This disorder affects almost all interpersonal or occupational situations. It is a method of dealing with stress or frustration, but it results in the person attacking other people in indirect ways. This disorder can manifest itself as resentment, stubbornness, procrastination, sullenness, or intentional failure at doing requested tasks. Though modern psychiatry no longer recognizes this condition as an official diagnosis [1], instead replacing it with a new disorder termed negativistic personality disorder, many of us have encountered it in person.
This behavior creates many problems in a person's work and social life. Unfortunately, passive-aggressive personality disorder lasts for life, and the patient needs frequent monitoring by a healthcare professional. There are no established risk factors for passive-aggressive personality disorder, but genetics may play a role.
Symptoms and Signs of Passive-Aggressive Personality Disorder
People diagnosed with passive-aggressive personality disorder present responsibility passively rather than through open expression of their feelings. In most cases, procrastination, inefficiency, and forgetfulness are behaviors commonly used to avoid doing what they need to do. A person with this disorder may appear to (want to) comply with another's wishes. However, the requested action is either performed too late or carried out in a way that is intentionally substandard. [2]
Certain behaviors help identify passive-aggressive behavior in other people:
- Obstructionism
- Procrastination
- Resentment
- Resisting suggestions from others
- Sullenness
- Ambiguity
- Avoiding responsibility by claiming forgetfulness
- Blaming others
- Chronic lateness and forgetfulness
- Complaining
- Not expressing hostility or anger openly
- Fear of competition
- Making excuses and lying
- Fear of dependency
- Fear of intimacy
- Fear of authority
- Fostering chaos
- Intentional inefficiency
Cause of passive-aggressive personality disorder
The exact cause of passive-aggressive personality disorder is still unknown but like in most personality disorders, it probably hails from a combination of genetic and environmental factors. [3] These may include the following.
Parental controlling behavior
According to most experts, the behaviors that can be considered characteristic of passive-aggressive personality disorder appear to have an origin in constant power struggles with one's parents in childhood. Parental over-control, neglect, or favoring of a sibling can all contribute to the development of the silent protest and grudging obedience associated with this disorder. That appears to be because in these situations, overt "defiance", or expressing one's opinion, is openly discouraged. Passive aggression then seems to be the only way to resist.
Five-factor model
There is a hypothetical model of personality found in people who are suffering from Passive-Aggressive Personality Disorder. [4]
High Neuroticism
This character trait is accompanied by chronic negative affect, including anxiety, fearfulness, tension, irritability, anger, dejection, hopelessness, guilt, and shame. Difficulty in inhibiting impulses is the predominant symptom as well as irrational beliefs, unrealistic expectations, perfectionistic demands on the self, and unwarranted pessimism.
High Extraversion
This character trait is characterized by excessive talking, leading to inappropriate self-disclosure, social friction, and an inability to spend time alone. All these behaviors are also accompanied by an overly dramatic expression of emotions; wild excitement seeking, and improper attempts to dominate and control others.
Low Openness
Low openness results in difficulties with adapting to social or personal change and a low tolerance or understanding of different points of view or lifestyles.
Low Agreeableness
This line of a character is characterized by cynicism and paranoid thinking. The affected people are unable to trust even friends or family members, are frequently too ready to pick fights, and are exploitive and manipulative, lying, rude and inconsiderate toward friends, something which may lead to alienation. They have a limited social support network, lack the respect for social conventions which can result in troubles with the law, have an inflated and grandiose sense of self, and show arrogance.
High Conscientiousness
People who score high on conscientiousness on personality tests are often recognizable by overachievement: workaholic absorption in a job can cause the exclusion of family, social, and personal interests. There are often signs of compulsiveness, including excessive cleanliness, tidiness, and attention to detail.
Passive-aggressive personality disorder and relationships
It has been proven that individuals with passive-aggressive personality disorder are ambivalent within their relationships. They are sometimes very hard to understand because they are constantly faced with a dilemma — a choice between expressing hostile defiance toward people they see and attempting to mollify these people by asking forgiveness. That’s why they are sometimes very difficult to handle.
These individuals are noted for the stormy nature of their interpersonal relationships and they are resentfully quarrelsome and irritable. They often feel like a victim. People in relationships with them are just waiting for the next struggle and round of volatility and carping criticism. In most cases, they engage in grumbling, moody complaints, and sour pessimism. These socially maladaptive behaviors result in inevitable interpersonal conflict and frustration. These individuals can control others by forcing them into an uncomfortable anticipatory stance. Passive-aggressive individuals are able to trap people into situations wherein whatever they do is wrong. [5]
Long-Term Effects of Passive-Aggressive Personality Disorder
A person with a passive-aggressive personality disorder will most probably have significant problems at work and in relationships with others. The person's behavior makes him or her difficult to deal with.
Diagnosis of Passive-Aggressive Personality Disorder
The criteria for passive-aggressive personality disorder (or negativistic personality disorder, as it is now called) as proposed by the Personality Disorders Work Group for the DSM-5 includes:
- Passive resistance to fulfilling social and occupational tasks through procrastination and inefficiency
- Complaints of being misunderstood, unappreciated, and victimized by others
- Sullenness, irritability, and argumentativeness in response to expectations
- Angry and pessimistic attitudes toward a variety of events
- Unreasonable criticism and scorn toward those in authority
- Envy and resentment toward those who are more fortunate
- Self-definition as luckless in life and an inclination to whine and grumble about being jinxed
- Alternating behavior between a hostile assertion of personal autonomy and dependent contrition
Treatment of passive-aggressive personality disorder
Counseling and cognitive-behavioral therapy
Counseling may help a person with passive-aggressive personality disorder identify and change behaviors. Cognitive behavioral therapy, group therapy, or individual psychotherapy may be used. Treatment is aimed at helping the person better relate to others. Some experts say that counseling can just increase the person's irritability and anxiety. This happens when he or she is forced to look at the negative behavior. [6]
Group therapy
Group therapy can be extremely useful because it provides individuals with this personality disorder an opportunity to learn how to manage their hostility. When their hostility emerges, group leaders can comment on hostile behavior and encourage other group members to respond. The group leader can assist these individuals in processing what it is they want or need at that moment and to rehearse appropriate behavior within a group context. [6] Likewise, sharing coping strategies with others who understand can be extremely productive.
Medications
Unfortunately, there is no cure for passive-aggressive personality disorder but there are medications which may help reduce some symptoms. Medications used to treat depression, called antidepressants, may reduce irritability. Fluoxetine or sertraline are commonly used. However, they may cause sleep disorders, drowsiness, or stomach upset. [7]
Treatment Techniques
When assessing individuals with PAPD, the following areas should be noticed:
- Survival skills and self-care
- Use of OTC drugs
- Psychosocial and AOD history
- Mental status
- Coexisting anxiety disorders
- Medication evaluations for antidepressants
- Identification of typical passive-aggressive mane
Incidence of Co-Occurring Substance-Abuse Disorders
Unfortunately, the incidence of co-occurring substance abuse with PAPD is extremely high. These individuals are prone to using drugs to regulate mood states. They believe they are entitled to an external solution to problems and are likely to use their addictions to justify their angry or violent behavior or to provide a rationale for nonperformance, incapacitation, or inaccessibility. Prescribed pain killers and anti-anxiety agents, in combination with alcohol, are probably the most common pattern of abuse.