Passive-aggressive personality disorder, also called negativistic personality disorder, is characterized by procrastination, covert obstructionism, inefficiency and stubbornness. The

DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatri ...

no longer uses this phrase or label, and it is not one of the ten listed specific personality disorders. The previous edition, the revision IV (DSM-IV) describes passive-aggressive personality disorder as a proposed disorder involving a "pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance" in a variety of contexts.

Passive-aggressive behavior Passive-aggressive behavior is characterized by a pattern of passive hostility and an avoidance of direct communication. Inaction where some action is socially customary is a typical passive-aggressive strategy (showing up late for functions, st ...

is the obligatory symptom of the passive-aggressive personality disorder.

Causes

Passive-aggressive disorder may stem from a specific childhood stimulus (e.g., alcohol/drug addicted parents, bullying, abuse) in an environment where it was not safe to express frustration or anger. Families in which the honest expression of feelings is forbidden tend to teach children to repress and deny their feelings and to use other channels to express their frustration. For example, if physical and psychological punishment were to be dealt to children who express anger, they would be inclined to be passive aggressive. Children who sugarcoat hostility may have difficulties being assertive, never developing better coping strategies or skills for self-expression. They can become adults who, beneath a "seductive veneer", harbor "vindictive intent", in the words of

Timothy F. Murphy Timothy Francis Murphy (born September 11, 1952) is an American former politician and psychologist who served as the U.S. representative for Pennsylvania's 18th congressional district from 2003 until his resignation in 2017. The district includ ...

and Loriann Oberlin. Alternatively individuals may simply have difficulty being as directly aggressive or assertive as others. Martin Kantor suggests three areas that contribute to passive-aggressive anger in individuals: conflicts about dependency, control, and competition, and that a person may be termed passive-aggressive if they behave so to few people on most occasions.

Diagnosis

Diagnostic and Statistical Manual

With the publication of the DSM-5, this label has been largely disregarded. The equivalent DSM-5 diagnostic label would be "Other specified personality and unspecified personality disorder", as the individual may meet general criteria for a personality disorder, but does not meet the trait-based diagnostic criteria for any specific personality disorder (p645). Passive-aggressive ersonality disorderwas listed as an Axis II personality disorder in the

DSM-III-R The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...

, but was moved in the DSM-IV to Appendix B ("Criteria Sets and Axes Provided for Further Study") because of controversy and the need for further research on how to also categorize the behaviors in a future edition. According to DSM-IV, people with passive-aggressive personality disorder are "often overtly ambivalent, wavering indecisively from one course of action to its opposite. They may follow an erratic path that causes endless wrangles with others and disappointment for themselves." Characteristic of these persons is an "intense conflict between dependence on others and the desire for self-assertion." Although exhibiting superficial bravado, their self-confidence is often very poor, and others react to them with hostility and negativity. This diagnosis is not made if the behavior is exhibited during a

major depressive episode A major depressive episode (MDE) is a period characterized by the symptoms of major depressive disorder. Those affected primarily have a depressed mood for at least two weeks or more, and a loss of interest or pleasure in everyday activities. Other ...

or can be attributed to

dysthymic disorder Dysthymia ( ), also known as persistent depressive disorder (PDD), is a mental disorder, mental and Abnormal behaviour, behavioral disease#Disorder, disorder, specifically a disorder primarily of mood disorder, mood, consisting of similar cognit ...

ICD-10

The 10th revision of the

International Classification of Diseases The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating ...

( ICD-10) of the

World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...

(WHO) includes passive-aggressive personality disorder in the "other specific personality disorders" rubric (description: "a personality disorder that fits none of the specific rubrics: F60.0–F60.7"). ICD-10 code for "other specific personality disorders" is . For this psychiatric diagnosis a condition must meet the general criteria for

personality disorder Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture ...

listed under F60 in the clinical descriptions and diagnostic guidelines. The general criteria for personality disorder includes markedly disharmonious behavior and attitudes (involving such areas of functioning as affectivity – ability to experience affects:

emotion Emotions are mental states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feelings, behavioral responses, and a degree of pleasure or suffering, displeasure. There is currently no scientific ...

s or feelings, involving ways of perceiving and

thinking In their most common sense, the terms thought and thinking refer to conscious cognitive processes that can happen independently of sensory stimulation. Their most paradigmatic forms are judging, reasoning, concept formation, problem solving, an ...

, impulse control, arousal, style of relating to others), the abnormal behavior pattern (enduring, of long standing), personal distress and the abnormal behavior pattern must be clearly

maladaptive In evolution, a maladaptation () is a trait that is (or has become) more harmful than helpful, in contrast with an adaptation, which is more helpful than harmful. All organisms, from bacteria to humans, display maladaptive and adaptive traits. I ...

and pervasive. Personality disorder must appear during childhood or adolescence and continue into adulthood. Specific diagnostic criteria of the passive-aggressive personality disorder in the "Diagnostic criteria for research" by WHO is not presented.

Millon's subtypes

The psychologist

Theodore Millon Theodore Millon () (August 18, 1928 – January 29, 2014) was an American psychologist known for his work on personality disorders. He founded the ''Journal of Personality Disorders'' and was the inaugural president of the International Society ...

has proposed four subtypes of "negativist" ("Passive-aggressive"). Any individual negativist may exhibit none or one of the following:

Treatment

Psychiatrist Kantor suggests a treatment approach using

psychodynamic Psychodynamics, also known as psychodynamic psychology, in its broadest sense, is an approach to psychology that emphasizes systematic study of the psychological forces underlying human behavior, feelings, and emotions and how they might relate t ...

, supportive, cognitive,

behavioral Behavior (American English) or behaviour (British English) is the range of actions and mannerisms made by individuals, organisms, systems or artificial entities in some environment. These systems can include other systems or organisms as we ...

and interpersonal therapeutic methods. These methods apply to both the passive-aggressive person and their target victim.

History

The first version of the '' Diagnostic and Statistical Manual of Mental Disorders'' (DSM-I), in 1952, listed "passive-aggressive", "passive-dependent", and "aggressive" types together under "Passive-aggressive personality". The three types were seen as manifestations of the same pathology, a "psychoneurotic reaction" to anxiety. The DSM-III-R stated in 1987 that Passive-aggressive disorder is typified by, among other things, "fail ngto do the laundry or to stock the kitchen with food because of procrastination and dawdling." It was not added in the DSM-5, with contributing factors of this decision including poor evidence for the validity of the diagnosis and poor internal consistency of diagnostic criteria.