PASSIVE AGGRESSIVE PERSONALITY DISORDER:-
The person with passive aggressive
personality disorder is characterized by covert obstructionism
procrstination,of underlying aggression, which is expressed passively.
Epidemology:- No data are available about
the epidemology of this disorder,Sex ratio,familial pattern, and
prevalence have not beenadeqately studied.
Passive aggressive personality disorder
patients characterstically procrastinate,resist demand for adequet
performance.find excuses for delay and find fault with those on whom they
depend; yet they refuse to extericate themselves from the dependant
relationship they usually lack assertiveness and are not direct about
their own need and wishes .They fail to ask needed questions about what
is expected of them and may be become anxious when forced to suceed or
when their usual defense of furuing anger against themselves is
In interpersonal relationships,passive
aggressive personality disorder patients attempt to manipulate themselves
into a position of dependancy, but their passive, self-detrimental
behavior is often experienced by others as punitive and manipulative.
Others must do their errands and carry out their routine responsibilities.
Friends and clinicians may become enmeshed in trying to assuage the
patients many claims of unjust treatment. The close relationships of
passive-aggressive personality disorder patients are rarely tranquil or
happy. Because these patients are bound to their resentment more closely
that to their satisfaction, they amy nerver even formulate what they want
for themselves in regard to enjoyment.
Course and Prognosis. :
In a flollow-up study averaging 11 years of 100 passive-aggressive
inpatients, small demonstrated that passive-aggressive personality
disorder was the primary diagnosis in 54 of them, 18 were also alchoholic,
and 30 could be clinically labeled as depressed. Of the 73 former patients
located, 58 ( 79 percent) had persistent psychiatric difficultiess, and 9
( 12 percent) were considered symptoms-free. Most seemed irritable,
anxious, and depressed, someatic coplaints were numerous.Only 32 ( 44
percent ) were employed full-time as workers or homemakers. Although
negledct of responsibility and scuicide in the internim. Although 28 ( 38
percent) were readmitted to a hospital,only 3 patients were called
Passive-aggressive personality disorder needs to be differentiated from
histrionic and borderline persoanlity disorders, however, the
passive-aggressive personality disroder patients is lessflamboyant,
dramatic, affective, and openly aggressive than are the histrionic and
borderline personality disorder patients. Patients with oppositional
defiant disorder aresimilar to patients with apssive-aggressive
personality disorder, buthte former diagnosis is reserved, according to
DSM-III-R, to persosn under age 18.
Passive-aggressive personality disorder patients who receive supportive
psychotherapy have good outcomes. However, psychotherapy for patients with
passive-aggressive personality disorder has many pitfalls: To fulfill
their demands is often to support their pathology, but to refuse their
demands is to reject them. The therapy session can thus become a
battleground in which the patient expreses feelings of resentment against
a therapist on whom the patients wishes to become dependnt. In
passive-aggressive personality disorder patients, it is important to treat
suicide gestures as one would any covert expression of anger and not as
one would treat object loss in major depression.
Antidepressants should be prescribed only when there are clinical
indications of depression and the possibility of suicide exists. The
therapist must point out the possibility of suicide exists. The therapist
must point out the probable consequencess of passive-aggressive behaviors
changing the patientís behavior than is a correct interpretation. Some
patients have responded to benzodiazepines and psychostimulants, depending
on the clinical features.
Sadomasochistic Personality Disorder.
Some personality types are chracterized by elements of sadism or masochism
or a combination of both. Sadomaschistic personality disorder is listed
here becouse it is of major clinical and historical interest in
psychiatry. It is not an official diagnostic category in DSM-III-R or its
appendix but is calssifeid as pesonality disorder not the otherwise
Sadism ( named after the Mariquis de Sade,
who wrote about persons who experienced sesual pleasure while infilicting
pain on on others ) is the deisireto cause others pain by being either
sexually abusive or physically or psychologically abusive in general.
Frued believed that sadists ward of castration are able to do to others
what they fear will be done to them.
Masochism ( named after Leopold von
Sacher-Masoch, a 19th-century Austrian novelist) is the
achievement of sexual gratification by inflicting pain on the self. More
generally, the so-called moral masochist seeks humiliation and failure,
rather than physical pain. Freud belived that masochists Ď ability to
achieve orgasm is distrubed by anxiety and guilt feelings about sex that
are alleviated by their own suffering and punishment.
Clinical observations indicate that
elements of both sadistic and masochisitc behavior are usually present in
the same person. Treatment with insight-oriented psychotherapy, including
psychonalysis, has been effective in some cases. As a result of therapy,
thte patients become aware of the needfor self come to recognize their
repressed aggresssive impulses, which origination in early childhood.
Self-defeating personality disorder.
DSM-III-R in-cludes the self-defeating personality disorder in its
appendix for diagnostic catergories requiring further study. It is not
considered an official part of DSM-III-R because it is controversial. To
receive this diagnosis, a person must have pervasive pattern of
self-defeating behavior, beginning by early adulthood and present in a
variety of contexts. Persons with this disorder often avoid or undermine
pleasurebale xperiences and are drawn to situations or relationship in
which they will suffer.
Persons with this disorder choose persons
and situations that lead to disappointment, failure, or mistreatment, even
when better options are clearly availabel to them. They reject the
attempts of theres to offer help. After positive personal events ( e.g.
new achievement), these persons with depression, guilt, or behavior that
produces pain ( e.g. an accident). They also invite rejecting respones
from others and then feel hurt, defeated, or humiliated ( e.g. a man may
make fun of this spuse in public, provking an angry relort, and them feel
devastated). In general, they engage in excessive self-sacrifice that is
unsolicited and discourged by others.
Self-defeating personality disorder
persons do not derive any sexual pleasure from humiliaiton, those persons
who do DSM-III-R diagnostic criterai for self-defeating personality
As mentioned above, the use of this
diagnostic label is controversial, as there is concern that victims of
abuse may be blamed for being abused when, in fact, thye are true victims
( i.e.blamelses) . There is also concern about wheather a new
diagnosis is necessary or wheather the disorder could be subsmed under an
J. Christopher Perry and Geaorge Vaillant
belive that most patients classified as self-defeating concurrently meet
the criteria for dependent or passive-aggressive personality disorder.
Sadistic personality disorder: Sadistic
personality disorder is also a controversial addition to DSM-III-R. It is
in the appendix of DSM-III-R. Persons with this personality disorder show
a pervasive pattern of cruel, demeaning, and aggressive behavior,
beginning in early adulthood, that is disgressive behavior, beginning in
early adulthood, that is directed toward others. Physical cruelty or
violences is used to inflict pain on others and not to achive some other
goal, such as mugging someone in orderto steal. Persons with the disorder
like to humiliate or demean people in front of others and usually have
treated or disciplined someone unusally harshly, especially children. In
general, sadistic personality or supposed to derive sexual arousal from
their behavior if they do , a paraphilia should be diagnosed.