embitterment, the Yale-Brown Obsessive–Compulsive Scale, the Metacognition Questionnaire and other psychometric questionnaires such as the Beck Depression Inventory and the State-Trait Anxiety Inventory. Results: Patients with OCD scored more than three times higher (mean = 2.0, SD = 1.1) than the healthy participants in the PTEDq (mean = 0.6, SD = 0.8; p < 0.001), but the cut-off of < 2.5 for a clinically relevant embitterment disorder was not reached. Dysfunctionally distorted metacognition (MCQ-30), which is a consistent finding in OCD, as well as a generally high degree of clinical impairment were significantly cor related to the degree of embitterment. Conclusion: Our findings suggest that embitterment as measured by PTEDq is important in patients with OCD, who are characterized by metacognitive distortions with an injustice of fate as well as a mortification of their self-image. In future, it would be necessary to screen patients with OCD not only for depressive symptoms but also specifically for feelings of embitterment in order to be able to initiate appropriate psychotherapeutic measures at an early stage. [ABSTRACT FROM AUTHOR]

Aim/Purpose Embitterment comprises a stress-related response to unjust life experiences. Studies have found that it can have a toll on employees' well-being. However, research on this matter is still in its infancy. Background Within the scope of the present study, sought to investigate how embitterment relates to burnout - the prolonged consequence of stress. This study further explored whether breaches of psychological contracts can trigger embitterment. Methodology The study employed a cross-sectional design where two hundred and eight (N = 208) participants from the general population completed an online survey. Contribution Findings suggest that the toll of embitterment might be much more than what research has suggested so far. Those who experience embitterment can become emotionally exhausted and cynical and these findings can be especially useful when identifying embitterment. Findings It was found that embitterment related to higher burnout levels and more specifically emotional exhaustion and cynicism. No significant findings were revealed for the relationship between professional inefficacy and embitterment. Also, psychological contract breach was found to be a significant predictor of embitterment, supporting further the notion that perceptions of injustice can trigger feelings of embitterment. Results also showed that embitterment mediated the relationship between psychological contract breach and burnout. Recommendations for Researchers The study highlights the notion that fairness is a key precursor of embitterment, and this finding is essential when developing interventions to prevent embitterment from arising. Future Research Future research could use a longitudinal study design to unravel whether burnout represents a precondition or the consequence of embitterment. Future research should also include more objective measures. For example, it would be useful to pair self-report data with more objective measures on embitterment (e.g. clinical interviews). [ABSTRACT FROM AUTHOR]

The global spread of the COVID-19 pandemic has increased the number of frontline medical staff complaining of problems such as anxiety, depression, and insomnia, thereby requiring urgent psychological support. Nurses are particularly exposed to various stressors and difficult environments, witnessing patients' pain, frustration, and death, while helping them recover. Music is known to be effective in inducing psychological stability by activating brain waves, relaxing the body, and alleviating negative reactions. This study examines how musical activities affect embitterment and psychological well-being among nurses and nursing students who suffer from various psychological difficulties. This study finds that musical activity helps nurses' psychological stability by lowering their embitterment index and increasing their psychological well-being. Further, the greater the music listening time is, the higher is the psychological well-being, indicating the necessity of increasing the music listening time and encouraging more musical activities for the psychological stability of nurses in the future. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has not only had an impact on the health of many people, but also on politics, the economy, and everyday life at large. It has been shown that some people respond with anxiety and depression, which is not surprising. Another reaction in the context of COVID-19 is embittered fights and disruptions between family members, friends, and neighbors, but also problems on a societal and political level, mutual public insults, political demonstrations, and even aggressive outbursts with a high number of participants. This calls for a separate explanation. One trigger may be embitterment, an emotion known to anybody in reaction to injustice, humiliation, and breach of trust, in association with helplessness. It comes along with a nagging desire to fight back and is usually accompanied by aggressive fantasies and combatively impulses towards the wrongdoer. This emotion also spreads indiscriminately to other people and the world. There are few initial studies which show that there is a significant increase in the rate of embitterment during the COVID-19 pandemic. Increased embitterment was related to financial losses, concern about restricted societal freedom, job insecurity, oppositional attitudes, helplessness, dissatisfaction with life, and inclination to join anti-COVID-19 demonstrations. These findings suggest that it is important to foster resilience against stressors, be it because of the virus itself, restrictions in daily freedom, negative comments by other persons, or imbalanced press releases. Of importance is also to abstain from insulting comments towards people who do not follow the mainstream, to allow adjustment of rules to given situations, and to take people along by listening to their grievances, instead of leaving demonstrations on the street as the only method to voice concerns.

Participants in legal disputes can harbor feelings of injustice, betrayal, humiliation. An often associated emotion is embitterment, which is characterized by an urge to reinstall justice and to fight back, whatever the cost. Embitterment-related dysfunctional behavior can complicate legal procedures. Fifty-one lawyers were asked to think about their last regular client and a client which they consider to suffer from embitterment. In the group of regular clients, 20.7% were judged to show signs of embitterment. Increased scores of 2.5 or higher on a list of embitterment symptoms was found in 18.2% of the regular and 56.2% of the embittered clients. The average duration of the legal dispute was significantly longer in embittered clients and more lawyers were involved. No associations were found with socio-demographic characteristics or type of the legal problem. The data show that embitterment is known to lawyers and seen in many clients. Attorneys, law scholars, courts, lawmakers, and clinicians should be aware of embitterment. Open questions are how one should deal with embitterment in legal discourses and court decisions and how one can avoid that embitterment causes unsuccessful legal disputes. [ABSTRACT FROM AUTHOR]

Although vegetarian and vegan dietary can positively contribute to animal welfare, the environment and health, they also entail social costs for the people following them. These costs may be an increased risk of stigmatization and, presumably, feelings of embitterment. In this study, we investigated for the first time the association between feelings of embitterment and dietary identity centrality and motivation. Dietary motivation, dietary pattern centrality for identity (DIQ-D), and embitterment (PTED scale) were assessed in and compared between people with vegan (n = 489), vegetarian (n = 339) and omnivorous (n = 319) dietary pattern. The vegan group reported higher embitterment and discrimination perception than the vegetarian and omnivorous groups. High (vegan) dietary centrality, eating disorder, moral motivation, discrimination perception was associated with embitterment. The association between vegan dietary centrality and moral motivation with embitterment is relevant for actions in dietary education and counseling in clinical and public health settings. When dietary pattern becomes relevant for identity building this may come along with problems when it makes the person prone for discrimination perception. [ABSTRACT FROM AUTHOR]

Embitterment is an emotion which is known to everybody in reaction to injustice, humiliation, and breach of trust. Children and adolescents have an understanding of justice/injustice and fairness, violations of injustice, humiliation, and breach of trust are also stressors at a young age. In this conceptual paper it is argued that embitterment is also seen in children and adolescents, and that parents, educators and therapists should recognize this emotion. This could possibly help to early identify children at risk for severe dysfunctional and aggressive behaviours, when preventive interventions are still possible. The article concludes with concepts on how to diagnose and treat children with embitterment. [ABSTRACT FROM AUTHOR]

Abstract Background Refugees and asylum seekers are frequently exposed to violence, human rights violations and unstable living conditions before, during, and after their displacement. Elevated prevalence rates of psychiatric disorders in forcibly displaced persons are well documented. However, less is known about other problems related to common refugee experiences, such as embitterment, moral injury, and diminished self-efficacy, and how they are related to trauma exposure and post-migration living difficulties. Methods A cross-sectional sample of 71 refugees and asylum seekers in treatment were examined regarding exposure to potentially traumatic events, post-migration living difficulties, moral injury appraisals, self-efficacy, and embitterment. Results Elevated levels of embitterment were reported by 68% of participants. The regression analysis revealed that greater moral injury appraisals and low levels of self-efficacy were significantly associated with higher levels of embitterment. Conclusion The results provide first insights into embitterment and associated factors in refugee populations. Furthermore, they highlight the significance of moral transgressions and low levels of self-efficacy emerging from displacement and traumatic experiences for the development of mental health problems in a clinical sample of refugees. The findings have implications for future research, policy development and clinical practice.

BACKGROUND: The negative consequences of job loss on financial and psychological quality of life have been well documented. OBJECTIVE: This study evaluated the level of unemployed individuals' embitterment and the mechanism by which negative life experiences increase embitterment by lowering the belief in a just world (BJW). METHODS: A survey was administered to 1,074 unemployed Korean adults who visited a regional Center for Employment and Welfare. Question items included the Korean version of posttraumatic embitterment disorder (PTED) self-rating scale, the BJW (personal and general) scale, negative life events, and sociodemographic characteristics. RESULTS: Only 45.9% of the participants were categorized as being in a 'normal state,' indicating that many of the unemployed were emotionally embittered. There was a positive direct effect of an increase in negative life events on embitterment. Negative life events also significantly and indirectly affected embitterment through personal BJW. CONCLUSIONS: Embitterment was prevalent among the unemployed participants and embitterment was a reactive emotion following personal downgrading, not so much related to conditions in the world at large. Thus, we recommend developing a screening program to detect extreme embitterment and an interventional program to help people better cope with emotional stress due to job loss. Efforts should be made to restore their violated expectation and trust that they would be treated in a just and fair way. [ABSTRACT FROM AUTHOR]

Major depression has become one of the most frequent diagnoses in Germany. It is also quite prominent in cases referred for medicolegal assessment in insurance, compensation or disability claims. This report evaluates the validity of clinicians’ diagnoses of major depression in a sample of claimants. In 2015, n = 127 consecutive cases were examined for medicolegal assessment. All had been diagnosed with major depression by clinicians. All testees underwent a psychiatric interview, a physical examination, they answered questionnaires for depressive symptoms according to DSM-5, embitterment disorder, post-concussion syndrome (PCS) and unspecific somatic complaints. Performance and symptom validity tests were administered. Only 31% of the sample fulfilled the diagnostic criteria for DSM-5 major depression according to self-report, while none did so according to psychiatric assessment. Negative response bias was found in 64% of cases, feigned neurologic symptoms in 22%. Symptom exaggeration was indiscriminate rather than depression-specific. By self-report (i.e. symptom endorsement in questionnaires), 64% of the participants qualified for embitterment disorder and 93% for PCS. In conclusion, clinicians’ diagnoses of depression seem frequently erroneous. The reasons are improper assessment of the diagnostic criteria, confusion of depression with bereavement or embitterment and a failure to assess for response bias.

Introduction Embitterment is an emotion which is known to everybody in reaction to injustice, humiliation, and breach of trust. In greater intensity it can cause severe suffering for the affected person and the social envirnment, can result in lasting impairment, and even lead to dysfunctional behavior, including aggression. Embittered patients need therapeutic help and are regularly seen in psychotherapy. The problem is often not properly recognized, because of the multiple accompanying symptoms and accusations against the environment. Objectives Goal of the present study was to learn about the prevalence of embitterment in psychotherapy patients Methods Outpatients in routine psychotherapy filled in the PTED scale (post-traumatic embitterment disorder selfrating scale), the K-FAF (short assessment of aggression) and the SCL-90 (symptom-checklist-90). Additionally, sociodemographic data were available. Results Included were 118 patients, of whom 22% showed a relevant severity of embitterment, 23.7% a relevant score for reactive aggression, and 54.2% a relevant score for irritable aggression. There was a significant correlation between the PTED scale and the aggression scale. Conclusions The data show that embitterment and related aggression are frequent phenomena in psychotherapy patients. Therapists should be aware of this emotion and take proper action to diagnose embitterment and aggressive ideation, which are often covered by other complaints. Special treatments are needed, as the aggressive and negativistic features of embitterment complicate the psychotherapy process. Disclosure No significant relationships.

Introduction: As Switzerland faced the "second wave" of COVID-19 incidences, a discussion of a potential vaccine against the virus emerged. While some individuals accept vaccines, others challenge or refuse to be vaccinated, a phenomena called vaccine hesitancy. Here, trust plays a vital role in vaccination intention. Embitterment not only goes along with the sense of being treated unjust but also innates a distrust in others. Thus, embitterment may influence individuals' vaccination intention against COVID-19. In the present study, we investigate how feelings of being socially excluded and the perceived negative impact of the pandemic are associated with embitterment and in turn, how embitterment is related to individuals' vaccination intention and the tendency to hold COVID-19-related conspiracy beliefs (CCBs). This is in regard of the perceived communication style by the government. Method: A convenience sample of 281 individuals completed an online survey developed on Qualtrics. In this cross-sectional, nonexperimental designed study, indirect effects of a moderated serial mediation were analyzed using Jamm (Jamovi, Version 0.9; 2019). Results: Results indicated that embitterment went along with increased feelings of social exclusion (β = 0.45, p < 0.001). Further, individuals high in embitterment generally indicated a higher vaccination intention against COVID-19 (β = 0.15, p < 0.01). However, embittered individuals holding CCBs had a decreased vaccination intention against COVID-19 (β = −0.71, p < 0.001). Thus, whether or not embittered individuals develop CCBs might be a crucial determinant for their vaccination intention. Noteworthy, the relationship between embitterment and the tendency to hold CCBs was reinforced by the notion of an unsatisfactory style of communication by the government. Conclusion: Taken together, results suggest that embitterment not only plays a relevant role in vaccination intention against COVID-19 but also for the susceptibility to engage in conspiracy beliefs. [ABSTRACT FROM AUTHOR]

Introduction: Embitterment can occur as a reaction to perceived injustice. During the pandemic and restrictions in daily living due to infection risk management, a range of many smaller or severe injustices have occurred. Objective: The aim of this study is to investigate what characterizes persons with high embitterment, mental illness, embitterment and mental illness, and those without embitterment or mental health problems. Methods: We conducted an online survey including persons from the general population in November 2020 and December 2020, the phase during which a second lockdown took place, with closed shops, restaurants, cultural and activity sites. 3,208 participants (mean age 47 years) gave self-ratings on their present well-being, burdens experienced during the pandemic, embitterment, wisdom, and resilience. Results: Embitterment occurred among 16% of the sample, which is a high rate in comparison with 4% during pre-pandemic times. Embitterment was weakly correlated with unspecific mental well-being. There were more persons with embitterment than those with embitterment and a mental health problem. Persons with embitterment reported less coronavirus-related anxiety than persons without embitterment. However, embittered persons reported more social and economic burdens and more frequent experiences of losses (job loss and canceling of medical treatments). Embittered persons perceive their own wisdom competencies on a similar level as persons with mental health problems or persons without mental health problems. Conclusion: Embitterment is a specific potentially alone-standing affective state, which is distinguishable from general mental health and coping capacities (here: wisdom). The economic and social consequences of pandemic management should be carefully recognized and prevented by policy. [ABSTRACT FROM AUTHOR]

BACKGROUND: The workplace can be associated with social stressors like vilification, humiliation, and breach of trust. A common emotional response is embitterment and aggressive behavior. OBJECTIVE: Aim of the study is to investigate the relation between work-related problems, including bullying, and fantasies of aggression. METHODS: Therapists of a department of behavioral medicine routinely had to fill in a diagnostic checklist whenever they saw signs of embitterment and/or aggression in their patients. The type of aggressive fantasies was categorized in no fantasy, minor harm, serious harm without bodily harm, or bodily harm. Independent of this interview, social workers assessed problems at work (duration of sickness absence, workplace insecurity, bullying at workplace, ability to work, expectation of pension). Patients were also asked to fill in an embitterment questionnaire and the Symptom-Checklist-90. Further sociodemographic and clinical information was taken from the hospital routine documentation. RESULTS: A total of 3211 patients were admitted to the hospital during the observation period. Therapists saw the indication for an in-depth interview because of aggressive fantasies in 102 (3.2%) patients. Aggressive ideations refer to "minor harm" in 27%, "serious harm" in 37%, and "bodily harm" in 35%of patients, respectively. There is a significant relation between the severity of aggressive ideations and bullying and duration of sick leave. There was also a significant correlation between ideas of aggression and feelings of embitterment. CONCLUSION: Aggressive ideations are interrelated with psychosomatic distress and workplace problems and feelings of embitterment. This is of importance for prevention and interventions in regard to workplace bullying. [ABSTRACT FROM AUTHOR]

Embitterment and in some cases also post‐traumatic embitterment disorder (PTED) are relevant problem in the general population and even more so in psychiatric patients. PTED screening should be an essential component of routine mental health management, which can be done by the 21‐item Post‐traumatic Embitterment Disorder Self‐Rating Scale (C‐PTED‐21), which measures the intensity of reactive stimulus bound embitterment. The PTED‐21 German version was translated into Chinese, and 200 nonpsychiatric inpatients, reporting major negative life events, were recruited through convenience sampling to evaluate test performance. Ninety patients were selected for retest 2 weeks later to examine scale reliability. Factor analysis was used to assess construct validity and receiving operating characteristic curve analysis based on the "PTED standardized diagnostic interview" to assess diagnostic utility. Correlations with depression, somatic symptom, and anxiety scales were examined to assess aggregate validity. The C‐PTED‐21 demonstrated high internal consistency (Cronbach's α = 0.944) and good test–retest reliability (total score r = 0.783, individual item r value range, 0.635–0.889). Factor analysis revealed three common factors consistent with PTED core features. Total C‐PTED‐21 score was strongly correlated with the score on the nine‐item Patient Health Questionnaire depression scale (PHQ‐9, r = 0.735). Mean PTED‐21 score ≥1.6 points distinguished clinical PTED as defined by diagnostic interview with 97.6% sensitivity and 90.5% specificity (AUC = 0.988, 95%CI: 0.976–0.999). The results show that the C‐PTED‐21 can assess the severity of PTED with good reliability and validity. [ABSTRACT FROM AUTHOR]

Background: Refugees and asylum seekers are frequently exposed to violence, human rights violations and unstable living conditions before, during, and after their displacement. Elevated prevalence rates of psychiatric disorders in forcibly displaced persons are well documented. However, less is known about other problems related to common refugee experiences, such as embitterment, moral injury, and diminished self-efficacy, and how they are related to trauma exposure and post-migration living difficulties. Methods: A cross-sectional sample of 71 refugees and asylum seekers in treatment were examined regarding exposure to potentially traumatic events, post-migration living difficulties, moral injury appraisals, self-efficacy, and embitterment. Results: Elevated levels of embitterment were reported by 68% of participants. The regression analysis revealed that greater moral injury appraisals and low levels of self-efficacy were significantly associated with higher levels of embitterment. Conclusion: The results provide first insights into embitterment and associated factors in refugee populations. Furthermore, they highlight the significance of moral transgressions and low levels of self-efficacy emerging from displacement and traumatic experiences for the development of mental health problems in a clinical sample of refugees. The findings have implications for future research, policy development and clinical practice. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) has made 'untact' life a new standard (next normal) way of life, minimizing physical contacts among people. Emotional exchanges between people are rapidly being replaced by contact through the Internet, social networks, and over-the-top services. Current Concepts: People are expressing more stress and anxiety that are caused by fear of infection, and also embitterment due to perceived distrust and injustice is increasing. In the era of COVID-19, it is necessary and important to manage burnout, depression, and anxiety symptoms of medical staff and quarantine personnel. The pandemic and the resulting social changes intensifies loneliness, leading to deterioration in mental and physical health. The World Health Organization has warned that loneliness and social isolation are leading to the exacerbation of physical illness and increased mortality due to suicide and other mental health problems. Discussion and Conclusion: It is needed to establish a next standard of mental health service such as untact diagnosis and follow-up support system. Government and society should establish a sustainable system even after the COVID-19 crisis, rather than stopgap measures made with people's sacrifice as collateral. [ABSTRACT FROM AUTHOR]

Background: Post-traumatic embitterment disorder (PTED) is characterized by embitterment reaction to stressful life events, which are seen as unjust and as a violation of basic beliefs. On 28 February 1997, a so-called post-modern coup took place in Turkey, declaring a ban on hijab which had a significant impact on women's lives by eliminating them from public sphere if they were to wear hijab. Aim: The aim of this study was to assess the frequency of PTED symptoms among woman victims of the coup after two decades, and to investigate its correlations. Embitterment reaction was also examined in woman victims of 1999 earthquakes of Turkey, and the findings were compared. Method: We used PTED, Beck Anxiety Inventory, Beck Depression Inventory and Brief Resilience Scale, and a purpose-designed socio-demographic form. Results: Out of eligible 101 hijab ban victims responded, substantial proportion of them (48%) were suffering from chronic embitterment as well as experiencing symptoms of anxiety (37.6%) and depression (26.8%) of moderate-to-severe intensity. There was no difference in the levels of anxiety, depression and resilience between the victims of the coup and earthquake (N = 20), but hijab ban victims were significantly more likely to present with PTED symptoms (p <.05). Women who had family support were more resilient with less likelihood of PTED (p <.05). Conclusion: This study provides some important insights into psychopathology of PTED as well as suggesting that it is more likely to manifest in people whose suffering is brought upon by fellow human beings. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the psychosocial differences between patients with psoriasis in different phases of the disease. Seventy-one patients in exacerbation and 83 in remission were evaluated regarding sociodemographic, clinical and psychological variables, on the premise that the visibility of lesions (exacerbation phase) may impact the emotional regulation and embitterment. A regression analysis was performed to identify the variables that contribute to explain embitterment: a diagnosis of anxiety and/or depression and psoriasis severity are the identified ones. The results point to higher values of emotional dysregulation and embitterment, as well as more critical clinical variables in patients with active disease, namely, alcohol and coffee consumption, smoking and less satisfaction with current treatment, more diagnoses and more family history of anxiety and depression, more psychology/psychiatry consultations and more use of anxiolytics and antidepressants. However, only the results referring to alcohol consumption and embitterment are significantly higher in subjects in the exacerbation phase of the disease. Particular clinical attention should be provided to patients in exacerbation phase regarding psychotherapeutic approach. [ABSTRACT FROM AUTHOR]

Background: Embitterment is an emotional state as a reaction to negative life events and is characterized as a nagging and burning feeling of being let down, insulted, or being a loser, and of being revengeful but helpless. There have been few studies concerning embitterment dynamics. This study aims to test a structural equation model for embitterment dynamics by examining likely factors that could have contributed to feelings of embitterment.Methods: A total of 2024 South Koreans completed Post-Traumatic Embitterment Disorder Self-Rating Scale and Bern Embitterment Inventory, as well as the scales of belief in a just world (BJW), negative life events, and social support.Results: Experiencing more negative life events was connected to a higher level of embitterment, whereas having more social supports decreased embitterment. As an indirect effect, BJW showed the most powerful influence on embitterment and BJW itself was reduced or increased either by negative life events or social support, respectively.Limitations: Although some significant influences on embitterment were examined, other aspects that include individual characteristics (self-efficacy, trust, political orientation, and media use) await examination.Conclusions: The level of embitterment was affected by BJW, social support, and negative life events, which suggests points of possible intervention. [ABSTRACT FROM AUTHOR]

Injustice, breach of trust, and humiliation are social stressors which can result in embitterment, known to everybody and which has been described in the Bible (Cain and Abel) or by Aristotle in the Nicomachean Ethics. It has been discussed by several authors since the early days of psychiatric classification. In the textbook 'Psychiatry' by E. Kraepelin a full chapter is devoted to 'querulant delusion', named a reactive psychosis, which can be discriminated from endogenous psychosis or personality disorders. Core symptoms are embitterment, negativism, helplessness, self blame, unspecific somatic symptoms, phobic avoidance of persons or situations related to the event, intrusions, phantasies of revenge and aggression. Another name is 'Posttraumatic Embitterment Disorder' according to the leading emotion. This severe mental disorder has by and large been ignored over the years by health professionals. In ICD-11 the term embitterment is mentioned for the first time in the category '6B43 adjustment disorder'. Embitterment can be measured with the 'Bern Embitterment Inventory (BVI)' and the 'Post-Traumatic Embitterment Self-rating Scale (PTED scale)'. Treatment must take into account the special features of embitterment including often aggressive rejection of help. A promising treatment approach is, to refer to wisdom psychology and transfer this in 'wisdom psychotherapy'. [ABSTRACT FROM AUTHOR]

Clinicians working in occupational health services often recognize features of embitterment in organizations; however, research on interventions for embitterment are scarce. The present study aimed to assess the effectiveness of an expressive writing intervention on working adults who experience workplace embitterment. Employing a randomized control trial we sought to test an expressive writing intervention for its effects on reducing embitterment, work-related rumination and sleep quality and assess whether the effect of the intervention was maintained over time by following up participants after one and three months. Findings partially supported our hypothesis as results showed that participants who completed the expressive writing intervention (N = 23) did not show significantly lower levels of embitterment, affective rumination, higher levels of detachment, either improved sleep quality, compared to participants who completed the factual writing (N = 21), when baseline values were controlled for. However, when looking at the mean scores embitterment and affective rumination levels diminished, detachment levels increased and sleep quality improved throughout the course of the intervention for both groups. Given the stability of embitterment and as findings from this study indicate embitterment diminished after a writing exercise irrespective of emotional disclosure taking place or not, further research and investigation are warranted. [ABSTRACT FROM AUTHOR]

Background: Post-traumatic embitterment disorder (PTED) has recently been introduced as a subgroup of adjustment disorders related to stressful life events. Embitterment is defined as persistent feelings of inadequacy or hoping for revenge after being insulted but feeling helpless after experiencing a life stressor. This study aims to investigate the cumulative and differential effects of negative life events on the risk of developing embitterment among young adults in South Korea. Methods: Data for the present study were collected from a web-based survey of 1,000 young adults aged 18–35 years. All participants completed a list of negative life events, the PTED Self-Rating Scale. Logistic regression analysis was conducted to evaluate the relationships between the number of negative life events and reactive embitterment. Analyses of the relationships between each negative life event and reactive embitterment were performed using covariates, including childhood trauma, depression, and anxiety symptoms. Results: The total number of participants with reactive embitterment (cut-off scores > 2.5) was 452 (45.2%). Greater exposure to negative life events increased the risk of reactive embitterment compared to no negative events. Negative life events, including financial problems, family problems, and being excluded by friends, had significant associations with the risk of reactive embitterment. Conclusions: The present study revealed a substantial number of young adults with a high level of embitterment. Furthermore, cumulative and differential effects of negative events increased the risk for reactive embitterment. Our findings underlined the crucial role of adverse life events in the development of reactive embitterment. [ABSTRACT FROM AUTHOR]

Major depression ranges among the most frequently diagnosed psychiatric disorders. Accordingly, diagnoses of depression are often underlying insurance, compensation or disability claims. This report evaluates the validity of clinicians’ diagnoses of major depression in a sample of claimants. In 2015, n = 127 consecutive cases were examined for medicolegal assessment. For all of them, a diagnosis of major depression had been established by clinicians. All testees underwent a psychiatric interview, a physical examination, they answered questionnaires for depressive symptoms according to DSM-5, embitterment disorder, post concussion syndrome (PCS) and unspecific somatic complaints. Performance and symptom validity tests were administered. Only 31% fulfilled the diagnostic criteria for DSM-5 major depression according to self-report, while none did so according to psychiatric assessment. Negative response bias was found in 64% of cases, feigned neurologic symptoms in 22%. Symptom exaggeration was indiscriminate rather than depression-specific. By self-report, 64% of the participants qualified for embitterment disorder and 93% for PCS. In conclusion, clinicians’ diagnoses of depression seem often confounded by improper assessment of the diagnostic criteria, confusion of depression with bereavement or embitterment and also by response bias. [ABSTRACT FROM AUTHOR]

Background: Mental disorders can be associated with suicidal or aggressive ideation and behavior, especially in the context of embitterment. The aim of this study is to investigate the types, prevalence, and dangerousness of aggressive and suicidal ideations associated with embitterment. Methods: When therapists from the department of behavioral medicine detected signs of embitterment, aggression, or suicidal thoughts in their patients, they routinely filled out a questionnaire on aggressive ideation, assessed the embitterment, and contacted a senior psychiatrist. Additionally, patients answered an embitterment scale. Results: There were 127 patients (3.84% of all patients) with suicidal and/or aggressive ideation. They had an increased score of 2.93 (SD 0.74) on the embitterment scale, associated with personal vilification (62.7%), breach of trust (30.2%), public humiliation (25.4%), death/loss (5.6%), or attacks by another person (14.3%). We found that 83.5% of the patients harbored aggressive ideations; in 94.1% of this group, these were directed against the person who had caused the problem, 88.3% wanted to inflict severe damage, 38.8% to harm another person, 31.5% showed suicidal ideation, and 3.2% had fantasies of murder-suicide. Only 34.3% of the patients reported spontaneously about their current aggressive ideation. The limitations of the study are that the data come from an inpatient sample and patients were identified according to clinical judgement. Conclusion: Aggressive ideation is regularly associated with embitterment. This deserves the attention of therapists for the prevention of aggressive acts. [ABSTRACT FROM AUTHOR]

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 socio-demographic variables were obtained from medical records and symptoms of depression were assessed with the Montgomery-Åsberg 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. [ABSTRACT FROM AUTHOR]

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Purpose Traumatic injury is a leading cause of work disability. Receiving compensation post-injury has been consistently found to be associated with poorer return to work. This study investigated whether the relationship between receiving compensation and return to work was associated with elevated symptoms of psychological distress (i.e., anxiety, depression, and posttraumatic stress disorder) and perceived injustice. Methods Injured persons, who were employed at the time of injury ( n = 364), were recruited from the Victorian State Trauma Registry, and Victorian Orthopaedic Trauma Outcomes Registry. Participants completed the Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist, Injustice Experience Questionnaire, and appraisals of pain and work status 12-months following traumatic injury. Results Greater financial worry and indicators of actual/perceived injustice (e.g., consulting a lawyer, attributing fault to another, perceived injustice, sustaining compensable injury), trauma severity (e.g., days in hospital and intensive care, discharge to rehabilitation), and distress symptoms (i.e., anxiety, depression, PTSD) led to a twofold to sevenfold increase in the risk of failing to return to work. Anxiety, post-traumatic stress and perceived injustice were elevated following compensable injury compared with non-compensable injury. Perceived injustice uniquely mediated the association between compensation and return to work after adjusting for age at injury, trauma severity (length of hospital, admission to intensive, and discharge location) and pain severity. Conclusions Given that perceived injustice is associated with poor return to work after compensable injury, we recommend greater attention be given to appropriately addressing psychological distress and perceived injustice in injured workers to facilitate a smoother transition of return to work. [ABSTRACT FROM AUTHOR]

Objectives. The aim of this study in employed people with FM was to test the hypothesis that embitterment is a function of the joint experience of invalidation from the work environment and helplessness regarding one's illness.Methods. Sixty-four full-time (36%) or part-time (64%) employed patients with FM (60 females, mean age 45 years) completed the Illness Invalidation Inventory (3*I) to assess work-related discounting and lack of understanding, the Illness Cognition Questionnaire (ICQ) to assess helplessness and the Bern Embitterment Inventory (BEI) to assess embitterment. Hierarchical regression analysis was performed.Results. Sixteen percent of the participants experienced embitterment levels in the clinical range. The interaction or combination of discounting and helplessness (P = 0.02) and the combination of lack of understanding and helplessness (P = 0.04) were associated with greater embitterment.Conclusions. The construct of embitterment has substantial face validity and may result from a combination of invalidation and helplessness. Whereas helplessness is a common target of cognitive–behavioural therapy, evidence-based interventions to redress invalidation and embitterment are needed. It is possible, however, to target invalidation by educating people in the work environment about the consequences of FM and patients' valid needs for work that is manageable, given each patient's specific health-related limitations. [ABSTRACT FROM PUBLISHER]