Have you ever met anyone like Seinfeld’s George Costanza, vacillating between submissiveness and obstinance? Perhaps an employee who’s a “yes man” when asked to do a project, only to become argumentative about the responsibilities? Maybe it’s a romantic partner who can’t do enough to please you, only to later become mysteriously unaffectionate? If these sound familiar, you’ve encountered passive-aggressive personality characteristics. For some, such behavior reaches pathological proportions, and the disorder was historically called passive-aggressive personality (PAP).
It’s not unusual for psychiatric diagnoses to have shape-shifting histories. Just look at Jonathan Sadowsky’s The Empire of Depression: A New History and see how this common affliction has been understood and reconceptualized over the years. Personality disorders have perhaps the most amoebic histories in psychopathology and PAP in particular.
Patterns of vacillating obedience and defiance have been categorically recognized since at least the mid-1800s (Millon, 2011). The phenomenon’s morphology ranged from understanding it as a matter of biologically-driven mood temperament, to perpetuated conflicts from the oral/biting stage, to internalization of inconsistent parental attitudes/behaviors.
The more recent history of PAP classification is rooted in post-World War 2 U.S. military undertakings. In the 1940s, a trial study about the utility of PAP was organized by the Veterans’ Administration (VA) as part of efforts examining conditions to help understand returning World War 2 servicemen. In 1949, PAP was accepted as a type of “immaturity reaction” (Millon, 2011) and included in the diagnostic manual called the Standard VA Classification in 1951. In 1952, the American Psychiatric Association (APA [APA.org, 2021]) released the first Diagnostic and Statistical Manual of Mental Disorders (DSM) and followed suit with a PAP diagnosis that had 3 subtypes.
In 1968, the DSM-2 maintained PAPD, minus subtypes. The DSM-3, in 1980, still included a standalone PAP diagnosis, but added a “passive-dependent” subtype to dependent personality disorder (Millon, 2011) to recognize passive-aggressive tendencies some dependents harbor. The DSM-4 (1994) and DSM-4 Text Revision (2000) found PAP relegated to the Conditions for Further Study appendix, as questions arose as to its distinctness from chronic depression and dependent personality disorder. By 2013, PAP was erased entirely from the DSM-5.
Add to this a parade of different names (e.g., cyclothymic personality early on, then negativistic, then passive-aggressive) being applied to the same presentation, and no wonder there’s been a perfect storm of diagnostic opaqueness. As with masochistic/self-defeating personality, which is not an APA-specified diagnosis, that does not mean clinicians who find it appropriate can't recognize it. In fact, some researchers (e.g., Laverdière et al., 2019; Lewis, et al., 2020) continue to acknowledge PAP and advocate for its global recognition. PAP would be recorded as "unspecified personality disorder (passive-aggressive/negativistic)," and a clear clinical formulation would follow, justifying the diagnosis.
Despite the befuddling categorical/name history, the PAP presentation has largely remained static. In fact, it may well be the term passive-aggressive that began disrupting how it’s understood and that it may be better accounted for by other conditions.
Passive-aggressive ostensibly suggests it's a condition centering around passive aggression. It’s easy to miss the hyphen, which implies a tendency for vacillation between passivity and aggression (i.e., passive or aggressive). Passive aggression (no hyphen) is more like retaliation behind someone’s back for fear of direct confrontation. While people with PAP can act this way, outright confrontation is in the repertoire.
THE BASICS
PAP is not simply about silent vindictiveness. It's a distinct, baseline presentation whose chief feature is an interpersonal style marked by unpredictable toggling between submissiveness and opposition/confrontation. This pattern is liberally seasoned with a discontented air consisting of negative outlooks, fickle irritability, and feelings of being unappreciated/misunderstood.
To illustrate the unpredictable toggling, a PAP boss dresses you down at a meeting about some issue, only to say how great of a job you do later on. It’s like getting punched in the face, and the assailant then hands you an ice pack for the bruise. Other times, they act like your best friend, but later provide a dose of silent treatment for no apparent reason, and tell you “nothing’s wrong.”
Personality Essential ReadsModern theories (Millon, 2011) dictate that the PAP experienced contradictory parenting. For example, being arbitrarily rewarded or punished for the same action, and watching parents sometimes submit and sometimes oppose the same stimulus. Essentially, the PAP learned that responding either which way is acceptable, albeit confusing. They don’t know which way is the right way, so go both ways.
Living within such contradictory confines must be irritating and limiting, hence the penchant for a brooding/crotchety disposition. It’s easy to see how a negative outlook can germinate. It's tough to have good interpersonal fortune with such unpredictable interactions.
Relationships are likely a struggle from an early age, understandably leaving a feeling of being misunderstood and thus unappreciated in the PAP. “No one likes me” is a self-fulfilling prophecy. Though it’s not the PAP’s intention to push others away, their proclivity towards unpredictable extremes leaves many to avoid them. This leaves them feeling misunderstood and solidifies the PAP’s idea they are unappreciated. Seeing others blossom while they stagnate from poor interpersonal abilities renders them to adopt a lens that “everyone else has it better than me.” This negative outlook is no surprise, because, by comparison, their demeanor tarnishes opportunities and thus there’s rarely favorable outcome.
An attitude of resentment often emerges towards people they're jealous of, or towards people misunderstanding them. However, instead of directly managing the grudge, there's passive aggressive (no hyphen) retaliation. Cold-shouldering, backstabbing, and failure to live up to expectations is less threatening than confronting the person they’re at odds with. Satisfaction is derived from observing the target’s bewilderment at the cold shoulder and how spreading rumors alters others’ perception of the target. It’s a sort of upper hand that can’t be fought against, a winning situation to the PAP.
Clearly, PAP is an ingrained, complicated, interpersonal style that requires unique recognition. Though the APA suggested PAP may be too similar to those with chronic depression, depression is a mood state with an identifiable onset, whereas a personality is the way the person has always been, back into childhood. Also, though depressed people often feel unappreciated and pessimistic, they aren’t likely to harbor the core feature of an erratic pattern of submissive and oppositional behaviors. Further, Dysthymic patients are often irritable, but it's a baseline, not an erratic, presentation.
While there may be some overlap with dependent personality disorder, it is largely in submissiveness (which is amoebic in PAP and unwavering in dependent personality) and expressing discontent in indirect ways (passive aggression [no hyphen]), hardly a reason to consider them too similar.
It's important to distinguish chronic depression and dependent personality from PAP because of vastly differing treatment focus. Though there is some symptom overlap, that doesn't mean they're treated similarly.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)
Laverdière, Olivier PhD∗; Ogrodniczuk, John S. PhD†; Kealy, David PhD† Interpersonal Problems Associated With Passive-Aggressive Personality Disorder, The Journal of Nervous and Mental Disease: October 2019 - Volume 207 - Issue 10 - p 820-825
doi: 10.1097/NMD.0000000000001044
Lewis, K.C., Ridenour, J.M., Pitman, S. & Roche, M. (2020). Evaluating stable and situational expressions of passive-aggressive personality disorder: A multimethod experience sampling case study. Journal of Personality Assessment. DOI: 10.1080/00223891.2020.1818572
Millon, T. (2011). Disorders of personality (3rd ed). Wiley
Sadowsy, J.H. (2020). The empire of depression: A new history. Polity.
