Anxious attachment may be a vulnerability factor for developing embitterment.

By predisposing to ego-defensive strategies in social situations, a negative attachment history may promote embitterment. The present study identified attachment anxiety - more than attachment avoidance - as a possible vulnerability factor for the development and maintenance of embitterment. This factor should be considered in theories and in interventions of embitterment.

A combination of illness invalidation from the work environment and helplessness is associated with embitterment in patients with FM.

OBJECTIVES: The aim of this study in employed people with FM was to test the hypothesis that embitterment is a function of the joint experience of invalidation from the work environment and helplessness regarding one's illness. METHODS: Sixty-four full-time (36%) or part-time (64%) employed patients with FM (60 females, mean age 45 years) completed the Illness Invalidation Inventory (3*I) to assess work-related discounting and lack of understanding, the Illness Cognition Questionnaire (ICQ) to assess helplessness and the Bern Embitterment Inventory (BEI) to assess embitterment. Hierarchical regression analysis was performed. RESULTS: Sixteen percent of the participants experienced embitterment levels in the clinical range. The interaction or combination of discounting and helplessness (P = 0.02) and the combination of lack of understanding and helplessness (P = 0.04) were associated with greater embitterment. CONCLUSIONS: The construct of embitterment has substantial face validity and may result from a combination of invalidation and helplessness. Whereas helplessness is a common target of cognitive-behavioural therapy, evidence-based interventions to redress invalidation and embitterment are needed. It is possible, however, to target invalidation by educating people in the work environment about the consequences of FM and patients' valid needs for work that is manageable, given each patient's specific health-related limitations.