PASSIVE/AGGRESSIVE PERSONALITY DISORDER
We throw around the term "passive/aggressive" (PA) these days quite frequently. Probably everyone has acted in passive/aggressive ways at some time. It almost seems in today’s insincere culture, trying to navigate double messages, PA is a useful, even a required tool. Work and family environments are probably the most popular areas to showcase this behavior. What is the saying? It is easier to get forgiveness than permission? There is a lot of PA in that statement!
Ever wonder, though, if you or someone you know or love has a serious issue with passive/aggressiveness? Does PA behavior negatively affect your relationships? Your work satisfaction? Your life?
There is actually a set of PA behaviors that, when significantly disruptive, can be diagnosed as a disorder—as a personality disorder.
WARNING: DO NOT ATTEMPT TO DIAGNOSE AND TREAT THIS DISORDER UNLESS YOU ARE A CLINICIAN AND NOT RELATED TO THE CLIENT!
WARNING: DO NOT ATTEMPT TO DIAGNOSE AND TREAT THIS DISORDER UNLESS YOU ARE A CLINICIAN AND NOT RELATED TO THE CLIENT!
DEFINITION OF PASSIVE/AGGRESSIVE PERSONALITY DISORDER
(PAPD) is a controversial personality disorder proposal, said to be marked by a pervasive pattern of negative attitudes and passive resistance in interpersonal or occupational situations.
The military in WWII first used the term when officers noted that some soldiers seemed to shirk duties by adopting passive-aggressive type behaviors.
If we turn to the diagnostic manual of psychiatric disorders, the DSM IV describes the PAPD essential feature as a pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance in social and occupational settings. (The pattern must NOT occur exclusively during periods of major depression nor can it be accounted for by dysthymia. However, PAPD clients are most likely to experience chronic dysthymia.)
INTERNATIONAL CLASSIFICATION OF DISEASES (ICD-10) CRITERIA:
To be diagnosed with PAPD client must have at least five of the following:
1. Procrastination and delay in completing essential tasks—particularly those that others seek to have completed.
2. Unjustified protests that other make unreasonable demands, sulkiness, irritability, or argumentativeness when asked to do something that the individual does not want to do.
3. Unreasonable criticism or scorn for authority figures.
4. Deliberately slow or poor work on unwanted tasks.
5. Obstruction of the efforts of others even as these individuals fails to do their share of the work.
6. Avoidance of obligations by claiming to have forgotten them.
SUBTYPES?
- those with anxiety or depression (about one third)
- those who are self-defeating and locked into punishing relationships
- those who are vindictive
- those who begrudgingly put their lives on hold to care for others, e.g. an ill parent
ONLY ADULTS CAN BE DIAGNOSED WITH PAPD. Because the pattern is similar to that of Oppositional Defiant Disorder (ODD), this diagnosis should be considered for children.
WHY ISN’T IT LISTED IN THE DSM IV-TR? (The latest “bible” on diagnosing mental disorders in America)
- It was listed in DSM-IIIR but moved to Appendix B in DSM-IV (Criteria Sets and Axes Provided for Further Study) because of controversy and need for further research
CURRENT CRITERIA FOR PAPD AS PROPOSED BY THE PERSONALITY DISORDERS WORK GROUP FOR THE DSM-IV:
- 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 hostile assertion of personal autonomy and dependent contrition
COMMON SIGNS/SYMPTOMS:
- Ambiguity
- Avoiding responsibility by claiming forgetfulness
- Blaming others
- Chronic lateness and forgetfulness
- Complaining
- Does not express hostility or anger openly
- Erratic
- Fear of competition
- Fear of dependency
- Fear of intimacy – difficulty expressing warm feelings
- Fears authority
- Fosters chaos
- Intentional inefficiency
- Indecisive
- Making excuses and lying
- Obstructionism
- Preaching
- Procrastination
- Resentment
- Resists suggestions from others
- Sarcasm
- Sullenness
- Negativity/Constant Complaints. Some professionals are considering calling PAPD “Negativistic Personality Disorder”.
- Unpredictable
People with PAPD appear to comply with wishes but the action is performed too late to be helpful, or done in a way that is useless, or otherwise sabotaged to express anger they cannot verbalize. (National Institute of Health, 2006)
WHAT IT ISN’T
- “Not all passive behavior is problematic or a sign of the disorder.” Wikipedia (2006)
- Merely being passive-aggressive isn’t a disorder but a behavior—sometimes a perfectly rational behavior, which lets you dodge unpleasant chores while avoiding confrontation. It’s only pathological if it’s a habitual, crippling response reflecting a pervasively pessimistic attitude.
- May result from society’s conditioning that direct confrontation can be dangerous.
- Insincerity accepted in cultural communication.
WHAT ARE THE CAUSES?: They are unknown but probably a combination of genetic and environmental factors.
Probable Environmental Factors (This is especially valuable information for parenting!):
- Child has extreme feelings of rejection or inadequate nurturing by the mother figure that results in extreme anger (attachment issues).
- Child has fear of expressing anger toward the parent, setting up the PA behaviors.
- Person with PAPD has a need to play out anger toward parent through other relationships.
- Models the PA parent.
- Exhibits an opposite reaction to a violent parent.
- Was abused through punishing, dominating, judging, and/or shaming for aggressive behavior.
- Power struggles with parents: PA behavior was used as a face-saving technique
WHAT IS THE UNDERLYING THOUGHT OF PEOPLE WITH PAPD?
I WILL FAIL IN ORDER TO PRESERVE MY AUTONOMY. They purposely fail in a way that indirectly expresses anger and defeats others in order to preserve autonomy in the only way they can because aggression is not allowed (and they do not have assertiveness skills).
SOME DISTORTIONS OF THEIR PERCEPTION:
- Sees self as cooperative
- Sees people who are controlling as assertive
- Sees people who are judgmental as perceptive
