Linden Michael
Research Group Psychosomatic Rehabilitation, Free University of Berlin and Department of Behavioral and Psychosomatic Medicine, BfA Rehabilitation Center Teltow/Berlin, Berlin, Germany.
Psychother Psychosom. 2003 Jul-Aug;72(4):195-202. doi: 10.1159/000070783.
Adjustment and reactive disorders are a heterogeneous group of mental disorders. Diagnostic criteria are vague and scientific research is limited despite the fact that these disorders play a major role in clinical practice.
The 'posttraumatic embitterment disorder' (PTED) is introduced as a new concept for a subgroup of adjustment disorders. A case vignette and diagnostic criteria are presented.
Core criteria of PTED are: (1) a single exceptional negative life event precipitates the onset of the illness; (2) the present negative state developped in the direct context of this event; (3) the emotional response is embitterment and feelings of injustice; (4) repeated intrusive memories of the event; (5) emotional modulation is unimpaired, patients can even smile when engaged in thoughts of revenge, and (6) no obvious other mental disorder that can explain the reaction. Additional symptoms are feelings of helplessness, self-blame, rejection of help, suicidal ideation, dysphoria, aggression, down-heartedness, seemingly melancholic depression, unspecific somatic complaints, loss of appetite, sleep disturbances, pain, phobic symptoms in respect to the place or to persons related to the event, reduced drive. Duration is longer than 3 months. Performance in daily activities and roles is impaired.
PTED is a frequent disorder. The diagnosis of PTED can lead to specific therapeutic interventions. PTED can be discriminated from PTSD, depression, anxiety disorders, and other adjustment disorders.
适应与反应性障碍是一组异质性精神障碍。尽管这些障碍在临床实践中起主要作用，但诊断标准模糊且科学研究有限。
引入“创伤后痛苦障碍”（PTED）作为适应障碍一个亚组的新概念。呈现了一个病例 vignette 和诊断标准。
PTED 的核心标准为：（1）单一异常负面生活事件促发疾病发作；（2）当前负面状态在该事件的直接背景下发展而来；（3）情绪反应为痛苦和不公正感；（4）对该事件反复出现侵入性记忆；（5）情绪调节未受损，患者在想到报复时甚至能微笑，以及（6）无明显其他可解释该反应的精神障碍。其他症状包括无助感、自责、拒绝帮助、自杀观念、烦躁不安、攻击性、情绪低落、看似抑郁性抑郁、非特异性躯体主诉、食欲减退、睡眠障碍、疼痛、对与该事件相关的地点或人物的恐惧症状、动力下降。病程超过 3 个月。日常活动和角色表现受损。
PTED 是一种常见障碍。PTED 的诊断可导致特定的治疗干预。PTED 可与创伤后应激障碍、抑郁症、焦虑症及其他适应障碍相鉴别。
