Passive aggressive personality disorder

‘Passive aggressive’ was first used clinically during World War 2 in the American military to describe soldiers who refused to comply with superiors’ demands ¹. According to the American Psychological Association, passive-aggression was considered a personality disorder in the DSM-3: “This behavior commonly reflects hostility which the individual feels he dare not express openly. Often the behavior is one expression of the patient’s resentment at failing to find gratification in a relationship with an individual or institution upon which he is over-dependent” ¹. After nearly 40 years, Passive Aggressive personality disorder was eliminated as an official psychiatric diagnosis and relegated to the appendix of the fourth edition of the American Psychiatric Association DSM 4 in 1994 ², even though passive aggressive behavior continues to play an important role in several theories of personality disorder ³. Some authors have questioned the decision to remove Passive Aggressive personality disorder from DSM-4 ⁴. In particular, Blashfield and Intoccia ⁵ noted that this decision was made in the context of a dramatically expanding diagnostic system and increased research on some personality disorders, and that Passive Aggressive personality disorder appears to meet the conventional standards for diagnostic inclusion ⁶ as well as most other personality disorders do.

There’s renewed interest in studying passive-aggression. Passive-aggression was found to be related to borderline and narcissistic personality disorders, negative childhood experiences, and substance abuse. One controversy that apparently contributed to the removal of Passive Aggressive personality disorder from DSM-4 involved diagnostic content ⁷. Although the list of characteristics signifying passive aggressive behavior is substantial ⁸, Millon ⁹ viewed passive aggressive behavior as a single symptom diagnostically embedded in a larger syndromal context, which he labeled negativistic. Millon’s negativistic personality disorder includes characteristics in addition to passive aggressive behavior, such as irritability, anger, pessimism, and discontent ⁹. In the end, the authors of DSM-4 Axis II, including Millon, added characteristics reflecting this wider operationalization of the disorder, and removed several DSM-3 symptoms that targeted passive aggressive behavior more directly. This group also agreed to move Passive Aggressive personality disorder to the appendix, concluding that further study was needed to justify including Passive Aggressive personality disorder as an official diagnosis.

Research implicates both genetic and environmental factors in the genesis of Passive Aggressive personality disorder. The heritability of the disorder was estimated at 0.50 in school-age twins ¹⁰. Consistent with various theoretical formulations, Passive Aggressive personality disorder is also associated with environmental factors, including ineffective parenting behavior ¹¹ in general as well as child abuse ¹², harsh/aversive parenting ¹³, and neglect ¹⁴ in particular.

Passive Aggressive personality disorder appears to have prevalence rates similar to other personality disorders in clinical ¹⁵ and community ¹⁶ samples. Passive Aggressive personality disorder is also linked to a host of external validating markers. For example, it is associated with an increased risk for substance use ¹⁷, anxiety disorder ¹⁸, depression ¹⁹, and narcissistic ²⁰ and borderline personality disorders ¹⁰. Little is known about effective treatments for Passive Aggressive personality disorder. Although data suggest that fluoxetine reduces passive aggressive symptoms among depressed patients ²¹, systematic studies of psychotherapy for Passive Aggressive personality disorder are rare and no firm conclusions can be drawn.

Bradley, Shedler, and Westen ²² found that clinician-rated Passive Aggressive personality disorder personality characteristics converged with ratings of DSM-4 Passive Aggressive personality disorder symptoms but had very limited overlap with other personality disorders. Furthermore, analyses of their data yielded a distinct group of patients who had classic Passive Aggressive personality disorder characteristics. These authors concluded that their data suggest clinicians tend to regard Passive Aggressive personality disorder as being uniquely associated with a particular pattern of personality characteristics. Consistent with theoretical articulations by Benjamin, Beck, and others, Passive Aggressive personality disorder is more strongly associated with autonomy/agency than sociotropy/communion personality dimensions ²³ and has been linked to authority conflicts among adolescents ²⁴. However, research has been limited; the relations of Passive Aggressive personality disorder to other common models of personality have not been thoroughly tested.

Passive aggressive behavior

Passive-aggressive behavior is a pattern of indirectly expressing negative feelings instead of openly addressing them. There’s a disconnect between what a passive-aggressive person says and what he or she does. For example, a passive-aggressive person might appear to agree — perhaps even enthusiastically — with another person’s request. Rather than complying with the request, however, he or she might express anger or resentment by failing to follow through or missing deadlines.

Passive-aggressive people act passive but express aggression covertly. They’re basically obstructionists who try to block whatever it is you want. Their unconscious anger gets transferred onto you, and you become frustrated and furious. Your fury is theirs, while they may calmly ask, “Why are you getting so angry?” and blame you for the anger they’re provoking.

Specific signs of passive-aggressive behavior include:

• Resentment and opposition to the demands of others
• Procrastination and intentional mistakes in response to others’ demands
• Cynical, sullen or hostile attitude
• Frequent complaints about feeling underappreciated or cheated

Passive-aggressive partners are generally codependent, and like codependents, suffer from shame and low self-esteem. Their behavior is designed to please to appease and counter to control. You may be experiencing abuse, but not realize it, because their strategy of expressing hostility is covert and manipulative, leading to conflict and intimacy problems.

Although passive-aggressive behavior can be a feature of various mental health conditions, it isn’t considered a distinct mental illness. However, passive-aggressive behavior can interfere with relationships and cause difficulties on the job. If you’re struggling with passive-aggressive behavior or you think a loved one is, consider consulting a therapist.

Passive aggressive signs and symptoms

Because you can’t have an honest, direct conversation with a passive-aggressive partner, nothing ever gets resolved. They say yes, and then their behavior screams NO. They try to sabotage your wants, needs, and plans using a variety of tactics. We all engage in some of these behaviors some of the time, but when there’s a pervasive pattern of multiple symptoms, it’s likely that you’re dealing with passive-aggression.

• Denial. Like all codependents, they’re in denial of the impact of their behavior. This is why they blame others, unaware of the problems they’re causing. They refuse to take responsibility for anything, and distort reality, rationalize, blame, make excuses, minimize, deny, or flat-out lie about their behavior or the promises or agreements they’ve made.
• Forgetting. Rather than say no or address their anger, they forget your birthday or the plans you’ve discussed, or forget to put gas in the car, pick up your prescription, or fix the leaky toilet. You end up feeling hurt and angry.
• Procrastinating. They’re avoidant and don’t like schedules or deadlines. It’s another form of rebellion, so they delay and delay with endless excuses. They don’t follow through on responsibilities, promises, or agreements. If they’re unemployed, they drag their feet looking for work. You may do more job-searching on their behalf than they do.
• Obstructing. This is another nonverbal form of saying no. When you try to decide on where or when to go on vacation, pick out an apartment, or make plans, they find fault with each suggestion and won’t offer any of their own.
• Ambiguity. They hate to take a stand. They don’t say what they want or mean. However, their behavior tells the truth, which is usually “no.” This way they retain control and blame you for being controlling. As you might expect, negotiating agreements, such as in a divorce or child visitation plan, is exasperating. In addition to procrastinating, they avoid being pinned down. They may insist on “reasonable visitation,” and label your attempts to specify a predictable plan as controlling. Don’t be fooled. This only postpones negotiation when repetitive arguments can occur over every exchange of the children. Alternatively, they might agree to terms but not abide by them. You can expect to be back in court.
• Never angry. They don’t express their anger openly. In childhood, they may have been punished or scolded for showing anger, or were never permitted to object. Their only outlet is passive-aggressive, oppositional behavior.
• Incompetency. When they finally do what you ask, you likely have to redo it. If they make a repair, it might not last or you’ll have to clean the mess they made. If they’re helping with housecleaning, their inefficiency may drive you to do it yourself. At work, they make careless errors.
• Lateness. Chronic lateness is a half-hearted way of saying no. They agree to a time, but show up late. You’re dressed up, waiting to go out, and they’re “stuck at the office,” on the Internet, or watching the game and not ready. Lateness at work or delivering assignments is a self-sabotaging form of rebellion that can get them dismissed.
• Negativity. Their personality may include pouting or acting sullen, stubborn, or argumentative. They feel misunderstood and unappreciated and scorn and criticize authority. They frequently complain and envy and resent those more fortunate.
• Playing the victim. The problem is always someone else’s fault. Their denial, shame, and lack of responsibility cause them to play the victim and blame others. You or their boss become the controlling, demanding one. They always have an excuse, but it’s their own self-destructive behaviors that cause them problems.
• Dependency. While fearing domination, they’re dependent, nonassertive, indecisive, and unsure of themselves. They’re unaware of their dependency and fight it whenever they can. Their obstructionism is a pseudoattempt at independence. They don’t leave, but withdraw or withhold intimacy instead. An autonomous person has healthy self-esteem, is assertive, and can take a stand and keep commitments. Not so for someone passive-aggressive. Their behavior is designed to avoid responsibility for themselves and family, and sometimes they depend unfairly on their partner for support.
• Withholding. Withholding communication is another form of expressing anger and asserting power passively. They may walk away, refusing to talk things over, or play the victim and say, “You’re always right,” shutting down the discussion. They’re unable to articulate what they want, feel, or need. Instead, they retain their power using the silent treatment or withholding material or financial support, affection, or sex. This undermines intimacy as a way to fight against their dependency.There are myriad other things they might do, like slamming doors, giving away something of yours, or offering you dessert that you’re allergic to or when you’re dieting.

Dealing with passive aggressive behavior

Because a passive-aggressive person is indirect, it may be hard to recognize what’s going on, but it’s essential that you recognize whom you’re dealing with. Look for a pervasive pattern of several of the above symptoms, and monitor your feelings. You may feel angry, confused, or powerless when trying to get cooperation. If this is a common pattern, you’re likely dealing with passive-aggression.

It’s important not to react. When you nag, scold, or get angry, you escalate conflict and give your partner more excuses and ammunition to deny responsibility. Not only that, you step into the role of parent – the very one your partner is rebelling against. Don’t be vague, drop hints, blame, or allow yourself to pay back in kind.

Neither be passive, nor aggressive. Instead, be assertive. It’s far better to address noncompliance and problems in the relationship directly. Frame it in terms of “We have a problem,” not “You are the problem,” which is shaming. Don’t blame or judge your partner, but describe the behavior you don’t like, how it affects you and the relationship, and what you want. If you let your partner come up with a solution to a problem, there’s a better chance of resolution.

When you go along with your partner’s tactics or take on his or her responsibilities, you enable and encourage more passive-aggressive behavior. It would be similar to nagging your child, but allowing the youngster not to do his or her chores. This takes practice and requires being assertive. Be prepared to set boundaries with consequences.

Passive behavior vs. assertive

If your style is passive, you may seem to be shy or overly easygoing. You may routinely say things such as “I’ll just go with whatever the group decides.” You tend to avoid conflict. Why is that a problem? Because the message you’re sending is that your thoughts and feelings aren’t as important as those of other people. In essence, when you’re too passive, you give others the license to disregard your wants and needs.

Consider this example: You say yes when a colleague asks you to take over a project, even though your plate is full, and the extra work means you’ll have to work overtime and miss your daughter’s soccer game. Your intention may be to keep the peace. But always saying yes can poison your relationships. And worse, it may cause you internal conflict because your needs and those of your family always come second.

The internal conflict that can be created by passive behavior can lead to:

• Stress
• Resentment
• Seething anger
• Feelings of victimization
• Desire to exact revenge

Aggressive behavior vs. assertive

Now consider the flip side. If your style is aggressive, you may come across as a bully who disregards the needs, feelings and opinions of others. You may appear self-righteous or superior. Very aggressive people humiliate and intimidate others and may even be physically threatening.

You may think that being aggressive gets you what you want. However, it comes at a cost. Aggression undercuts trust and mutual respect. Others may come to resent you, leading them to avoid or oppose you.

Passive-aggressive behavior vs. assertive

Now consider passive-aggressive behavior. If you communicate in a passive-aggressive manner, you may say yes when you want to say no. You may be sarcastic or complain about others behind their backs. Rather than confront an issue directly, you may show your anger and feelings through your actions or negative attitude. You may have developed a passive-aggressive style because you’re uncomfortable being direct about your needs and feelings.

What are the drawbacks of a passive-aggressive communication style? Over time, passive-aggressive behavior damages relationships and undercuts mutual respect, thus making it difficult for you to get your goals and needs met.

The benefits of being assertive

Being assertive is usually viewed as a healthier communication style. Being assertive offers many benefits. It helps you keep people from walking all over you. It can also help you from steamrolling others.

Behaving assertively can help you:

• Gain self-confidence and self-esteem
• Understand and recognize your feelings
• Earn respect from others
• Improve communication
• Create win-win situations
• Improve your decision-making skills
• Create honest relationships
• Gain more job satisfaction

Learning to be more assertive can also help you effectively express your feelings when communicating with others about issues.

Learning to be more assertive

People develop different styles of communication based on their life experiences. Your style may be so ingrained that you’re not even aware of what it is. People tend to stick to the same communication style over time. But if you want to change your communication style, you can learn to communicate in healthier and more effective ways.

Here are some tips to help you become more assertive:

• Assess your style. Do you voice your opinions or remain silent? Do you say yes to additional work even when your plate is full? Are you quick to judge or blame? Do people seem to dread or fear talking to you? Understand your style before you begin making changes.
• Use ‘I’ statements. Using “I” statements lets others know what you’re thinking or feeling without sounding accusatory. For instance, say, “I disagree,” rather than, “You’re wrong.” If you have a request, say “I would like you to help with this” rather than “You need to do this.” Keep your requests simple and specific.
• Practice saying no. If you have a hard time turning down requests, try saying, “No, I can’t do that now.” Don’t hesitate — be direct. If an explanation is appropriate, keep it brief.
• Rehearse what you want to say. If it’s challenging to say what you want or think, practice typical scenarios you encounter. Say what you want to say out loud. It may help to write it out first, too, so you can practice from a script. Consider role-playing with a friend or colleague and ask for blunt feedback.
• Use body language. Communication isn’t just verbal. Act confident even if you aren’t feeling it. Keep an upright posture, but lean forward a bit. Make regular eye contact. Maintain a neutral or positive facial expression. Don’t cross your arms or legs. Practice assertive body language in front of a mirror or with a friend or colleague.
• Keep emotions in check. Conflict is hard for most people. Maybe you get angry or frustrated, or maybe you feel like crying. Although these feelings are normal, they can get in the way of resolving conflict. If you feel too emotional going into a situation, wait a bit if possible. Then work on remaining calm.
• Breathe slowly. Keep your voice even and firm.
• Start small. At first, practice your new skills in situations that are low risk. For instance, try out your assertiveness on a partner or friend before tackling a difficult situation at work. Evaluate yourself afterward and tweak your approach as necessary.

When you need help being assertive

Remember, learning to be assertive takes time and practice. If you’ve spent years silencing yourself, becoming more assertive probably won’t happen overnight. Or if anger leads you to be too aggressive, you may need to learn some anger management techniques.

If despite your best efforts you’re not making progress toward becoming more assertive, consider formal assertiveness training. And if certain issues such as anger, stress, anxiety or fear are getting in your way, consider talking with a mental health provider. The payoff will be worth it. By becoming more assertive, you can begin to express your true feelings and needs more easily. You may even find that you get more of what you want as a result.

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