Week 5-Post-traumatic embitterment disorder (PTED) Flashcards
What are Stressor-Related Disorders in ICD-11 and DSM-5?
ICD-11: Disorders specifically associated with stress:
1. Traumatic stress disorders i.e., (complex) PTSD
2. Adjustment disorders
3. Prolonged grief disorders
DSM-5: Trauma-and Stressor-Related disorders:
1. PTSD
2. Adjustment disorders
3. Reactive attachment disorder
4. Disinhibited social engagement disorder
5. Other specified trauma and stressor-related disorder
-Adjustment disorders aren’t formed from life threatening events but more typical every day e.g., being fired SO should not be a long-lasting disorder
What are Unjust events and its impact?
-“Querulant delusion” (Kraepelin, 1915)
-“Hwa-bung” in Asia (Lin, 1983)
-“PTED” in Europe after German reunification (Linden, 2003)
-“Social stressors” because it is human nature to fight, insult and downgrade others, and even take what belongs to others.
-Ordinary stressors include divorce, dismissal, bullying and work
-People develop disorders from unjust events
-Querulant disorder: after encountering something unjust, encountered embitterment and wanted justice e.g., legal disputes, homelessness, unemployment etc., (in different cultures known as ‘Hwa-bung’ and ‘PTED’)
-These events can then lead to PTED
Aetiology: How does a Belief in a just world (BJW) cause PTED?
-BJW as a personality disposition protects against injustices (Lerner, 1980)
-Dalbert (2011) lasting injustice can cause BJW to break down leading to embitterment
-’What goes around comes around’ is more a personality trait as the severity of this belief differs in all individuals
Aetiology: How does the workplace affect PTED?
-73% of PTED patients reported the triggering event as work-related (Linden et al., 2007)
-People define themselves and their social status through their profession (Muschalla & Linden, 2011)
-Social/interpersonal conflicts can occur at work (workload, recognition, promotion, friendship, ‘cliques’, bullying)
Aetiology: How does potentially morally injurious events (PMIEs) affect PTED?
-Violation of moral beliefs by perpetrating, witnessing or learning about acts (Litz et al., 2009) or experiences of betrayal (Shay, 2014)
-Leads to symptoms of guilt, shame, anger i.e., moral injury
-Moral injury is someone’s moral beliefs being violated (these events are called PMIEs)
-Whilst PTED is described as a disorder, Moral injury isn’t and many people believe it would be unethical to do so as it’s medicalising moral beliefs
What did Brennan measure in Occupational moral injury and PTED?
-Prevalence
-Risk and resiliency factors
-Consequences
-Relationship between exposure to PMIEs and PTED
-Looked at police officers (especially armed), students and health workers during the pandemic
What did Brennan, Roberts & Cole (2023) find in their Study 1 Meta-Analysis?
-67% of employees were exposed to a PMIE
-26% were embittered (compared to 2.5% of gen pop – Linden et al., 2009)
-Associated with poor mental and occupational health outcomes
-Essentially a quarter of employees confirming it does often occur in workplace
-Linked to poor occupational and mental health
What did Brennan & Cole (2023) find in their Study 2-Police?
-40 authorised firearms officers
-15% were embittered
-Risk factors: Existing PTSD or depression, feeling as though the post incident procedure was problematic, low belief in distributive justice
-Outcome: anger
-AFOs=authorised firearms officers
-Post-incident procedure is investigating suitability of firearm use after using firearm e.g., shooting an innocent civilian
-Study was to see if officers were embittered after investigation or not
-Believed investigation was more problematic that the firearm misuse incident
-Distributive justice=fair outcomes for themselves
What did Brennan, McKay & Cole (2022) find in their Study 3-HSCWs during COVID?
-400 health and social care workers (HSCWs)
-73% were exposed to a PMIE
-19% were embittered
-Risk factors: exposure to occupational stressors, low belief in procedural justice
-PMIE: deaths, illnesses, worry of own health and families whilst separated
-Occupational stressors=lack of PPEE or PPA, feelings of providing inadequate care, being separated from family
-Low procedural justice=Lack of belief they receive fair processes and procedures
What did Brennan, McKay & Cole (2023) find in their Study 4-HSCWs during COVID 12 months later?
-12 months later
-71% were exposed to a PMIE
-20% were embittered
-Risk factors: Exposure to PMIEs > decreased belief in procedural justice >
-Belief in procedural justice isn’t just ingrained and can change based off the environment
What did Brennan, McKay & Cole (2023) find in their Study 5-Higher Education Students?
-287 students
-December 2020-March 2022
-86% were exposed to a PMIE
-32% were embittered
-Risk factors: University stressors, low belief in procedural justice, low self-esteem, high consideration of the future/immediate consequences of actions
-University stressors: disruption to social life
What quotes did Brennan, McKay & Cole (2023) find in their Study 5?
“I quite liked people, now I absolutely hate them.”
“You suddenly just became a number, and you were filling shifts rather than actually being cared about as like an employer and employee”.
“it’s had a lifechanging impact on me in as far as I was quite outgoing. I kind of have to force myself to go to places that are full of people.”
-Could have a negative implication on healthcare if staff dislike patients more
Should PTED be a ‘disorder’?
-Short-term embitterment is normal (similar to anxiety before public speaking)
-Stimulus-bound long-term embitterment is normal (anxious when reminded of a speech)
-Chronic embitterment that lasts > 6 months and significantly impairs daily functioning is a disorder (Linden & Arnold, 2021).
