Adjustment disorders with and without embitterment

Michael Linden 1, Christopher Arnold 1, Barbara Lieberei 2, Matthias Rose 1, Beate Muschalla 3

1 Charité University Medicine Berlin, Department of Psychosomatic Medicine, Berlin, Germany; 2 Dr. Ebel Rehabilitation Centre for Psychosomatic Medicine, Potsdam, Germany; 3 Technical University, Department of Clinical Psychology, Braunschweig, Germany

DOI 10.36148/2284-0249-474


Adjustment disorders have been greatly revised in the 11th version of the ICD. The definition of adjustment disorders as stress-related disorders is in accordance with many years of research on embitterment and posttraumatic embitterment disorder. The question is how often adjustment disorders are accompanied by embitterment and/or PTED and what the differences are between pure adjustment disorders (A), embittered adjustment disorders (E) and PTED (PTED).


A total of 186 rehabilitation patients with adjustment disorder symptomatology were classified according to their embitterment symptomatology and examined for differences in terms of sociodemographic data, depressiveness, life stresses, embitterment, wisdom, and general symptomatology.


PTED was found in 8.1% and feelings of embitterment in 35.5% of patients with adjustment disorder. 

Pure adjustment disorder patients reported lower levels of depression (BDI-II: A:10.13 vs E:19.93; PTED:20.58), adjustment disorder symptomatology (ADNM-8: A:24.7 vs E:32.2; PTED:32.7), and higher levels of wisdom (MDW-30: A:81.0 vs E:69.4; PTED:72.6). Patients with embittered adjustment disorders and PTED did not differ significantly in terms of impairment.


The data show that adjustment disorder with embitterment and adjustment disorder without embitterment and PTED can and should be distinguished as they come along with different impairment severity and symptomatology profiles. Diagnostic criteria for PTED are rather strict, which helps to avoid overdiagnosis. 

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