At our October workshop on workplace bullying held in Boston, no topic generated more intense discussion than post-traumatic embitterment disorder (PTED).
PTED is a psychiatric disorder proposed by Dr. Michael Linden, a German psychiatrist, grounded in his findings that people may become so embittered by a negative life event that normal functioning is impaired. In a 2003 article published in the journal Psychotherapy and Psychosomatics (abstract here; article must be purchased), Dr. Linden defines the elements of PTED:
- “a single exceptional negative life event precipitates the onset of the illness”;
- “the present negative state developed in the direct context of this event”;
- “the emotional response is embitterment and feelings of injustice”;
- “repeated intrusive memories of the event”;
- “emotional modulation is unimpaired, patients can even smile when engaged in thoughts of revenge”; and,
- “no obvious other mental disorder that can explain the reaction.”
Linden lists other symptoms, including severe depression, “feelings of helplessness,” disrupted sleep, aggression, and even suicidal ideation. PTED lasts “longer than 3 months,” during which “(p)erformance in daily activities and roles is impaired.”
PTED is not yet a recognized condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM), considered the most authoritative source for defining mental disorders. However, Dr. Linden and others are producing a growing body of peer review research on PTED that supports the possibility of eventual inclusion.
PTED and workplace bullying
When I first wrote about the relationship between PTED and workplace bullying some four years ago, the post attracted dozens of comments from readers. The topic obviously strikes a chord, with some nodding their heads in agreement and others questioning its application to bullying.
The word embitterment tends to carry negative connotations. Someone tagged as embittered is often regarded as being angry and unpleasant. Because the term refers to individuals, it’s easy to dismiss how they got this way. In fact, more often than not, they are blamed for stewing in their own juices, as if they had a character flaw. The circumstances that triggered these emotions — in this context, various forms of workplace mistreatment — usually get a free pass.
However, I suggest looking at this differently. How about acknowledging that anger, even deep, ongoing anger, is a natural response to unjust actions and behaviors that threaten or destroy one’s health, livelihood, and/or career? Obviously being stuck in a state of embitterment isn’t good for anyone, but let’s not blame a person for having these feelings, while failing to hold an employer accountable for having precipitated the response.
As for moving beyond embitterment, that’s a necessary piece of the discussion as well. Last year I wrote about the challenges that some targets of workplace bullying face in getting “unstuck,” at least to a point where the bullies and bullying behaviors no longer have an emotional stranglehold on their lives. Acknowledging embitterment as a potential and normal consequence of workplace bullying can be an important part of that recovery process.
Thanks to Tanya Sidawi-Ostojic for her Boston workshop talk on PTED. She will be continuing her doctoral research on this topic, which certainly merits our attention.
Helping workplace bullying targets get beyond rumination (2015)
Targets of workplace bullying: Getting unstuck (2014)
David, as a psychiatrist, not sure why PTED is not just another version of PTSD.
Steve, I agree there are strong similarities. I won’t try to speak for Dr. Linden, but one obvious difference is that in terms of precipitating events, PTED does not require exposure to serious or life-threatening injury, whereas PTSD (DSM version, at least) has that requirement. Our discussion at the Boston workshop included consideration of whether severe forms of workplace bullying would meet that element of PTSD. At the very least, wider recognition of PTED might help those who cannot meet the clinical definition of PTSD.
PTSD and PEST are synonymous in my
Mind. Some call it complexity PTSD since the bullying incidents are often discrete, subtle and cumulative assaults on the targets sense of defense, which disrupts their self-bond originally cultivated by childhood attachment with loving validating caregivers. I believe bullying involves an insidious shaming and shunning that overtime disrts the early mirroring that was internalized, and disrupts the targets sense of attachment, safety, security and self compassion. This self bond must be repaired with a corrective emotional relationship with a therapist who repeatedly validates and mirrors loving kindness and empathy to the target.
Reblogged this on Awaiting Moderation.
I respond as someone who has experienced bullying in the workplace and has been dealing with subsequent episodes of anxiety attacks and depression, I truly appreciate the recognition of this as a unique diagnosis. For me, rumination is a form of agonizing self-appraisal. I constantly revisit the situation and wonder if there was something I could have done differently to prevent it, often assuming blame. I now realize that in the last two jobs I had I was working for narcissists and that I was essentially set up to fail. It took a long time for me to understand that nothing I could have done would have prevented the bullying, blaming, lying and demeaning behavior. I am now underemployed which creates its own set of issues to deal with but at least I am not being manipulated, decieved and used. It took me a long time and one hospitalization for a severe depression which included suicide ideation to overcome these bad experiences. Unfortunately there are cruel and manipulative people in workplaces who have the power to wreak havoc on dedicated and hardworking employees. David, your blog and research on the topic of workplace bulling has been so helpful to my recovery. I do hope that human resource professionals will take notice and monitor the behavior of executives and managers closely. The game of sucking up and kicking down has to end.
David, very good to see there is recognition of PTED. Very good article. I doubt most health care professionals truly understand the severe anger that ferments within someone who was bullied in the workplace. The anger takes time to grow as the target eventually loses his job, physical health, mental health, career, money and possessions. The anger continues to ferment over losing himself; the good person he once was before the bullying is gone and hardly recognizable. He can also be on the verge of losing a spouse and family. I can imagine that big business would not want PTED to become a recognized mental health disorder, as it would require the full legitimacy of workplace bullying as something illegal. As long as it’s not related to gender or race, it’s perfectly legal to perform psychological terror on a daily basis against an employee until he quits, commits suicide or is committed to an inpatient health care facility. This is serious business and should not be dismissed by the health care community. Thanks again for your work.
There’s value in creating another label ONLY if that label means more effective treatment as a result. The helping professions have a long way to go in understanding the dynamics of work abuse and applying that awareness to help targets heal.
The therapists I’ve talked with want to blame the target for being too nice, a people pleaser, not strong or assertive enough. Bullies equate kindness with weakness and increase their attacks when people try to win them over, but they also increase their attacks when targets try to stand up for themselves, especially if management and other employees back the bully up in what is called mobbing. It seems no win, and it’s so hard not to doubt and blame myself for triggering the bullying somehow.
Well, first off, thank you for the article, great info, i had never heard of PTED until now. Then again, I never knew what workplace bullying was until 4 yrs ago, when In went to work for the school district I grew up in, as a mechanic, in the transportation department.
Earlier this year, I became a healthy work place advocate with bullyfreeworkplace.org in Northern California. 4/26/15 was the day I was forced out of my career, in my home town. The article mentions a “single exceptional negative life’s event.” Does over 3yrs of daily stocking,taunting.exclusion,discrimination,harassment,and work place bullying, allowed by management, like it was some sort of sick game these people were playing with the lives of me,my children,my family. By this point I have no more friends, qualify as embitterment?
I left 3 moths in the rear view mirror a long time ago. I worked everyday,side by side with mt immediate supervisor. Showing and telling that person everything that was going on. Only,come to find out, nothing was ever reported. I called meetings with the President of the Union,the director of everything, to officially report the work place bullying. I asked for official paperwork to show that those meetings took place time and time and time again, never getting anything. The only thing that came out of those meetings was the person I accused of bullying, all the sudden, started covering the inside of their bus with anti-bullying slogans, and my working conditions got worse. Every time I stood up for myself, my situation got worse. Just like clock work.
I reported to H.R on up to the Superintendent. 1.5 years ago the old superintendent, and their regime retired. Now there is a new superintendent, new regime. They are in the process of “sweeping it under the rug.” Since no one ever did their job,filed any paper work, now that I’m trying to get help,been begging for help for years,workers comp/disability doesn’t want a thing to do with me because there isn’t any paper work! So, I am being treated as a liar, border line criminal.
I now, don’t have an income, can’t pay my child support, license gone, IRS all over me, no health coverage, Mentally twisted with no sight of any kind of help. Couple of weeks from now, I will be homeless, soon after that,since I can’t pay my child support, my kids might be homeless.
I would like to offer myself to any study, program, anything to help raise awareness of this epidemic that is destroying our world. Thank you once again
I appreciate everyone’s comments here. I know that some folks here are dealing with the very subject of this blog piece. Thank you for taking the time to write and share your insights and experiences.
It occurs to me that just as there are those championing a change to categorize PTSD as an injury rather than a disorder, PTED might well be considered a reaction rather than a disorder. The experience of being bullied out of the workforce is disillusioning- and the loss of illusions is real, where the illusions (like of a fair and just system of employment) were not…and the research on prevalence suggests that it’s not over-generalizing an unusual experience.
When a response to harm is considered more dysfunctional than the actions doing the harm, it’s quite the deal. PTED is defined as an adjustment disorder precipitated by “exceptional, though normal negative life event that is experienced as a violation of basic beliefs and values.” I guess it’s ‘normal’ to have lives turned upside down due to the unchecked behaviors of others.
It’s thought that people with PTED expect the world to change, not themselves.
There is hope for the future. At one time blood-letting was considered curative. And mental disorders were thought to be the result of evil spirits inhabiting the body. Maybe PTED could someday stand for “Prevent Traumatic Evil Doing.” (wink)
Thank you to everyone,
Every article/reply I read,helps in it’s own way, again, thank you. Piggy backing off of the reply Kachina left, which I hadn’t thought of until I read it, for me, the illusion, was created by the employee hand book. “If you ever have any problems on the job site, report it to your immediate supervisor and it will be handled in a timely manner” that was the I fell most victim to.
Keep up the great work.
Supervisors, managers, co-workers, HR professionals, senior administrators, unions, health professionals, legislators…it’s a pretty broad spectrum of people who don’t meet their obligations (legal and moral) to bullied workers. And to stigmatize a worker who has experienced it as “disordered”…seems just to invalidate the experience and its consequences yet again. What’s right with someone who finds it unacceptable?
This embitterment is very real, and sad. It can unfortunately become a filter through which new and even healthier experiences are distorted. I believe that working through all the gaslighting and self doubt to a place of internal validation and self compassion is key. Working through early rejection wounds, retriggered by the aggreguous targeting, bulling, mobbing, and turning away by once trusted colleagues who, themselves, are afraid of being targeted. Being shunned and treated like a pariah is very shaming to the core, where one even buys into the bullying and distorted mirroring, caused by the bully and mobs projections and group-think, by rejecting themselves. It is the shaming and separation from self love and the self- bond that must be healed, with a loving spiritual connection. This often needs to be cultivated by a healing and corrective emotional experience with a therapist who validates validates validates!
When I was going through it, I referred to it as “PSTD” – pissed, stressed, tired, and depressed.
For anyone going through it, take heart. I went through it a few years ago and survived. My life and job are better now than they ever were. I feel stronger, smarter, and a whole lot less willing to take crap. There are evil people in the world and stupid people who will let the evil people be evil. Get away from them.
Find that ray of light and follow it.