Understanding Passive-Aggressive Personality Disorder

The term "passive-aggressive" is used to describe behavior that expresses defiance or hostility indirectly, rather than openly. These behaviors can include deliberately "forgetting" or procrastinating, complaining about a lack of appreciation, and a sullen demeanor.

Passive-aggressive personality disorder (also called negativistic personality disorder) was first officially described by the U.S. War Department in 1945. Over the years, the associated symptoms changed; later, passive-aggressiveness was declassified as a formal diagnosis.

Origins and History

The first official documentation of passive-aggressive personality disorder was in a technical bulletin issued in 1945 by the U.S. War Department. In the bulletin, Colonel William Menninger described soldiers who refused to comply with orders. Instead of outwardly expressing their defiance, however, the soldiers behaved in a passively aggressive manner. For instance, according to the bulletin, they would pout, procrastinate, or otherwise behave stubbornly or inefficiently.

When the American Psychiatric Association prepared the first edition of Diagnostic and Statistical Manual of Mental Disorders, the association incorporated many phrases from the bulletin to describe the disorder. Some later editions of the manual also listed passive-aggressiveness as a personality disorder. However, by the time the third edition of the manual was released, the disorder had become controversial, as some psychologists believed that passive-aggressive behavior was a response to specific situations rather than being itself a broad personality disorder.

Subsequent editions and revisions of the DSM expanded and changed the diagnostic requirements for passive-aggressive personality disorder, including symptoms like irritability and sulking. In the fourth edition of the manual published in 1994, the DSM-IV, passive-aggressive personality disorder was renamed “negativistic” personality disorder, which was thought to more clearly delineate the underlying causes of passive-aggressiveness. The disorder was also moved to the appendix, indicating the need for further study before it could be listed as an official diagnosis.

In the DSM-V, released in 2013, passive-aggressiveness was listed under “Personality Disorder – Trait Specified,” emphasizing that passive-aggressiveness is a personality trait rather than a specific personality disorder.

Theories on Passive-Aggressive Personality Disorder

Joseph McCann’s 1988 review on passive-aggressive disorder lists a number of potential causes of passive-aggressive personality disorder, divided into five distinct approaches. However, McCann noted that many of the writings are speculative; not all of them are necessarily backed by research.

1. Psychoanalytic. This approach has roots in Sigmund Freud’s work and emphasizes the role of the unconscious in psychology. For example, one psychoanalytic view suggests that when individuals exhibit passive-aggressive behavior, they are attempting to reconcile their need to be seen as agreeable by others with their desire to express a negative attitude.
2. Behavioral. This approach emphasizes observable and quantifiable behaviors. The behavioral approach suggests that passive-aggressive behavior occurs when someone has not learned how to assert themselves, feels anxiety about asserting themselves, or fears a negative response to their assertive behavior. 
3. Interpersonal. This approach emphasizes the associations between two or more people. One interpersonal approach suggests that passive-aggressive people may be both quarrelsome and submissive in their relationships with other people.
4. Social. This approach emphasizes the role of the environment in influencing human behavior. One social approach suggests that contradictory messages from family members during someone’s upbringing can cause that person to be more “on guard” later in life.
5. Biological. This approach emphasizes the role of biological factors in contributing to passive-aggressive behavior. One biological approach suggests that there may be specific genetic factors that would cause someone to have erratic moods and irritable behaviors, as may be seen in passive-aggressive personality disorder. (At the time of McCann's review, there was no research to solidify this hypothesis.)

Sources

• Beck AT, Davis DD, Freeman, A. Cognitive therapy of personality disorders. 3rd ed. New York, NY: The Guilford Press; 2015.
• Grohol, JM. DSM-5 change: Personality disorders (Axis II). PsychCentral website. https://pro.psychcentral.com/dsm-5-changes-personality-disorders-axis-ii/. 2013.
• Hopwood, CJ et al. The construct validity of passive-aggressive personality disorder. Psychiatry, 2009; 72(3): 256-267.
• Lane, C. The surprising history of passive-aggressive personality disorder. Theory Psychol, 2009; 19(1).
• McCann, JT. Passive-aggressive personality disorder: A review. J Pers Disord, 1988; 2(2), 170-179.