Suicidal and Aggressive Ideation Associated with Feelings of Embitterment

Emphatic Memories and Their Meaning in Societal and Legal Contexts: A Narrative Review and Position Paper

BACKGROUND

Many past and ongoing conflicts in the world are associated with memories. The role of emphatic memories is however often neglected in conflict solving. Therefore, this narrative review gives a short introduction to the phenomenon of emphatic memories and implications for counteracting dysfunctional effects of emphatic memories.

SUMMARY

Memory has two connotations. One is remembering and knowing (I can remember when I got married) and on the other is reminding and emphasizing memories (I remind my partner of our wedding day). Memories are less a report on the past but result of current emotions and motives. Emphatic memories serve for self-portrayal and distinction from others, self-exculpation, accusation of others, justification of claims. They are regularly reproachful, have an aggressive character, and are distorted and pseudologic. This is also true on a societal level, as memories are used for defining social groups, and by this for political purposes, in order to juxtapose one group against the other. If memories are revoked, they are regularly accompanied with the very emotions, which were associated with the past event. Corresponding behavior is motivated. Many people suffer from memories and associated emotions and dysfunctional behavior, as is well described in the context of post-traumatic stress disorders. Also, social groups can as a whole suffer from negative emotions because of memories, which may go back up to thousand years. To ensure that memories do not adversely affect individuals and social groups, they should best be forgotten, or at least rescripted, in a way that they are disentangled from negative emotions and motives. An important psychological process in this regard is wisdom and forgiveness, which must not be confused with understanding, justification, tolerating, or reconciliation. Wisdom and forgiveness allow persons to close the books, act self-determined, find freedom from external events, and end suffering because of the past. It is a rational and emotional act.

KEY MESSAGES

Emphatic memories can cause that individuals and groups do not find peace and persistently provoke new conflicts. Internal and interactional peace can be found if memories are let alone and fade away. Forgiveness and wisdom describe avenues to let dysfunctional memories go.

Associations between humiliation, shame, self-harm and suicidal behaviours among adolescents and young adults: A systematic review protocol

BACKGROUND

Suicide is the second leading cause of death among young people worldwide and remains a major public health concern. Research indicates that negative social contexts involving familial and peer relationships, have far-reaching influences on levels of suicidal behaviours in later life. Previous systematic reviews have focused on evaluating associations between negative life events such as abuse and bullying in childhood and subsequent self-harm or suicidality. However, the association between adolescent experiences of humiliation and shame, and subsequent self-harm or suicidal behaviour among children and young adults has not been well examined. As such, this systematic review is conducted to examine the prevalence and association between humiliation and shame and self-harm, suicidal ideation, and death by suicide among adolescents and young adults.

METHODS

A systematic literature search in extant electronic databases including; MEDLINE, Web of Science Core Collection, CINAHL, PsycINFO, and Embase will be conducted to identify potential studies. Google Scholar, and the reference list of the retrieved articles and/or previous systematic reviews in this area, will also be scanned to identify further potential studies. ProQuest will be searched to identify relevant studies available within grey literature. There are no restrictions on the date of publications. Based on our initial review, the following terms were identified: Population: Adolescent (MESH), young adult (MESH), teen, teenage. Exposure: Humiliation, degradation, shame (MESH) or embarrassment (MESH), harassment victimisation, abasement. Outcome: Self-injurious behaviour (MESH), suicide (MESH), suicide attempted (MESH), suicide completed (MESH), self-harm, intentional self-injury, deliberate self-harm, overdose, deliberate self-poisoning, non-suicidal self-injury, self-mutilation, suicidal thought, suicidal ideation, suicidal intent, suicide. At least one term from each category will be used for conducting the literature search. All original quantitative studies published in the English language which examined the prevalence or association between humiliation or shame and self-harm and/or suicidal ideation and/or completed suicide will be included. The studies will be assessed for methodological quality using the Joanna Briggs Institute critical appraisal tools. Narrative synthesis will be performed for all of the studies. If the studies are sufficiently homogenous, the results will be pooled for a meta-analysis. This systematic review protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) guidelines. The protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) [CRD42022289843].

DISCUSSION

This is the first review to synthesise evidence on the prevalence of, and associations between the experiences of humiliation and shame and subsequent self-harm and/or suicidal behaviours among adolescents and young adults. As there is growing evidence on increased self-harm among this age group, it is important to identify population-specific risk factors for self-harm and suicidality which will have significance in formulating tailored and effective treatment and therapeutic services for adolescents and young adults.

The neuroanatomy of social trust predicts depression vulnerability

Trust attitude is a social personality trait linked with the estimation of others’ trustworthiness. Trusting others, however, can have substantial negative effects on mental health, such as the development of depression. Despite significant progress in understanding the neurobiology of trust, whether the neuroanatomy of trust is linked with depression vulnerability remains unknown. To investigate a link between the neuroanatomy of trust and depression vulnerability, we assessed trust and depressive symptoms and employed neuroimaging to acquire brain structure data of healthy participants. A high depressive symptom score was used as an indicator of depression vulnerability. The neuroanatomical results observed with the healthy sample were validated in a sample of clinically diagnosed depressive patients. We found significantly higher depressive symptoms among low trusters than among high trusters. Neuroanatomically, low trusters and depressive patients showed similar volume reduction in brain regions implicated in social cognition, including the dorsolateral prefrontal cortex (DLPFC), dorsomedial PFC, posterior cingulate, precuneus, and angular gyrus. Furthermore, the reduced volume of the DLPFC and precuneus mediated the relationship between trust and depressive symptoms. These findings contribute to understanding social- and neural-markers of depression vulnerability and may inform the development of social interventions to prevent pathological depression.

Embitterment - Conception of a Potential Moderator to Dysfunctional and Aggressive Behaviour in Children and Adolescents

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.

[Embitterment and Aggression in Psychotherapy Patients]

BACKGROUND

  Embitterment is an emotion which is known to everybody. Embitterment results in suffering for the afflicted person and the environment, including dysfunctional behavior and aggressive phantasies. This should be recognized in psychotherapy. There is a lack of respective data. The present study examines the rate and correlation of embitterment and aggression in psychotherapy patients.

METHOD

  The study was done in an outpatient behavior therapy clinic. Patients filled in the PTED scale (Post-Traumatic Embitterment Disorder self-rating scale), the K-FAF (brief questionnaire to assess aggression factors), and the SCL-90-S (Symptom Checklist-90-Standard). Sociodemographic data were taken from the routine database of the clinic.

RESULTS

  A total of 118 patients, with a mean age of 38 years (SD=13.3 years, R=18-76 years), agreed to participate in the study. The mean score of the PTED scale was M=1.8 (SD=0.81; R=0-3.38). A cut-off-value of M≥2.5, which indicates clinically relevant embitterment was found in 22% of patients. The mean sum score of the aggressiveness scale (total) was 30.25 (SD=17.94). There were 23.7% of patients with a cut-off≥18.37 in reactive aggression and 54.2% with a cut-off≥14.8 in explosive aggression. Significant correlations were found between the PTED scale and the aggression scale (total) (r=0.422, p<0.001), as well as the subcategories "explosive" (r=0.355, p<0.001) and "reactive" aggression (r=0.425, p<0.001). A comparison of patients with increased embitterment, with increased aggression, with increased combined embitterment/aggression, and with inconspicuous patients showed a significant increase in regard to general mental distress as measured with the SCL-90 (GSI of the SCL-90-S: f(3,71)=4.00, p=0.011) and the rate of unemployment (Fisher-Test p=0.008) in the combined as compared to the inconspicuous group (GSI of the SCL-90-S: f(3,71)=4.00, p=0.011). There were no further significant differences in regard to other sociodemographic variables (age, gender, family status and education).

DISCUSSION AND CONCLUSION

  The data show that embitterment and aggression are seen in relevant frequency in psychotherapy patients. They are significantly correlated, as suggested by theory. Therapists should be aware of this problem and intervene adequately.

Reliability and validity of the Chinese version of the post-traumatic embitterment disorder self-rating scale (PTED-21) among inpatients in general hospital

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.

Embitterment: The Nature of the Construct and Critical Issues in the Light of COVID-19

Embitterment is a construct that is vast and complex and may be seen in a variety of conditions and circumstances. The following paper reviews the construct of embitterment and tries to explain the concept from a psychological perspective. It also looks at the role of embitterment in the genesis of psychiatric disorders like depression, anxiety, and PTSD, while focusing on the nature and factors needed to make a diagnosis of Posttraumatic Embitterment Disorder. Situations due to the current pandemic where embitterment may develop are discussed and this is coupled with a need to manage embitterment when it develops, as it may progress to a chronic condition where its effects may be both physical and psychological. Embitterment and its management from a psychotherapy standpoint is also discussed and the same is done from a workplace perspective.

Querulant delusion and post-traumatic embitterment disorder

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'.

Verbitterung, Weisheit und Suizidgedanken

Inwieweit Verbitterung mit Suizidgedanken assoziiert ist, wurde bislang nur selten untersucht. Darüber hinaus stellt sich die Frage, ob Weisheit bzw. Weisheitskomponenten den Zusammenhang zwischen Verbitterung und Suizidgedan­ken moderieren, Weisheit also als ein Resilienzfaktor gegenüber Suizidgedanken zu verstehen ist. Insgesamt nahmen 311 Proband*innen (<i>n</i> = 179, 57,6% weiblich; Alter: Mittelwert = 32,63 Jahre, SD = 14,06) an einer internetbasierten Fragebogenstudie teil. Es zeigte sich sowohl, dass Verbitte­rung und Suizidgedanken eng assoziiert sind, als auch, dass dieser Zusammenhang durch die Weisheitskomponente Humor moderiert wird. In Bezug auf weitere Weisheitskomponenten fanden sich keine erwartungskonformen Zusammenhänge. Die Ergebnisse unterstützen aktuelle Befunde zur Bedeutung von Humor als Resilienzfaktor gegenüber suizidalem Erleben.

Influence of disease phase on embitterment and emotional dysregulation in psoriatic patients

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.