Passive Aggresive Personality Disorder, Essays (university) of Medicine

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Passive Aggressive Personality

Disorder

CHAPTER I

INTRODUCTION

Passive aggressive personality disorder was first documented in 1945 by the US War Department at the end of the second world war. Colonel William Menninger voiced his concern about soldiers neglecting their duties due to willful incompetence. They are not openly defiant, but express their aggressiveness with passive actions such as being sullen, stubborn, procrastinating and inefficient. When the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was published, experts cited aggressiveness that was conveyed "with passive resistance to fulfilling a demanding routine". The development of the understanding of passive aggressive disorder continues to be updated, until the DSM-IV which was published 42 years later, This disorder is also referred to as negativistic (passive aggressive) personality disorder by Theodore Millon who is a DSM consultant. The definition of passive aggressive personality disorder in the DSM-IV seeks to maintain the key criteria of the DSM-III while enlarging the scope of the disorder.1, The DSM-IV describes passive aggressive personality disorder as “a pervasive pattern of negative attitudes and passive resistance to adequate performance demands, beginning in early adulthood and present in a variety of contexts”. This is indicated by fulfilling four of the following seven criteria: (1) passively refusing to fulfill routine social and work duties; (2) complaining of being misunderstood and unappreciated by others; (3) sullen and argumentative; (4) irrationally criticizing and ridiculing; (5) express jealousy and hatred towards those who seem to be more

CHAPTER II

LITERATURE REVIEW

A. Definition Recent formulations of passive aggressive personality disorder maintain initial notions of what characterizes the disorder, including passive resistance to meeting routine demands, stubbornness, procrastination and efficiency. The description of the disorder in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) emphasizes irritable mood patterns and negative attitudes. Thus this disorder is listed in the DSM-IV as a "Passive-Aggressive (Negativistic) Personality Disorder".5– B. Epidemiology In America, passive aggressive personality disorder has an average prevalence of 3.3%. Research conducted in 1992 reported that passive aggressive personality disorder is more common in women than in men. This could be due to the fact that passive aggressive personality is a way for women to avoid social stigma and rejection which are often associated with women who are seen as challenging or aggressive in advocating what they need or want.^8 C. Etiology

The exact cause of passive aggressive personality disorder is unknown due to a lack of research, but it is thought that this disorder, like most other personality disorders, is caused by a combination of genetic and environmental factors. Childhood abuse and neglect and sexual abuse also contributed to this disorder.8, There are five main perspectives on its etiology, namely psychoanalytic, behavioral, interpersonal, social learning, and biology. It should be noted that much of the literature on the etiology of passive-aggressive personality disorder consists of speculative and theoretical writings.

1. Psychoanalytic It has previously been noted that passive-aggressives experience ambivalence and conflict to express negativism and irritability as well as a strong need to please and be accepted by others. This ambivalence was first noted by Karl Abraham, who divided the oral stage of Freud's psychosexual development into distinct biting and sucking stages; fixation can occur in both stages. Fixation in the biting stage is an "oral- sadistic" complex that produces an oral-sadistic character. The core ambivalence is conflict for the oral-sadistic character. It follows, therefore, that in adulthood, oral-sadistic behavior such as active negative verbal comments, and irritable and moody communication patterns are typical features. The second precursor of the passive-aggressive personality is the psychoanalytic formulation of the "masochistic" personality. Wilhelm

have taken exception to the observation that this style is common. Given that the concept of passive-aggressiveness has a much longer presence in the psychoanalytic literature than in behavioral writings, viewing passive- aggressive behavior as an "expression" of anger in social interaction in a maladaptive verbal and nonverbal way that does not lead to profitable problem solving. Therefore, Failure to learn appropriate assertive behavior is a major cause of the etiological factors explaining passive aggressiveness. Whereas reflective assertive behavior refers to actions taken to ensure that wants and wishes are announced without interfering with the rights and desires of others, there are a number of behavioral hypotheses about the causes of indecisive behavior. Three possible causes of failure to behave assertively are: (1) passive-aggressive individuals never learn appropriate assertive responses; (2) excessive anxiety before venting or inhibiting assertive reactions; and (3) the anticipated punishment for demonstrating assertive behavior reduces the likelihood that an individual will react in a certain social situation in an assertive way.

3. interpersonal It has been suggested that personality disorders reflect pathological patterns of interpersonal relatedness. A systematic method for diagnosing personality disorders along the interpersonal dimension is by virtue of itself. Building on the early work of Sullivan and Leary, Wiggins (1982) and Kiesler (1986) have proposed an interpersonal circumplex that

locates personality disorders at various points along the circle. Two perpendicular dimensions define the circle: affiliation (ie, contention of some consent) and power (ie, submission to dominance). People with a certain personality type are placed along this dimension in such a way that those located on opposite poles are negatively correlated whereas those located perpendicular to each other are uncorrelated;

4. Social Learning The main proponent of a social learning perspective for personality disorders is Millon (1981, 1986). He has developed a three-dimensional approach to diagnosing personality. One dimension deals with the primary source of reinforcement for individuals, which is defined as a self-other orientation, and seeks to determine whether an individual tends to get reinforcement through other people or achieve his own needs. The second dimension refers to the tendency to receive positive reinforcement and avoid pain and discomfort. The third dimension serves to define individual coping behavior patterns that are used in maximizing pleasure and minimizing pain. Active individuals are those who manipulate life events so as to achieve maximum satisfaction whereas passive individuals allow existing events to get their way. Consequently, Millon has formulated a matrix for 13 personality styles along these three dimensions that correspond to DSM-III-R personality disorders. Millon's active ambivalent style is roughly equivalent to a passive-aggressive personality.

childhood and adolescence and passive aggressive personality disorder in adulthood has been suggested by the DSM-III. Thus, there may be certain genetic and/or metabolic factors that contribute to this lifelong pattern of erratic mood and irritability. Unfortunately, there is no research evidence to support this hypothesis and it must be viewed as a speculative theory until sufficient evidence can be obtained to support its validity. there may be certain genetic and/or metabolic factors that contribute to this lifelong pattern of erratic mood and irritability. Unfortunately, there is no research evidence to support this hypothesis and it must be viewed as a speculative theory until sufficient evidence can be obtained to support its validity. there may be certain genetic and/or metabolic factors that contribute to this lifelong pattern of erratic mood and irritability. Unfortunately, there is no research evidence to support this hypothesis and it must be viewed as a speculative theory until sufficient evidence can be obtained to support its validity. D. Psychodynamics The assumptions underlying passive-aggressive personality disorder tend to involve anger and justice. For example, a very basic belief is: "I must avoid conflict at all costs," which can be summed up as "It is dangerous to express anger directly"; "it is dangerous to experience anger"; and it is slightly dangerous to be open and assertive about one's wishes." Such an assumption leads to passivity, anger denial, and overt conflict avoidance. With only these

beliefs, however, the individual may become indecisive and episodically passive-aggressive. into assumptions about justice and fairness that lead to his chronic anger and, consequently, to chronic passive-aggressiveness. The passive-aggressive individual has strong beliefs about how he or she should be treated, such as "Everyone should know the right way to treat someone," and, therefore, "I don't have to ask for what I want." When these people fail to get what they want from others and think they deserve it, they interpret that as mean to the mean, restrained, and unfair that other people have. And because people are assumed to know what passive-aggressive individuals want without being told, he assumes that "if people don't [spontaneously] do what I want, asking them won't help." So the beliefs that lead to anger and avoidance of affirmation coexist and lead to ambivalent passive-aggressive solutions. Burns and Epstein (1983) grouped these beliefs into three main assumptions of passive-aggressiveness: (1) the idea that "other people must live up to one's expectations," (2) reciprocity; that the person "has received a favorable response from" others through good behavior," and (3) conflict phobia; "People who care for each other shouldn't fight."(Freeman) E. Clinical symptoms Symptoms associated with passive aggressive personality disorder include:8,

1. Is a long-term (chronic) condition in which a person appears to actively comply with the wants and needs of others, but actually passively resists them. In the process the person becomes increasingly hostile and angry.

11. Other symptoms include procrastination, deliberately forgetting to do things others ask, stubbornness, frequent complaining, deliberately working poorly or slowly, feeling unappreciated, blaming problems on other people, irritability, dislike of other people's ideas others even if it is useful, often fight. F. Diagnosis Diagnostic criteria for passive aggressive personality disorder according to the Diagnostic and Statistical Manual of Mental Disorders-IV are:^11
12. Passive aggressive behavior is a pattern of expressing negative feelings indirectly.
13. A pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance, beginning by early adulthood and present in a variety of contexts, as indicated by four or more of the following: a. Passively refuses to fulfill routine social and work duties b. Complaining of being misunderstood and not appreciated by others c. Sullen and argumentative d. Criticizing and scorning authority unreasonably

e. Expresses jealousy and hatred of those who seem to be more fortunate f. Voicing excessive and persistent complaints about his own misfortunes g. Alternating between defiance and hostility, and remorse

3. Does not occur exclusively during a major depressive episode and is not better explained by dysthymic disorder
4. Mood patterns that are sullen and irritable, and negative attitudes G. Management People with personality disorders have poor insight, they don't recognize that they are a major factor in the problems they have. They do not see that they have a problem and are usually forced by their families to seek treatment. Counseling is useful in helping people identify and change behaviors. Currently cognitive therapy (cognitive therapy for depression, cognitive therapy for passive aggressive personality disorder which consists of initial and advanced phases) and antidepressants from the Serotonin Selective Reuptake Inhibitor (SSRI) class are very effective for controlling negative behavior.^12 H.

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